Department of Orthopedics, Hospital for Special Surgery, New York, New York.
USC Spine Center, Keck School of Medicine of USC, Los Angeles, California.
Spine (Phila Pa 1976). 2022 Aug 15;47(16):1145-1150. doi: 10.1097/BRS.0000000000004370. Epub 2022 Apr 21.
Retrospective study of a multicenter Adult Spinal Deformity (ASD) Database.
To investigate the change in Pelvic tilt (PT) imparted by regional changes in lumbar lordosis at 2-year minimum follow up.
The distribution of lumbar lordosis between L1-4 and L4-S1 is known to vary based on pelvic incidence (PI). However, the extent to which regional changes effect PT is not clearly elucidated. This information can be useful for ASD surgical planning.
Operative patients from a multicenter ASD database were included with Lowest Instrumented Vertebrae (LIV) S1/Ilium, >5 levels of fusion, Proximal Junction Kyphosis (PJK) angle < 20, and >5 degrees of change in lumbar lordosis from L4-S1 and L1-4. Radiographic analysis was performed evaluating Thoracic Kyphosis (TK), T10-L2 kyphosis (TL), L1-S1 lordosis (LL), L4-S1 lordosis, L1-4 lordosis, sagittal vertical axis (SVA) and PI-LL from preoperative to postoperative, and change at 2-years follow-up. Stepwise regression analysis was performed in order to determine the relationship between PT and the above radiographic parameters. Health-related quality of life (HRQOL) outcomes were also compared between preoperative and postoperative timepoints at 2 years.
103 patients met inclusion for the study. There was improvement in all the radiographic parameters and HRQOLs at 2 years follow-up (p < 0.01). Stepwise regression model showed an inverse relationship between PT and LL change (r = 0.71, p < 0.01). Regionally, an increase in 10 degrees from L4-S1 correlated with a 2.4 degree decrease in PT (p < 0.01), while an increase in 10 degrees from L1-4 resulted in a 1.6 degree decrease in PT (p < 0.01).
In the surgical planning for ASD, our data demonstrated significant correlational difference between corrections in the upper (L1-4) and lower (L4-S1) lumbar spine and PT changes. These calculations can be useful in planning sagittal plane corrections for ASD.
多中心成人脊柱畸形（ASD）数据库的回顾性研究。
研究 2 年最低随访时腰椎前凸区域变化对骨盆倾斜度（PT）的影响。
已知腰椎前凸在 L1-4 和 L4-S1 之间的分布取决于骨盆入射角（PI）。然而，区域变化对 PT 的影响程度尚不清楚。这些信息对于 ASD 手术计划很有用。
纳入多中心 ASD 数据库中具有以下特征的手术患者：最低固定椎 S1/髂骨，融合>5 个节段，近端交界后凸角（PJK）<20°，L4-S1 和 L1-4 之间腰椎前凸变化>5°。对胸椎后凸角（TK）、T10-L2 后凸角（TL）、L1-S1 前凸角（LL）、L4-S1 前凸角、L1-4 前凸角、矢状垂直轴（SVA）和 PI-LL 进行放射学分析，分别评估术前和术后以及 2 年随访时的变化。为了确定 PT 与上述放射学参数之间的关系，进行了逐步回归分析。还比较了 2 年时的术前和术后健康相关生活质量（HRQOL）结果。
研究共纳入 103 例符合条件的患者。所有放射学参数和 HRQOL 在 2 年随访时均有改善（p<0.01）。逐步回归模型显示 PT 与 LL 变化呈负相关（r=0.71，p<0.01）。区域上，L4-S1 增加 10°与 PT 减少 2.4°相关（p<0.01），而 L1-4 增加 10°与 PT 减少 1.6°相关（p<0.01）。
在 ASD 的手术计划中，我们的数据显示腰椎上部（L1-4）和下部（L4-S1）矫正与 PT 变化之间存在显著的相关性差异。这些计算结果可用于 ASD 矢状面矫正的规划。
