The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
World Neurosurg. 2022 Aug;164:e1153-e1160. doi: 10.1016/j.wneu.2022.05.120. Epub 2022 Jun 1.
Osteotomized debridement (OD) has been proved to be highly effective in treating active thoracolumbar tuberculosis (TB); however, no research has investigated how OD affects spinal alignment. The goal of this study was to explore the global alignment compensatory mechanism after lumbar OD, as well as the correlation between spinopelvic parameters and patient-reported outcomes (PROs).
Sixty-two patients with active lumbar spinal TB who underwent OD surgery were included. Spinopelvic parameters (C2-7 Cobb angle [C2-7 CA], sagittal vertical axis [SVA], proximal thoracic kyphosis, thoracic kyphosis, lumbar lordosis [LL], sacral slope [SS], pelvic tilt [PT], pelvic incidence [PI], spinosacral angle, and PI minus LL [PI-LL]) and PROs (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS] score) were reviewed. The correlation between spinopelvic realignment and improved PROs was evaluated.
Compared with preoperative measurements, C2-7 CA, proximal thoracic kyphosis, thoracic kyphosis, LL, SS, and spinosacral angle significantly increased after OD, whereas SVA, PT, and PI-LL significantly decreased. ODI and VAS score significantly improved postoperatively. The improvement of VAS was observed to be correlated with variations of C2-7 CA, SVA, LL, and PI-LL. The improvement of ODI was found to be correlated with variations of SVA, LL, and PI-LL. The multiple stepwise regression analysis showed that LL was an independent predictor for ODI and VAS score.
The whole spine and pelvis are involved in realignment after lumbar spinal OD, which is closely related to PROs. More attention should be drawn to restoring an appropriate LL in lumbar TB surgery.
截骨清创术（OD）已被证明对治疗活动性胸腰椎结核（TB）非常有效；然而，尚无研究探讨 OD 如何影响脊柱排列。本研究旨在探讨腰椎 OD 后整体脊柱矢状面平衡的代偿机制，以及脊柱骨盆参数与患者报告的结局（PRO）之间的相关性。
纳入 62 例接受 OD 手术的活动性腰椎脊柱 TB 患者。评估脊柱骨盆参数（C2-7 Cobb 角 [C2-7 CA]、矢状垂直轴 [SVA]、近端胸椎后凸、胸椎后凸、腰椎前凸 [LL]、骶骨倾斜角 [SS]、骨盆倾斜角 [PT]、骨盆入射角 [PI]、脊柱骶骨角和 PI-LL）和 PRO（Oswestry 残疾指数 [ODI] 和视觉模拟量表 [VAS] 评分）。评估脊柱骨盆重新排列与 PRO 改善之间的相关性。
与术前测量值相比，OD 后 C2-7 CA、近端胸椎后凸、胸椎后凸、LL、SS 和脊柱骶骨角显著增加，而 SVA、PT 和 PI-LL 显著降低。术后 ODI 和 VAS 评分显著改善。VAS 的改善与 C2-7 CA、SVA、LL 和 PI-LL 的变化相关。ODI 的改善与 SVA、LL 和 PI-LL 的变化相关。多元逐步回归分析显示，LL 是 ODI 和 VAS 评分的独立预测因子。
腰椎 OD 后整个脊柱和骨盆都参与了重新排列，这与 PRO 密切相关。在腰椎 TB 手术中，应更加关注恢复适当的 LL。
