Karamian Brian A, DiMaria Stephen, Lambrechts Mark J, D'Antonio Nicholas D, Sawires Andrew, Canseco Jose A, Kaye I David, Woods Barrett I, Kurd Mark F, Rihn Jeffery A, Lee Joseph K, Hilibrand Alan S, Kepler Christopher K, Vaccaro Alexander R, Schroeder Gregory D
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Orthopedic Surgery, Lenox Hill Hospital, New York City, New York, USA.
J Craniovertebr Junction Spine. 2022 Apr-Jun;13(2):127-139. doi: 10.4103/jcvjs.jcvjs_144_21. Epub 2022 Jun 13.
Retrospective cohort study.
The objective of this study is to determine the effect of focal lordosis and global alignment and proportion (GAP) scores on patient reported outcome measures (PROMs) after posterior lumbar fusion for patients with 1- or 2-level lumbar degenerative spondylolisthesis (DS).
In patients with DS, improvements in spinopelvic parameters are believed to improve clinical outcomes. However, the effect of changing focal lordosis in patients with 1-or 2-level degenerative lumbar spondylolisthesis is unclear.
Postoperative spinopelvic parameters and perioperative focal lordosis changes were measured for 162 patients at a single academic center from January 2013 to December 2017. Patients were divided into three groups: >2° (lordotic group), between 2° and -2° (neutral group), and -2°° (kyphotic group). Patients were then reclassified based on GAP scores. Recovery ratios (RR) and the number of patients achieving the minimal clinically important difference (MCID) were calculated for PROMs. Standard descriptive statistics were reported for patient demographics and outcomes data. Multiple linear regression analysis controlled for confounders. Alpha was set at < 0.05.
There was no significant association between change in focal lordosis and surgical complications including adjacent segment disease ( = 0.282), instrumentation failure ( = 0.196), pseudarthrosis ( = 0.623), or revision surgery ( = 0.424). In addition, the only PROM affected by change in focal lordosis was Mental Component Scores (ΔMCS-12) (lordotic = 2.5, neutral = 8.54, and kyphotic = 5.96, = 0.017) and RR for MCS-12 (lordotic = 0.02, neutral = 0.14, kyphotic 0.10, = 0.008). Linear regression analysis demonstrated focal lordosis was a predictor of decreased improvement in MCS-12 (β = -6.45 [-11.03- -1.83], = 0.007). GAP scores suggested patients who were correctly proportioned had worse MCID compared to moderately disproportioned and severely disproportioned patients ( = 0.024).
The change in focal lordosis not a significant predictor of change in PROMs for disability, pain, or physical function. Proportioned patients based on the GAP score had worse MCID for Oswestry Disability Index.
III.
回顾性队列研究。
本研究的目的是确定对于1或2级腰椎退行性椎体滑脱（DS）患者，局部前凸以及整体对线和比例（GAP）评分对腰椎后路融合术后患者报告结局指标（PROMs）的影响。
在DS患者中，脊柱骨盆参数的改善被认为可改善临床结局。然而，1或2级退行性腰椎椎体滑脱患者局部前凸变化的影响尚不清楚。
对2013年1月至2017年12月在单一学术中心的162例患者测量术后脊柱骨盆参数和围手术期局部前凸变化。患者分为三组：>2°（前凸组）、2°至-2°之间（中立组）和<-2°（后凸组）。然后根据GAP评分对患者重新分类。计算PROMs的恢复率（RR）和达到最小临床重要差异（MCID）的患者数量。报告患者人口统计学和结局数据的标准描述性统计。采用多元线性回归分析控制混杂因素。设定α<0.05。
局部前凸变化与手术并发症之间无显著关联，包括相邻节段疾病（P = 0.282）、内固定失败（P = 0.196）、假关节形成（P = 0.623）或翻修手术（P = 0.424）。此外，受局部前凸变化影响的唯一PROM是心理成分评分（ΔMCS-12）（前凸组=2.5，中立组=8.54，后凸组=5.96，P = 0.017）以及MCS-12的RR（前凸组=0.02，中立组=0.14，后凸组=0.10，P = 0.008）。线性回归分析表明局部前凸是MCS-12改善下降的预测因素（β=-6.45[-11.03--1.83]，P = 0.007）。GAP评分表明比例正常的患者与比例中度失调和严重失调的患者相比，MCID更差（P = 0.024）。
局部前凸变化不是残疾、疼痛或身体功能PROMs变化的显著预测因素。根据GAP评分比例正常的患者，Oswestry功能障碍指数的MCID更差。
III级。
