Tchachoua Jiembou Gabriel, Nda Hermann Adonis, Konan Meleine Landry
Department of Neurosurgery, University Hospital of Toulouse, 31300, Toulouse, France.
Department of Neurosurgery, University Hospital Yopougon, 21 BP 632, Abidjan, Ivory Coast.
Chin Neurosurg J. 2023 Jun 28;9(1):18. doi: 10.1186/s41016-023-00333-4.
Posterior lumbar arthrodesis has become a widely used therapeutic option to correct sagittal imbalances in patients suffering from degenerative lumbar conditions. However, in western Africa, there is no study have reported long-term outcome of posterior lumbar arthrodesis. The aim of this study was to investigate the relationship between the restoration of adequate lordosis and the patient's postoperative quality of life.
The study was retrospective. From January 2012 to December 2019, 80 patients who underwent posterior lumbar arthrodesis for lumbar degenerative diseases were included with a mean follow-up of 43.2 months. Mean age was 50.8 years (SD = 12.2). Preoperative and postoperative patients' symptoms were assessed by the visual analog scale (VAS), Oswestry Disability Index (ODI), and 12-item Short Form (SF-12). Pre- and post-operative radiographic evaluation included lumbar lordosis measured (LLm), pelvic incidence (PI), sacral slope (SS), and pelvic stilt (PS). Theoretical lumbar lordosis (LLt) was defined by the following: LL = 0.54 × PI + 27.6. Data analysis was done using the statistical software "R." The risk of error was 5% (p < 0.05).
The mean pelvic incidence was 57.23°. There was no statistically significant difference between preoperative and postoperative lumbar lordosis (p = 0.2567). There was no statistical difference between preoperative and postoperative PI-LL (p = 0.179). There was a statistically significant difference between the pre and postoperative clinical scores (p < 0.001). Statistical analysis showed a correlation between recovery of lumbar lordosis and improvement in physical component of SF-12 (PCS) (p < 0.05) and lumbar and radicular VAS (p < 0.05) for the subgroup of narrow lumbar spine. There was a statistical relationship between the restoration of lumbar lordosis and improvement in PCS (p = 0.004) and VAS (p = 0.003) for the subgroup of isthmic lysis spondylolisthesis.
The root decompression performed in most patients could explain the clinical improvement regardless of recovery of lordosis. The failure to consider spinal parameters and sagittal balance of patients in the surgery could explain no restoration of lumbar lordosis. Our study had limitations inherent to its retrospective character such as the classic selection bias.
Satisfactory correction of spinopelvic alignment may improve long-term clinical signs.
腰椎后路融合术已成为治疗退行性腰椎疾病患者矢状面失衡的一种广泛应用的治疗选择。然而，在西非，尚无关于腰椎后路融合术长期疗效的研究报道。本研究的目的是探讨恢复足够的腰椎前凸与患者术后生活质量之间的关系。
本研究为回顾性研究。纳入2012年1月至2019年12月期间因腰椎退行性疾病接受腰椎后路融合术的80例患者，平均随访43.2个月。平均年龄为50.8岁（标准差=12.2）。术前和术后患者的症状通过视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和12项简明健康调查量表（SF-12）进行评估。术前和术后的影像学评估包括测量腰椎前凸（LLm）、骨盆入射角（PI）、骶骨倾斜度（SS）和骨盆倾斜角（PS）。理论腰椎前凸（LLt）定义如下：LL = 0.54×PI + 27.6。使用统计软件“R”进行数据分析。误差风险为5%（p < 0.05）。
平均骨盆入射角为57.23°。术前和术后腰椎前凸之间无统计学显著差异（p = 0.2567）。术前和术后PI-LL之间无统计学差异（p = 0.179）。术前和术后临床评分之间存在统计学显著差异（p < 0.001）。统计分析显示，对于腰椎管狭窄亚组，腰椎前凸的恢复与SF-12身体成分（PCS）的改善（p < 0.05）以及腰部和神经根性VAS的改善（p < 0.05）之间存在相关性。对于峡部裂型腰椎滑脱亚组，腰椎前凸的恢复与PCS的改善（p = 0.004）和VAS的改善（p = 0.003）之间存在统计学关系。
大多数患者进行的神经根减压可以解释临床症状的改善，而与腰椎前凸的恢复无关。手术中未考虑患者的脊柱参数和矢状面平衡可以解释腰椎前凸未能恢复的原因。我们的研究具有回顾性研究固有的局限性，如经典的选择偏倚。
满意地矫正脊柱骨盆对线可能改善长期临床症状。
