Varol Eyüp
Neurological Surgery, Umraniye Training and Research Hospital, Istanbul, TUR.
Cureus. 2023 Oct 1;15(10):e46302. doi: 10.7759/cureus.46302. eCollection 2023 Oct.
Introduction The role of sagittal spinopelvic alignment in lumbar spinal stenosis (LSS) patients and its potential influence on post-decompression surgery outcomes is a topic of growing interest. Lumbar spinal stenosis is a prevalent degenerative condition, and with an aging population, the frequency of surgical interventions for LSS has risen. While decompression surgery aims to relieve symptoms, the potential impact of preoperative spinopelvic alignment on postoperative results remains controversial. This study examined the correlation between sagittal spinopelvic parameters and clinical outcomes in LSS patients undergoing decompression surgery. Methods This study included 100 patients with LSS who underwent decompression surgery between 2021 and 2023 and 100 healthy individuals as a control group. The LSS group comprised 50 men and 50 women, with a mean age of 55.8±12.41 years, while the control group consisted of 50 men and 50 women, with a mean age of 55.17±13.39 years. Sagittal spinopelvic alignment parameters, including pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis, were assessed preoperatively. Postoperative clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results In the cohort of 200 participants, 100 were diagnosed with lumbar spinal stenosis (LSS), and 100 were healthy controls. Both groups had an equal gender distribution (50 males and 50 females). The mean age was 55.8 (±12.4) years for the LSS group and 55.2 (±13.4) years for the control group. Among the analyzed radiographic parameters, only lumbar lordosis (LL) levels showed a significant difference between groups, notably lower in the LSS group (p=0.020). Preoperative VAS scores in LSS patients averaged 7.58±1.32, which postoperatively dropped to 2.22±1.95 (p<0.001). Similarly, ODI (%) declined from a preoperative average of 55.76±11.65 to 18.62±18.17 postoperatively (p<0.001). Patients with postoperative ODI levels exceeding 20% had higher preoperative scores and significantly altered radiographic measurements. The receiver operating characteristic (ROC) analysis indicated PT as the most predictive radiographic parameter, with an area under the curve (AUC) of 0.945. Multivariate logistic regression pinpointed PT and LL as key predictors associated with increased risks for postoperative Oswestry disability levels exceeding 20%. Conclusion Our study suggests that sagittal spinopelvic alignment plays an important role in the development and progression of LSS. Addressing sagittal alignment may be crucial for achieving optimal clinical outcomes after decompression surgery. Further research is needed to elucidate the mechanisms underlying the relationship between sagittal alignment and LSS.
引言 矢状位脊柱骨盆对线在腰椎管狭窄症（LSS）患者中的作用及其对减压手术后结果的潜在影响是一个越来越受关注的话题。腰椎管狭窄症是一种常见的退行性疾病，随着人口老龄化，LSS手术干预的频率有所上升。虽然减压手术旨在缓解症状，但术前脊柱骨盆对线对术后结果的潜在影响仍存在争议。本研究探讨了接受减压手术的LSS患者矢状位脊柱骨盆参数与临床结果之间的相关性。
方法 本研究纳入了2021年至2023年间接受减压手术的100例LSS患者，并以100名健康个体作为对照组。LSS组包括50名男性和50名女性，平均年龄为55.8±12.41岁，而对照组由50名男性和50名女性组成，平均年龄为55.17±13.39岁。术前评估矢状位脊柱骨盆对线参数，包括骨盆倾斜（PT）、骨盆入射角-腰椎前凸不匹配和矢状垂直轴。术后临床结果采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评分进行评估。
结果 在200名参与者的队列中，100例被诊断为腰椎管狭窄症（LSS），100例为健康对照。两组性别分布相同（50名男性和50名女性）。LSS组的平均年龄为55.8（±12.4）岁，对照组为55.2（±13.4）岁。在分析的影像学参数中，只有腰椎前凸（LL）水平在两组之间存在显著差异，LSS组明显较低（p=0.020）。LSS患者术前VAS评分平均为7.58±1.32，术后降至2.22±1.95（p<0.001）。同样，ODI（%）从术前平均55.76±11.65降至术后18.62±18.17（p<0.001）。术后ODI水平超过20%的患者术前评分较高，影像学测量有显著改变。受试者工作特征（ROC）分析表明PT是最具预测性的影像学参数，曲线下面积（AUC）为0.945。多因素逻辑回归确定PT和LL是与术后Oswestry功能障碍水平超过20%风险增加相关的关键预测因素。
结论 我们的研究表明，矢状位脊柱骨盆对线在LSS的发生和发展中起重要作用。解决矢状位对线问题可能对减压手术后获得最佳临床结果至关重要。需要进一步研究以阐明矢状位对线与LSS之间关系的潜在机制。
