Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Nagoya, Japan.
Eur Spine J. 2023 Dec;32(12):4153-4161. doi: 10.1007/s00586-023-07976-y. Epub 2023 Oct 14.
It is still unclear how lumbar spinal surgery affects the lipid metabolism of patients with lumbar spinal disorders (LSDs) such as lumbar spinal canal stenosis and lumbar disk herniation. The present study aimed to assess the impact of lumbar spinal surgery on lipid metabolism in patients with LSDs and clarify the factors associated with changes in visceral fat (VF) accumulation before and after lumbar spinal surgery.
Consecutive patients with lumbar spinal surgery for LSDs were prospectively included. Abdominal computed tomography images and blood examination of the participants were evaluated before surgery and at 6 months and 1 year after surgery. The cross-sectional VF area (VFA) was measured at the level of the navel using computed tomography images. Blood examination items included triglycerides and high-density lipoprotein (HDL).
The study enrolled a total of 138 patients. Female patients with LSDs had significantly increased VFA and serum triglyceride levels after lumbar spinal surgery. On multivariable analysis, the group with > 100 cm of preoperative VFA and a postoperative decrease in VFA had a significantly worse preoperative walking ability based on the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (relative risk 2.1; 95% confidence intervals 1.1-4.1).
The present study demonstrated that patients with LSDs did not necessarily improve their lipid metabolism after lumbar spinal surgery. Instead, female patients with LSDs had significantly deteriorated lipid metabolism after lumbar spinal surgery. Finally, a worse preoperative walking ability was associated with the improvement in excess VF accumulation after lumbar spinal surgery.
目前尚不清楚腰椎脊柱手术如何影响腰椎管狭窄症和腰椎间盘突出症等腰椎疾病（LSD）患者的脂质代谢。本研究旨在评估腰椎脊柱手术对 LSD 患者脂质代谢的影响，并阐明与腰椎脊柱手术后内脏脂肪（VF）积聚变化相关的因素。
前瞻性纳入接受 LSD 腰椎脊柱手术的连续患者。在手术前、手术后 6 个月和 1 年后，评估患者的腹部计算机断层扫描图像和血液检查结果。使用计算机断层扫描图像在脐水平测量横截面积 VF（VFA）。血液检查项目包括甘油三酯和高密度脂蛋白（HDL）。
本研究共纳入 138 例患者。女性 LSD 患者腰椎脊柱手术后 VFA 和血清甘油三酯水平显著升高。多变量分析显示，术前 VFA > 100cm 且术后 VFA 减少的组，日本矫形协会腰痛评估问卷（relative risk 2.1；95% confidence intervals 1.1-4.1）的术前行走能力明显更差。
本研究表明，腰椎脊柱手术后 LSD 患者的脂质代谢不一定得到改善。相反，腰椎脊柱手术后女性 LSD 患者的脂质代谢明显恶化。最后，术前行走能力越差，与腰椎脊柱手术后多余 VF 积聚的改善相关。
