Sun Wenzhi, Wang Shuaikang, Wang Baobao, Li Yongjin, Chen Xiaolong, Kong Chao, Wang Peng, Lu Shibao
Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
Eur Spine J. 2024 Jun;33(6):2486-2494. doi: 10.1007/s00586-024-08245-2. Epub 2024 Apr 17.
To evaluate outcomes of choosing different Roussouly shapes and improving in Schwab modifiers for surgical Roussouly type 1 patients.
Baseline (BL) and 2-year (2Y) clinical data of adult spinal deformity (ASD) patients presenting with Roussouly type 1 sagittal spinal alignment were isolated in the single-center spine database. Patients were grouped into Roussouly type 1, 2 and 3 with anteverted pelvis (3a) postoperatively. Schwab modifiers at BL and 2Y were categorized as follows: no deformity (0), moderate deformity (+), and severe deformity (++) for pelvic tilt (PT), sagittal vertical axis (SVA), and pelvic incidence and lumbar lordosis mismatch (PI-LL). Improvement in SRS-Schwab was defined as a decrease in the severity of any modifier at 2Y.
A total of 96 patients (69.9 years, 72.9% female, 25.2 kg/m) were included. At 2Y, there were 34 type 1 backs, 60 type 2 backs and only 2 type 3a. Type 1 and type 2 did not differ in rates of reaching 2Y minimal clinically important difference (MCID) for health-related quality of life (HRQOL) scores (all P > 0.05). Two patients who presented with type 3a had poor HRQOL scores. Analysis of Schwab modifiers showed that 41.7% of patients improved in SVA, 45.8% in PI-LL, and 36.5% in PT. At 2Y, patients who improved in SRS-Schwab PT and SVA had lower Oswestry disability index (ODI) scores and significantly more of them reached MCID for ODI (all P < 0.001). Patients who improved in SRS-Schwab SVA and PI-LL had more changes of VAS Back and Short Form-36 (SF-36) outcomes questionnaire physical component summary (SF-36 PCS), and significantly more reached MCID (all P < 0.001). By 2Y, type 2 patients who improved in SRS-Schwab grades reached MCID for VAS back and ODI at the highest rate (P = 0.003, P = 0.001, respectively), and type 1 patients who improved in SRS-Schwab grades reached MCID for SF-36 PCS at the highest rate (P < 0.001).
For ASD patients classified as Roussouly type 1, postoperative improvement in SRS-Schwab grades reflected superior patient-reported outcomes while type 1 and type 2 did not differ in clinical outcomes at 2Y. However, development of type 3a should be avoided at the risk of poor functional outcomes. Utilizing both classification systems in surgical decision-making can optimize postoperative outcomes.
评估手术治疗鲁索利1型患者时选择不同鲁索利形态并改善施瓦布修正因素的效果。
从单中心脊柱数据库中提取呈现鲁索利1型矢状面脊柱排列的成人脊柱畸形（ASD）患者的基线（BL）和2年（2Y）临床数据。术后将患者分为鲁索利1型、2型和前倾骨盆的3a型。BL和2Y时的施瓦布修正因素分类如下：骨盆倾斜（PT）、矢状垂直轴（SVA）以及骨盆入射角与腰椎前凸不匹配（PI-LL）无畸形（0）、中度畸形（+）和重度畸形（++）。SRS-施瓦布的改善定义为2Y时任何修正因素严重程度的降低。
共纳入96例患者（69.9岁，72.9%为女性，体重指数25.2kg/m²）。2Y时，有34例1型背部、60例2型背部，仅2例3a型。1型和2型在健康相关生活质量（HRQOL）评分达到2Y最小临床重要差异（MCID）的比率方面无差异（所有P>0.05）。2例3a型患者的HRQOL评分较差。施瓦布修正因素分析显示，41.7%的患者SVA有所改善，45.8%的患者PI-LL有所改善，36.5%的患者PT有所改善。2Y时，SRS-施瓦布PT和SVA有所改善的患者的Oswestry功能障碍指数（ODI）评分较低，且其中更多患者达到ODI的MCID（所有P<0.001）。SRS-施瓦布SVA和PI-LL有所改善的患者在视觉模拟评分法背部（VAS Back）和简明健康调查36项量表身体成分总结（SF-36 PCS）结果方面有更多变化，且更多患者达到MCID（所有P<0.001）。到2Y时，SRS-施瓦布分级有所改善的2型患者在VAS背部和ODI方面达到MCID的比率最高（分别为P=0.003，P=0.001），而SRS-施瓦布分级有所改善的1型患者在SF-36 PCS方面达到MCID的比率最高（P<0.001）。
对于分类为鲁索利1型的ASD患者，SRS-施瓦布分级的术后改善反映出更好的患者报告结局，而1型和2型在2Y时的临床结局无差异。然而，应避免出现3a型，因为其有功能结局不佳的风险。在手术决策中同时使用这两种分类系统可优化术后结局。
