Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
Eur Spine J. 2024 Jul;33(7):2813-2823. doi: 10.1007/s00586-024-08248-z. Epub 2024 Apr 18.
This study aimed to evaluate preoperative (pre-op) radiographic characteristics and specific surgical interventions in patients with degenerative lumbar spondylolisthesis (DLS) who underwent lumbar fusion surgery (LFS), with a focus on analyzing predictors of postoperative restoration of segmental lumbar lordosis (SLL).
A retrospective review at a single center identified consecutive single-level DLS patients who underwent LFS between 2016 and 2022. Radiographic measures included disc angle (DA), SLL, lumbar lordosis (LL), anterior/posterior disc height (ADH/PDH), spondylolisthesis percentage (SP), intervertebral disc degeneration, and paraspinal muscle quality. Surgery-related measures included cage position, screw insertion depth, spondylolisthesis reduction rate, and disc height restoration rate. A change in SLL ≥ 4° indicated increased segmental lumbar lordosis (ISLL), and unincreased segmental lumbar lordosis (UISLL) < 4°. Propensity score matching was employed for a 1:1 match between ISLL and UISLL patients based on age, gender, body mass index, smoking status, and osteoporosis condition.
A total of 192 patients with an average follow-up of 20.9 months were enrolled. Compared to UISLL patients, ISLL patients had significantly lower pre-op DA (6.78° vs. 11.84°), SLL (10.73° vs. 18.24°), LL (42.59° vs. 45.75°), and ADH (10.09 mm vs. 12.21 mm) (all, P < 0.05). ISLL patients were predisposed to more severe intervertebral disc degeneration (P = 0.047) and higher SP (21.30% vs. 19.39%, P = 0.019). The cage was positioned more anteriorly in ISLL patients (67.00% vs. 60.08%, P = 0.000), with more extensive reduction of spondylolisthesis (- 73.70% vs. - 56.16%, P = 0.000) and higher restoration of ADH (33.34% vs. 8.11%, P = 0.000). Multivariate regression showed that lower pre-op SLL (OR 0.750, P = 0.000), more anterior cage position (OR 1.269, P = 0.000), and a greater spondylolisthesis reduction rate (OR 0.965, P = 0.000) significantly impacted SLL restoration.
Pre-op SLL, cage position, and spondylolisthesis reduction rate were identified as significant predictors of SLL restoration after LFS for DLS. Surgeons are advised to meticulously select patients based on pre-op SLL and strive to position the cage more anteriorly while minimizing spondylolisthesis to maximize SLL restoration.
本研究旨在评估退行性腰椎滑脱症（DLS）患者行腰椎融合术（LFS）术前（术前）影像学特征和特定手术干预措施，重点分析术后节段腰椎前凸（SLL）恢复的预测因素。
在一家单中心进行回顾性研究，纳入了 2016 年至 2022 年间行单节段 DLS LFS 的连续患者。影像学测量包括椎间盘角度（DA）、SLL、腰椎前凸（LL）、前后椎间盘高度（ADH/PDH）、滑脱百分比（SP）、椎间盘退变和脊柱旁肌肉质量。手术相关测量包括椎间笼位置、螺钉插入深度、滑脱复位率和椎间盘高度恢复率。SLL 增加≥4°定义为增加节段性腰椎前凸（ISLL），SLL 增加＜4°定义为未增加节段性腰椎前凸（UISLL）。根据年龄、性别、体重指数、吸烟状况和骨质疏松状况，对 ISLL 和 UISLL 患者进行 1:1 倾向评分匹配。
共纳入了 192 例患者，平均随访 20.9 个月。与 UISLL 患者相比，ISLL 患者术前 DA（6.78° vs. 11.84°）、SLL（10.73° vs. 18.24°）、LL（42.59° vs. 45.75°）和 ADH（10.09 mm vs. 12.21 mm）均显著降低（均 P＜0.05）。ISLL 患者更倾向于存在更严重的椎间盘退变（P=0.047）和更高的 SP（21.30% vs. 19.39%，P=0.019）。ISLL 患者的椎间笼位置更靠前（67.00% vs. 60.08%，P=0.000），滑脱复位程度更大（-73.70% vs. -56.16%，P=0.000），ADH 恢复程度更高（33.34% vs. 8.11%，P=0.000）。多因素回归分析显示，术前 SLL 较低（OR 0.750，P=0.000）、椎间笼位置更靠前（OR 1.269，P=0.000）和滑脱复位程度更大（OR 0.965，P=0.000）显著影响 SLL 的恢复。
术前 SLL、椎间笼位置和滑脱复位程度是 DLS 患者行 LFS 后 SLL 恢复的重要预测因素。建议外科医生根据术前 SLL 仔细选择患者，并努力使椎间笼更靠前，同时尽量减少滑脱，以最大限度地恢复 SLL。
