SBÜ, Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, 06000 Keçiören, Ankara, Türkiye.
Jt Dis Relat Surg. 2024 Jul 8;35(3):603-609. doi: 10.52312/jdrs.2024.1683.
The aim of this study was to evaluate the effect of extreme weight loss on low back pain and spinopelvic parameters.
A total of 45 patients (11 males, 34 females; mean age: 40.2±9.4 years; range, 18 to 57 years) who had bariatric surgery between January 2018 and December 2021 were retrospectively analyzed. Radiological spinopelvic parameters including lumbar lordosis (LL), pelvic incidence (PI), spinopelvic harmony (when PI is within LL±10°), pelvic tilt (PT) and sacral slope (SS) were evaluated pre- and postoperatively. Clinical outcomes were assessed using the Visual Analog Scale-Back Pain (VAS-BP) and Oswestry Disability Index (ODI).
The mean BMI loss at the end of the first year after surgery was 28.1±6.7% (range, 21 to 36%). The mean PI was 55.75°±12.47° preoperatively and 53.64°±11.86° at one year and the difference was -3.10°±5.25 (p=0.02), 1.10°±4.95° for PT (p=0.46), -2,70°±3.50° for SS (p<0.001), and 3.1±6.55 for LL (p<0.001). At one year, spinopelvic harmony remained unchanged in 31 patients, nine patients regained harmony, and was lost in five patients who had previously. No significant correlation between alterations in spinopelvic alignment and ODI scores was shown (p<0.05). The mean VAS-BP score was 40±30 mm preoperatively, and 20±3.5 mm postoperatively, indicating a difference of -39±29.5 (p<0.001). The mean ODI was 34.71±20.87 preoperatively, and 16±24 postoperatively, indicating a difference of -15±13 (p<0.001). Subgroup analyses showed that the change in SS was more pronounced with regard to PT change, particularly in young and female patients with >10 kg/m reduction in BMI (p<0.001).
Weight loss after bariatric surgery improves lower back pain leading to changes in PT without affecting SS and altering PI.
本研究旨在评估极重度体重减轻对下腰痛和脊柱骨盆参数的影响。
回顾性分析了 2018 年 1 月至 2021 年 12 月间接受减重手术的 45 名患者（男性 11 名，女性 34 名；平均年龄：40.2±9.4 岁；年龄范围 18 至 57 岁）。评估了术前和术后脊柱骨盆参数，包括腰椎前凸角（lordosis，LL）、骨盆入射角（pelvic incidence，PI）、脊柱骨盆协调性（当 PI 在 LL±10°范围内）、骨盆倾斜角（pelvic tilt，PT）和骶骨倾斜角（sacral slope，SS）。使用视觉模拟评分法（visual analog scale，VAS）下腰痛评分（back pain，BP）和 Oswestry 功能障碍指数（Oswestry Disability Index，ODI）评估临床结果。
术后第一年结束时，平均 BMI 减轻 28.1±6.7%（范围 21 至 36%）。术前 PI 为 55.75°±12.47°，术后一年时为 53.64°±11.86°，差值为-3.10°±5.25（p=0.02），PT 差值为 1.10°±4.95°（p=0.46），SS 差值为-2.70°±3.50°（p<0.001），LL 差值为 3.1±6.55°（p<0.001）。术后一年时，31 名患者脊柱骨盆协调性保持不变，9 名患者恢复协调性，5 名先前失去协调性的患者再次失去协调性。脊柱骨盆排列变化与 ODI 评分之间无显著相关性（p<0.05）。术前 VAS-BP 评分为 40±30mm，术后为 20±3.5mm，差值为-39±29.5（p<0.001）。术前 ODI 为 34.71±20.87，术后为 16±24，差值为-15±13（p<0.001）。亚组分析显示，SS 变化与 PT 变化更为显著，特别是 BMI 降低>10kg/m2的年轻和女性患者（p<0.001）。
减重手术后的体重减轻可改善下腰痛，导致 PT 改变，而不影响 SS，并改变 PI。
