Song Junho, Samuel Andre, Shahi Pratyush, Fourman Mitchell, Shinn Daniel, Dalal Sidhant, Araghi Kasra, Melissaridou Dimitra, Vaishnav Avani, Sheha Evan, Dowdell James, Qureshi Sheeraz A
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2024 May;20(2):222-229. doi: 10.1177/15563316231162851. Epub 2023 Apr 8.
Postoperative sagittal alignment has been shown to be associated with patient-reported outcome measures (PROMs) following open lumbar decompression procedures, although it is unknown whether preoperative sagittal imbalance affects clinical outcomes of minimally invasive surgical (MIS) decompression only surgery. : We sought to evaluate the impact of preoperative pelvic incidence-lumbar lordosis (PI-LL) imbalance on PROMs after MIS laminectomy for the treatment of neurogenic claudication symptoms. : We conducted a retrospective cohort study of adult patients undergoing MIS laminectomy for degenerative lumbar spinal stenosis between April 2017 and April 2021 at a single institution. Of the 52 patients included (mean follow-up, 17 months) radiographs were taken prior to surgery and assessed for sagittal alignment parameters. Patients were grouped based on the preoperative PI-LL (balanced vs unbalanced). Changes in PROMs were compared between unbalanced PI-LL and balanced PI-LL groups. Minimal clinically important difference (MCID) for Oswestry Disability Index (ODI) was also assessed. : Of the 52 patients, 17 (32.7%) had unbalanced age-adjusted preoperative PI-LL. There was no significant difference found in PROMs between unbalanced and balanced PI-LL groups preoperatively or at final follow-up. Compared with those with unbalanced PI-LL, patients with balanced PI-LL were shown to have no added benefit in achieving MCID for ODI at long-term follow-up and no added benefit in the time to achieving MCID. : These retrospective findings suggest that patients with unbalanced preoperative PI-LL may experience significant benefit in long-term clinical outcomes following MIS laminectomy, similarly to those with balanced PI-LL at baseline. The findings also suggest that the presence of sagittal imbalance preoperatively may not appreciably influence the long-term clinical outcomes following MIS laminectomy. Prospective study involving a larger population is warranted.
术后矢状面排列已被证明与开放式腰椎减压手术后患者报告的结局指标（PROMs）相关，尽管术前矢状面失衡是否仅影响微创手术（MIS）减压手术的临床结局尚不清楚。我们试图评估术前骨盆入射角-腰椎前凸（PI-LL）失衡对MIS椎板切除术后治疗神经源性间歇性跛行症状的PROMs的影响。我们对2017年4月至2021年4月在单一机构接受MIS椎板切除术治疗退行性腰椎管狭窄的成年患者进行了一项回顾性队列研究。在纳入的52例患者中（平均随访17个月），术前拍摄了X线片并评估矢状面排列参数。患者根据术前PI-LL（平衡与不平衡）进行分组。比较不平衡PI-LL组和平衡PI-LL组之间PROMs的变化。还评估了Oswestry功能障碍指数（ODI）的最小临床重要差异（MCID）。在52例患者中，17例（32.7%）术前年龄调整后的PI-LL不平衡。术前或最终随访时，不平衡和平衡PI-LL组之间的PROMs没有显著差异。与PI-LL不平衡的患者相比，PI-LL平衡的患者在长期随访中实现ODI的MCID方面没有额外益处，在达到MCID的时间方面也没有额外益处。这些回顾性研究结果表明，术前PI-LL不平衡的患者在MIS椎板切除术后的长期临床结局中可能会有显著益处，与基线时PI-LL平衡的患者相似。研究结果还表明，术前矢状面失衡的存在可能不会明显影响MIS椎板切除术后的长期临床结局。有必要进行涉及更大人群的前瞻性研究。
