Cabrera Juan P, Virk Michael S, Cho Samuel K, Muthu Sathish, Ambrosio Luca, Yoon S Tim, Buser Zorica, Wang Jeffrey C, Diwan Ashish D, Hsieh Patrick C
Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile.
Faculty of Medicine, University of Concepción, Concepción, Chile.
Global Spine J. 2024 Dec 4:21925682241306105. doi: 10.1177/21925682241306105.
Cross-sectional survey.
Surgical treatment of degenerative lumbar spondylolisthesis is remarkably varied due to heterogeneity of clinical-radiological presentations. This study aimed to assess which spinopelvic radiological parameters were considered for decision-making.
Survey distributed to International AO Spine members to analyze surgeons' considerations for treatment. Data collected includes demographics, training background, years of experience, and treatment decisions based on various radiographical findings, including segmental and global spinopelvic parameters.
From 479 responses, the most frequently radiological parameter considered was slippage on dynamic X-rays (79.1%), followed by disc height (78.9%), global sagittal balance SVA (71.4%), and PI-LL mismatch (69.7%), while the least important was absolute spondylolisthesis on static lateral radiograph (22.8%). Fellowship-trained surgeons were likelier to use SVA (OR = 1.73, 95% CI = 1.02-2.99, = 0.049), and disc height (2.13, 1.14-3.98, < 0.05). There was no difference between orthopedics and neurosurgery in applying SVA and PI-LL mismatch. Surgeons from Asia Pacific emphasizes segmental lordosis (2.39, 1.11-5.15, = 0.026) as from Latin America (2.55, 1.09-5.95, = 0.030) and Middle East (4.33, 1.66-11.28, = 0.003). However, surgeons from Latin America and Middle East also significant consider disc height (2.95, 1.07-8.15, = 0.037) and (3.03, 1.04-8.83, = 0.043), respectively. Additionally, the surgeons' age was associated with using angular motion on flexion-extension radiographs, and volume of treated cases yearly with consideration for disc height.
Treatment of degenerative lumbar spondylolisthesis was influenced by slippage on dynamic radiographs, disc height, global alignment, and PI-LL mismatch. Surgeons' age and Region, fellowship-trained, and volume of treated cases were significantly associated to apply these radiological parameters.
横断面调查。
由于临床-放射学表现的异质性，退行性腰椎滑脱的手术治疗差异显著。本研究旨在评估在决策时会考虑哪些脊柱骨盆放射学参数。
向国际AO脊柱协会成员发放调查问卷，以分析外科医生的治疗考量因素。收集的数据包括人口统计学信息、培训背景、经验年限以及基于各种影像学检查结果（包括节段性和整体脊柱骨盆参数）做出的治疗决策。
在479份回复中，最常被考虑的放射学参数是动态X线片上的滑脱（79.1%），其次是椎间盘高度（78.9%）、整体矢状面平衡SVA（71.4%）和PI-LL失配（69.7%），而最不重要的是静态侧位X线片上的绝对腰椎滑脱（22.8%）。接受过专科培训的外科医生更倾向于使用SVA（OR = 1.73，95% CI = 1.02 - 2.99，P = 0.049）和椎间盘高度（2.13，1.14 - 3.98，P < 0.05）。在应用SVA和PI-LL失配方面，骨科医生和神经外科医生之间没有差异。亚太地区的外科医生更强调节段性前凸（2.39，1.11 - 5.15，P = 0.026），拉丁美洲（2.55，1.09 - 5.95，P = 0.030）和中东地区（4.33，1.66 - 11.28，P = 0.003）的医生也是如此。然而，拉丁美洲和中东地区的外科医生也分别显著考虑椎间盘高度（2.95，1.07 - 8.15，P = 0.037）和（3.03，1.04 - 8.83，P = 0.043）。此外，外科医生的年龄与屈伸位X线片上的角运动使用情况相关，每年治疗病例数与对椎间盘高度的考虑相关。
退行性腰椎滑脱的治疗受动态X线片上的滑脱、椎间盘高度、整体对线情况以及PI-LL失配的影响。外科医生的年龄、地区、是否接受过专科培训以及每年治疗病例数与这些放射学参数的应用显著相关。
