Ge Yang, Wang Aobo, Song He, Fan Ning, Zang Lei
Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
J Pain Res. 2025 Mar 18;18:1351-1360. doi: 10.2147/JPR.S505372. eCollection 2025.
Percutaneous transforaminal endoscopic decompression (PTED) is widely used for treating lumbar spinal stenosis (LSS), yet predictors of reoperation remain unclear. This study aimed to explore the association between spinopelvic alignment and the reoperation following PTED.
A 1:2 matched case-control study was conducted, involving patients who underwent single-level PTED for LSS at our institution from May 2014 to August 2022. Cases comprised patients requiring reoperation after initial PTED, while controls were those without reoperation during the follow-up. Measured radiological parameters included pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), mismatch between pelvic incidence and lumbar lordosis (PI-LL), disc height (DH), Pfirrmann classification, and Modic changes (MCs). Univariate and multivariate logistic regression analyses were performed to identify predictors. Receiver operating characteristic (ROC) curves were generated to determine cut-off points.
76 cases and 152 controls were selected from 1967 enrolled patients. Both groups had an average age of 61 years, a male-to-female ratio of 43:33, and a mean BMI of 25.95 kg/m². No significant differences in baseline characteristics were found between groups. Multivariate analysis identified PT (OR = 1.061, P = 0.007), PI-LL (OR = 1.057, P = 0.021), and DH (OR = 1.194, P = 0.015) as independent risk factors for the reoperation. ROC analysis revealed PI-LL with an area under the curve (AUC) of 0.662 at a cut-off of 12.95° (95% CI = 0.582-0.741), PT with an AUC of 0.685 at a cut-off of 21.98° (95% CI = 0.606-0.763), and DH with an AUC of 0.602 at a cut-off of 8.22° (95% CI = 0.521-0.683).
PI-LL ≥ 12.95°, PT ≥ 21.98°, and DH ≥ 8.22° are independent risk factors for reoperation following PTED.
经皮椎间孔镜减压术（PTED）广泛应用于治疗腰椎管狭窄症（LSS），但再次手术的预测因素仍不明确。本研究旨在探讨矢状面骨盆对线与PTED术后再次手术之间的关联。
进行了一项1:2匹配的病例对照研究，纳入2014年5月至2022年8月在我院接受单节段PTED治疗LSS的患者。病例组为初次PTED术后需要再次手术的患者，对照组为随访期间未进行再次手术的患者。测量的影像学参数包括骨盆倾斜角（PT）、骨盆入射角（PI）、骶骨倾斜角（SS）、腰椎前凸角（LL）、骨盆入射角与腰椎前凸角的差值（PI-LL）、椎间盘高度（DH）、Pfirrmann分级和Modic改变（MCs）。进行单因素和多因素逻辑回归分析以确定预测因素。绘制受试者工作特征（ROC）曲线以确定截断点。
从1967例登记患者中选取76例病例和152例对照。两组的平均年龄均为61岁，男女比例为43:33，平均体重指数为25.95kg/m²。两组间基线特征无显著差异。多因素分析确定PT（OR = 1.061，P = 0.007）、PI-LL（OR = 1.057，P = 0.021）和DH（OR = 1.194，P = 0.015）为再次手术的独立危险因素。ROC分析显示，PI-LL在截断值为12.95°时曲线下面积（AUC）为0.662（95%CI = 0.582-0.741），PT在截断值为21.98°时AUC为0.685（95%CI = 0.606-0.763），DH在截断值为8.22°时AUC为0.602（95%CI = 0.521-0.683）。
PI-LL≥12.95°、PT≥21.98°和DH≥8.22°是PTED术后再次手术的独立危险因素。
