Silva Pedro Santos, Leocádio Joana Sofia Neves, Vaz Rui, Pereira Paulo
Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
Spine Unit, Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal.
Sci Rep. 2025 Apr 1;15(1):11113. doi: 10.1038/s41598-025-93319-4.
In this study we investigated the effect that lumbar decompression for lumbar spinal stenosis (LSS) has on sagittal balance and its clinical significance. This was an observational cohort study for LSS cases treated with decompression surgery. Core Outcome Measures Index (COMI), EuroQoL (EQ-5D) and Oswestry Disability Index (ODI) were used preoperatively and at 1 year follow-up. Pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA) and lumbar lordosis (LL) were measured before and 1 year after surgery. Hierarchical clustering (HC) was performed to identify subgroups with distinct patterns of variation. Ninety-five patients were included, mean age of 63 years, with good/excellent outcome in 71.6%. The median difference between postoperative and preoperative LL was - 1.3. Increased lumbar lordosis was correlated to ODI improvement (Pearson, r=-0.33). Three clusters were identified after HC. Patients in cluster 2 (31.6% ) had decrease in LL after surgery (mean values for cluster 1, 2, 3: 3.3, -5.6, 0.8), increase in SVA (-5 mm, + 25 mm, -19 mm) and no improvement in ODI (-23.1, 3.77, -17.1). Lumbar decompression has little effect in lumbar lordosis and sagittal balance. Cluster analysis yielded a subgroup of patients with worse outcomes, associated to decrease of LL and increase of SVA after surgery.
在本研究中，我们调查了腰椎减压术治疗腰椎管狭窄症（LSS）对矢状面平衡的影响及其临床意义。这是一项针对接受减压手术治疗的LSS病例的观察性队列研究。术前及随访1年时使用核心结局指标指数（COMI）、欧洲生活质量量表（EQ-5D）和奥斯威斯利残疾指数（ODI）。手术前后测量骨盆入射角（PI）、骨盆倾斜度（PT）、矢状垂直轴（SVA）和腰椎前凸（LL）。进行分层聚类（HC）以识别具有不同变化模式的亚组。纳入95例患者，平均年龄63岁，71.6%的患者预后良好/极佳。术后与术前LL的中位数差异为-1.3。腰椎前凸增加与ODI改善相关（Pearson相关系数，r=-0.33）。HC后识别出三个聚类。聚类2中的患者（31.6%）术后LL降低（聚类1、2、3的平均值分别为3.3、-5.6、0.8），SVA增加（-5mm、+25mm、-19mm），ODI无改善（-23.1、3.77、-17.1）。腰椎减压术对腰椎前凸和矢状面平衡影响较小。聚类分析产生了一组预后较差的患者亚组，与术后LL降低和SVA增加有关。
