Lv Jiaheng, Zhou Quan, He Wei, Fang Tianci, Shen Yujie, Chen Yulin, Liu Hao, Yang Huilin, Zheng Yifei, Liu Tao
Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Orthopaedics, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.
Orthop Surg. 2025 Jun;17(6):1749-1760. doi: 10.1111/os.70050. Epub 2025 May 5.
Despite the widespread use of posterior lumbar interbody fusion (PLIF) for L5-S1 isthmic spondylolisthesis (IS) with lumbar spinal stenosis (LSS), residual sagittal imbalance critically impairs long-term pain relief and functional recovery. This study analyzes the influence of residual sagittal imbalanceon health-related quality of life (HRQOL) after PLIF for L5-S1 IS with LSS, aiming to optimize surgical correction and prognostic accuracy.
This study analyzed 103 consecutive patients with L5-S1 IS and LSS undergoing PLIF from 2020 to 2022, followed at 3 days, 3 months, and ≥ 1 year postoperatively, using SPSS 26.0 for statistical analysis. Preoperatively, patients were stratified into balanced (SVA ≤ 50 mm) and unbalanced (SVA > 50 mm) groups. Postoperatively, the unbalanced group was reclassified into postoperative balanced (SVA ≤ 50 mm) and postoperative unbalanced (SVA > 50 mm) groups. Spinal parameters-including SVA, slip degree (SD), disc height (HOD), lumbar lordosis (LL), pelvic tilt (PT), and pelvic incidence (PI)-and clinical outcomes (Oswestry Disability Index [ODI], Visual Analogue Scale [VAS]) were analyzed preoperatively and postoperatively to assess surgical efficacy. Postoperative unbalanced group.
In the balanced and unbalanced groups, SD and HOD significantly improved postoperatively versus preoperative values (p < 0.05). The balanced group showed no postoperative changes in SVA, LL, or PT (p > 0.05), while the unbalanced group exhibited marked improvements in these parameters (p < 0.05). At final follow-up, the balanced group maintained superior SVA, SD, HOD, LL, and PT compared to the unbalanced group (p < 0.05). Among the unbalanced group, postoperative balanced and unbalanced groups demonstrated significant improvements in SVA, SD, HOD, and PT (p < 0.05). However, LL remained unchanged in the postoperative unbalanced group (p > 0.05), whereas it improved in the postoperative balanced group (p < 0.05). The postoperative balanced group also achieved better SVA, SD, HOD, LL, and PT outcomes versus the postoperative unbalanced group (p < 0.05). ODI and VAS scores improved across all groups postoperatively, with the balanced group and postoperative balanced group outperforming their counterparts at final follow-up (p < 0.05).
Preoperative and postoperative sagittal balance are pivotal determinants of long-term functional recovery and HRQOL in patients undergoing PLIF for L5-S1 IS with LSS.
尽管后路腰椎椎间融合术（PLIF）广泛用于治疗伴有腰椎管狭窄症（LSS）的L5 - S1峡部裂型腰椎滑脱（IS），但残余矢状面失衡严重影响长期疼痛缓解和功能恢复。本研究分析残余矢状面失衡对伴有LSS的L5 - S1 IS行PLIF术后健康相关生活质量（HRQOL）的影响，旨在优化手术矫正和预后准确性。
本研究分析了2020年至2022年连续103例接受PLIF治疗的L5 - S1 IS和LSS患者，术后3天、3个月及≥1年进行随访，使用SPSS 26.0进行统计分析。术前，患者被分为平衡组（矢状面垂直轴[SVA]≤50 mm）和非平衡组（SVA>50 mm）。术后，非平衡组重新分为术后平衡组（SVA≤50 mm）和术后非平衡组（SVA>50 mm）。分析术前和术后的脊柱参数，包括SVA、滑脱程度（SD）、椎间盘高度（HOD）、腰椎前凸（LL）、骨盆倾斜度（PT）和骨盆入射角（PI）以及临床结果（Oswestry功能障碍指数[ODI]、视觉模拟评分[VAS]），以评估手术疗效。术后非平衡组。
在平衡组和非平衡组中，SD和HOD术后较术前显著改善（p<0.05）。平衡组术后SVA、LL或PT无变化（p>0.05），而非平衡组这些参数有显著改善（p<0.05）。在末次随访时，平衡组的SVA、SD、HOD、LL和PT优于非平衡组（p<0.05）。在非平衡组中，术后平衡组和术后非平衡组的SVA、SD、HOD和PT有显著改善（p<0.05）。然而，术后非平衡组的LL保持不变（p>0.05），而术后平衡组的LL有所改善（p<0.05）。术后平衡组的SVA、SD、HOD、LL和PT结果也优于术后非平衡组（p<0.05）。所有组术后ODI和VAS评分均改善，平衡组和术后平衡组在末次随访时优于相应对照组（p<0.05）。
术前和术后矢状面平衡是伴有LSS的L5 - S1 IS行PLIF患者长期功能恢复和HRQOL的关键决定因素。
