Thijs Dieter, Kashtiara Ardavan, Beldé Sarah, Van de Kelft Erik
Department of Neurosurgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium.
Faculty of Medicine, and Health Sciences, University of Antwerp, Universiteitsplein 1, 2600 Wilrijk, Belgium.
Life (Basel). 2025 May 22;15(6):833. doi: 10.3390/life15060833.
For the past two decades, the consideration of spinopelvic parameters, sagittal balance, and spine shape has gained importance in the diagnosis and optimal surgical management of painful adult spinal deformity. These principles are used with increasing frequency in the surgical planning and treatment of degenerative mechanical lower back pain. Several parameters exist to analyze both global and regional spinal balance. Chronic lower back pain due to degenerative disc disease, degenerative spondylolisthesis, or adult spinal deformity can be surgically managed in a multitude of ways ranging from simple decompression to multilevel arthrodesis with or without corrective osteotomies, depending on the presumed etiology of the pain, surgical planning, and the surgical goal. In surgical candidates, preoperative evaluation of spinopelvic parameters is paramount, as increasing evidence shows that restoration of the shape of the spine while respecting these parameters improves patient-reported outcome measures (PROMs), decreases re-operation rates, and reduces mechanical complications such as proximal junctional kyphosis/failure (PJK/PJF), distal junctional kyphosis/failure (DJK/DJF), adjacent segment disease (ASD), and rod fracture. This review provides a conceptual analysis of spinopelvic alignment, global and regional sagittal balance, and the restoration of the spine's shape in relation to patient outcomes during surgical treatment of degenerative spine disorders.
在过去二十年中，对于脊柱骨盆参数、矢状面平衡和脊柱形态的考量在成人疼痛性脊柱畸形的诊断及最佳手术治疗中愈发重要。这些原则在退变性机械性下背痛的手术规划和治疗中使用得越来越频繁。存在多种参数可用于分析整体和局部的脊柱平衡。由椎间盘退变、退变性椎体滑脱或成人脊柱畸形引起的慢性下背痛，可根据疼痛的假定病因、手术规划和手术目标，通过多种方式进行手术治疗，从简单减压到多级融合术（有无矫正截骨术）不等。在手术候选者中，术前评估脊柱骨盆参数至关重要，因为越来越多的证据表明，在尊重这些参数的同时恢复脊柱形态可改善患者报告结局指标（PROMs），降低再次手术率，并减少诸如近端交界性后凸/失败（PJK/PJF）、远端交界性后凸/失败（DJK/DJF）、相邻节段疾病（ASD）和棒材骨折等机械并发症。本综述对脊柱骨盆对线、整体和局部矢状面平衡以及在退变性脊柱疾病手术治疗期间脊柱形态恢复与患者预后的关系进行了概念性分析。
