CAN PATIENTS WITH SAGITTALLY WELL-COMPENSATED LUMBAR DEGENERATIVE KYPHOSIS BENEFIT FROM SURGICAL TREATMENT FOR INTRACTABLE BACK PAIN?
CAN PATIENTS WITH SAGITTALLY WELL-COMPENSATED LUMBAR DEGENERATIVE KYPHOSIS BENEFIT FROM SURGICAL TREATMENT FOR INTRACTABLE BACK PAIN?
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DOI：
10.1227/01.neu.0000335642.14527.26
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发表时间：
2009-01-01
期刊：
影响因子：
4.8
通讯作者：
Maeng, Dae Hyeon
中科院分区：
文献类型：
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作者：
Jang, Jee-Soo;Lee, Sang-Ho;Maeng, Dae Hyeon
目的：分析术前和术后矢状位脊柱X线片，并回顾21例腰椎退行性后凸患者的手术结果，这些患者的脊柱通过代偿机制得到了矢状位的良好补偿，但仍然遭受顽固性背痛。方法：我们对21例采用前后联合脊柱关节融合术治疗的患者进行了回顾性分析。入选标准为：腰椎退行性后凸患者，伴有顽固性背痛，其脊柱通过代偿机制得到矢状面良好的代偿，定义为C7铅垂线到L5-S1椎间盘后部小于5 cm。结局变量包括：术前、术后和随访的影像学测量;使用平均数字评定量表、奥斯韦斯特里残疾指数和患者满意度指数进行临床评估;以及术后并发症的回顾。术前平均矢状面不平衡为19.5（+/- 17.6）mm，术后改善至-15.8（+/- 22.2）mm。术前平均腰椎前凸为13.2度（+/- 15.3），随访时增加至38.1度（+/- 14.4）（P < 0.0001）。术前平均胸椎后凸为5.5度（+/- 10.2），随访时增加至18.9度（+/- 12.4）（P < 0.0001）。术前平均骶骨倾斜度为12.9度（+/- 11.1），随访时增加至26.3度（+/- 9.6）（P < 0.0001）。平均数字评定量表评分从术前的7.8（背痛）和8.1（腿痛）改善至术后的3.0（背痛）和2.6（腿痛）（P < 0.0001）。平均奥斯韦斯特里功能障碍指数评分从术前的56.2%改善至术后的36.7%（P < 0.0001）。在18（85.5%）的21例患者中，满意的结果被证明的时间的最后一次随访assessment.CONCLUSION：这项研究表明，即使腰椎退行性脊柱后凸患者的脊柱矢状面以及补偿机制可能会遭受顽固性背痛，这些患者可以有效地治疗腰椎前凸的恢复。
OBJECTIVE: To analyze pre- and postoperative x-rays of sagittal spines and to review the surgical results of 21 patients with lumbar degenerative kyphosis whose spines were sagittally well compensated by compensatory mechanisms but who continued to suffer from intractable back painMETHODS: We performed a retrospective review of 21 patients treated with combined anterior and posterior spinal arthrodesis. Inclusion criteria were: lumbar degenerative kyphosis patients with intractable back pain and whose spines were sagittally well compensated by a compensatory mechanism, defined as a C7 plumb line to the posterior aspect of the L5-S1 disc of less than 5 cm. Outcome variables included: radiographic measures of preoperative, postoperative, and follow-up films; clinical assessment using the mean Numeric Rating Scale, Oswestry Disability Index, and Patient Satisfaction index; and a review of postoperative complications.RESULTS: All patients were female (mean age, 64.5 years; age range, 50-74 years). The mean preoperative sagittal imbalance was 19.5 (+/- 17.6) mm, which improved to -15.8 (+/- 22.2) mm after surgery. Mean lumbar lordosis was 13.2 degrees (+/- 15.3) before Surgery and increased to 38.1 degrees (+/- 14.4) at follow-up (P < 0.0001). Mean thoracic kyphosis was 5.5 degrees (+/- 10.2) before surgery and increased to 18.9 degrees (+/- 12.4) at follow-up (P < 0.0001). Mean sacral slopes were 12.9 degrees (+/- 11.1) before surgery and increased to 26.3 degrees (+/- 9.6) at follow-up (P < 0.0001). The mean Numeric Rating Scale score improved from 7.8 (back pain) and 8.1 (leg pain) before surgery to 3.0 (back pain) and 2.6 (leg pain) after surgery (P < 0.0001). The mean Oswestry Disability Index scores improved from 56.2% before surgery to 36.7% after surgery (P < 0.0001). In 18 (85.5%) of 21 patients, satisfactory outcomes were demonstrated by the time of the last follow-up assessment.CONCLUSION: This study shows that even lumbar degenerative kyphosis patients with spines that are sagittally well compensated by compensatory mechanisms may suffer from intractable back pain and that these patients can be treated effectively by the restoration of lumbar lordosis.