The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study.
The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study.
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DOI：
10.1186/1471-2474-12-69
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发表时间：
2011-04-05
影响因子：
2.3
通讯作者：
Lee CS
中科院分区：
文献类型：
--
作者：
Kim MK;Lee SH;Kim ES;Eoh W;Chung SS;Lee CS
对于退行性腰椎滑脱病例中矢状面垂直轴与临床结果之间的关系，我们知之甚少。本研究的目的是确定腰椎矢状面平衡是否影响后路椎间融合术后的临床结局。该系列研究表明，在退行性脊柱滑脱的后路椎间融合术中考虑矢状面平衡可以获得较高的患者满意度并恢复脊柱平衡。对18例单节段或两节段退行性脊柱滑脱患者进行了临床结局回顾性研究和影像学审查。将患者分为两组：术后骨盆倾斜度无改善的患者（A组，n = 10）和术后骨盆倾斜度改善的患者（B组，n = 8）。进行术前和术后临床结局调查，以确定视觉疼痛评分（VAS）和奥斯韦斯特里残疾指数（ODI）。此外，我们还对骨盆倾斜（PT）、骶骨倾斜度（SS）、骨盆倾斜度（PI）、胸椎后凸（TK）、腰椎前凸（LL）、骶股骨距离（SFD）和骶C7铅垂线距离（SC 7 D）的全脊柱X线片进行了评价。所有18例患者均接受了手术，主要是为了缓解神经根性腿部疼痛和背部疼痛。在A组和B组中，平均术前VAS分别为6.85和6.81，末次随访时分别改善至3.20和1.63。平均术前ODI分别为43.2和50.4，末次随访时分别改善至23.6和18.9。在脊髓骨盆参数中，除A组PT外，术前与随访变量之间无显著差异。B组PT、SS、TK、LL、SFD/SC 7 D与术前比较差异有统计学意义。A、B组术前PT、术前LL、末次随访SS的各项参数之间存在临界意义。相关性分析显示，A组的VAS改善与术后腰椎前凸显著相关（Pearson系数= -0.829; p = 0.003）。同样，ODI改善也与术后腰椎前凸相关（Pearson系数= -0.700; p = 0.024）。然而，在B组中，未发现VAS和ODI改善与术后腰椎前凸和脊柱骨盆参数相关。在当前系列中，发现融合后PT改善的患者在退行性腰椎滑脱中获得了良好的临床结局。总的来说，我们的研究结果表明，在对退行性脊椎滑脱进行腰椎融合时，量化矢状面脊柱骨盆参数和促进矢状面平衡是很重要的。
Comparatively little is known about the relation between the sagittal vertical axis and clinical outcome in cases of degenerative lumbar spondylolisthesis. The objective of this study was to determine whether lumbar sagittal balance affects clinical outcomes after posterior interbody fusion. This series suggests that consideration of sagittal balance during posterior interbody fusion for degenerative spondylolisthesis can yield high levels of patient satisfaction and restore spinal balance A retrospective study of clinical outcomes and a radiological review was performed on 18 patients with one or two level degenerative spondylolisthesis. Patients were divided into two groups: the patients without improvement in pelvic tilt, postoperatively (Group A; n = 10) and the patients with improvement in pelvic tilt postoperatively (Group B; n = 8). Pre- and postoperative clinical outcome surveys were administered to determine Visual Analogue Pain Scores (VAS) and Oswestry disability index (ODI). In addition, we evaluated full spine radiographic films for pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), sacrofemoral distance (SFD), and sacro C7 plumb line distance (SC7D) All 18 patients underwent surgery principally for the relief of radicular leg pain and back pain. In groups A and B, mean preoperative VAS were 6.85 and 6.81, respectively, and these improved to 3.20 and 1.63 at last follow-up. Mean preoperative ODI were 43.2 and 50.4, respectively, and these improved to 23.6 and 18.9 at last follow-up. In spinopelvic parameters, no significant difference was found between preoperative and follow up variables except PT in Group A. However, significant difference was found between the preoperative and follows up values of PT, SS, TK, LL, and SFD/SC7D in Group B. Between parameters of group A and B, there is borderline significance on preoperative PT, preoperative LL and last follow up SS. Correlation analysis revealed the VAS improvements in Group A were significantly related to postoperative lumbar lordosis (Pearson's coefficient = -0.829; p = 0.003). Similarly, ODI improvements were also associated with postoperative lumbar lordosis (Pearson's coefficient = -0.700; p = 0.024). However, in Group B, VAS and ODI improvements were not found to be related to postoperative lumbar lordosis and to spinopelvic parameters. In the current series, patients improving PT after fusion were found to achieve good clinical outcomes in degenerative spondylolisthesis. Overall, our findings show that it is important to quantify sagittal spinopelvic parameters and promote sagittal balance when performing lumbar fusion for degenerative spondylolisthesis.
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