Factors related to postoperative coronal imbalance in adult lumbar scoliosis
Factors related to postoperative coronal imbalance in adult lumbar scoliosis
复制标题
DOI：
10.3171/2020.6.spine20670
复制
发表时间：
2021-01-01
影响因子：
2.8
通讯作者：
Nakamura, Hiroaki
中科院分区：
文献类型：
--
作者：
Matsumura, Akira;Namikawa, Takashi;Nakamura, Hiroaki
目的本研究的目的是分析成人腰椎侧凸患者术后冠状面失衡（CIB）的患病率及其相关因素。方法本研究是一项回顾性单中心研究，数据来自2009年至2017年期间由单一外科医生进行矫正手术的成人脊柱畸形（ASD）患者。入选标准如下：1）手术时年龄> 40岁，2）胸腰椎/腰椎（TL/L）弯曲的Cobb角> 40度，3）T9或T10的上部内固定椎体，4）L5或骨盆的最下部内固定椎体，5）至少2年随访期。术前、术后2周和最后随访时测量影像学参数。还使用侧弯X线片评估弯曲灵活性。使用22项脊柱侧凸研究协会结局问卷（SRS-22）和SF-36评估临床结局。如果C7铅垂线在中央骶骨垂直线外侧超过2.5 cm（即，冠状垂直轴[CVA] > 2.5 cm）。结果：66例ASD患者中，37例（平均手术年龄66.3岁，平均随访时间63个月）符合入选标准。在末次随访时，6例患者（16.2%）发现CIB，CIB组所有患者的CVA均向TL/L曲线的凸侧移动。在最终随访时，CB组和CIB组之间的比较分析分别表明以下因素与CIB相关：腰骶（LS）弯曲，11.0度/16.5度（p = 0.02）; LS矫正率（CR），61%/47%（p = 0.02）; CR比（LS vs TL/L），0.93/0.67（p = 0.0002）。关于临床结局，SRS-22的满意度领域（CB 4.4 vs CIB 3.5）显示CIB组和CB组之间存在显著差异（p = 0.02），CB组的患者在疼痛领域的评分往往更好（CB 4.3 vs CIB 3.7），但差异不显著（p = 0.06）。结论术后CIB对患者的HRQOL有负面影响。TL/L和LS曲线之间的不平衡校正比可能导致术后CIB。因此，适当矫正LS曲线可预防术后CIB。
OBJECTIVE The object of this study was to analyze the prevalence of postoperative coronal imbalance (CIB) and related factors in patients with adult lumbar scoliosis.METHODS This was a retrospective single-center study of data from patients with adult spinal deformity (ASD) who had undergone corrective surgery performed by a single surgeon between 2009 and 2017. The inclusion criteria were as follows: 1) age at surgery > 40 years, 2) Cobb angles of the thoracolumbar/lumbar (TL/L) curve > 40 degrees, 3) upper instrumented vertebra of T9 or T10, 4) lowest instrumented vertebra of L5 or the pelvis, and 5) minimum 2-year follow-up period. Radiographic parameters were measured before surgery, 2 weeks after surgery, and at the latest follow-up. Curve flexibility was also assessed using side bending radiographs. Clinical outcomes were evaluated using the 22-Item Scoliosis Research Society Outcomes Questionnaire (SRS-22) and the SF-36. CIB was considered to have occurred if the C7 plumbline was more than 2.5 cm lateral to the central sacral vertical line (i.e., coronal vertical axis [CVA] > 2.5 cm) at the final follow-up. Parameters between the patients with (CIB group) and without (coronal balance [CB] group) CIB were compared, and factors related to CIB were evaluated.RESULTS From among 66 consecutively treated ASD patients, a total of 37 patients (mean age at surgery 66.3 years, average follow-up 63 months) met the study inclusion criteria. CIB was found in 6 patients at the final follow-up (16.2%), and the CVA of all patients in the CIB group shifted to the convex side of the TL/L curve. A comparative analysis between the CB and CIB groups, respectively, at the final follow-up indicated the following factors were related to CIB: lumbosacral (LS) curve, 11.0 degrees/16.5 degrees (p = 0.02); LS correction rate (CR), 61%/47% (p = 0.02); and CR ratio (LS vs TL/L), 0.93/0.67 (p = 0.0002). Regarding clinical outcomes, the satisfaction domain of the SRS-22 (CB 4.4 vs CIB 3.5) showed a significant difference between the CIB and CB groups (p = 0.02), and patients in the CB group tended to score better on the pain domain (CB 4.3 vs CIB 3.7), but the difference was not significant (p = 0.06).CONCLUSIONS Postoperative CIB negatively impacted patients' HRQOL. An imbalanced correction ratio between the TL/L and LS curves may cause postoperative CIB. Therefore, adequate correction of the LS curve may prevent postoperative CIB.