Effect of spinal-pelvic sagittal balance on the clinical outcomes after lumbar fusion surgery.
Effect of spinal-pelvic sagittal balance on the clinical outcomes after lumbar fusion surgery.
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DOI：
10.1186/s12893-023-02240-y
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发表时间：
2023-11-01
期刊：
影响因子：
1.9
通讯作者：
Zhang, Liang-ming
中科院分区：
文献类型：
--
作者：
Tan, Li-xian;Du, Xiao-kang;Tang, Run-min;Rong, Li-min;Zhang, Liang-ming
脊柱-骨盆矢状平衡对于在正常和患病状态下维持节能姿势非常重要。迄今为止，很少有报告评估脊柱-骨盆矢状平衡对腰椎退行性疾病（LDD）患者腰椎间融合术后临床结果的影响。根据纳入标准，共纳入2012年1月至2019年12月因腰椎退行性疾病接受后路腰椎椎间融合手术治疗的303例患者。评估并比较患者术前、术后骨盆倾角(PI)、骨盆倾斜(PT)、骶骨斜度(SS)、腰椎前凸(LL)等脊柱-骨盆矢状参数。术后PI-LL≤ 10°的患者163例分为脊柱-骨盆匹配组（M组），140例患者分为脊柱-骨盆不匹配组（MM组）。比较两组患者术前、术后Oswestry功能障碍指数(ODI)和背痛视觉模拟量表(VAS)。除手术失血量外，两组人口统计学和手术数据无显着差异。两组患者末次随访时的LL、PI、PT、SS均与术前差异有统计学意义（P<0.05）。术前两组间LL、PI、PT、SS无显着性差异。末次随访时两组的LL、PI、PT差异有统计学意义（P < 0.05）。与术前相比，末次随访时两组腰背部ODI、VAS均显着下降（P<0.05）。末次随访时两组VAS和ODI差异有统计学意义（P<0.05）。 M组VAS和ODI改善率均显着高于MM组。回归分析显示，年龄和脊柱-骨盆匹配对患者末次随访时腰痛的改善有显着影响。腰椎椎间融合术可显着改善LDD患者的预后。从平均随访时间超过2年的结果来看，脊柱-骨盆匹配对患者的生活质量和腰痛的缓解有积极的影响。
Spinal-pelvic sagittal balance is important for maintaining energy-efficient posture in normal and diseased states.Few reports to date have evaluated the effect of spinal-pelvic sagittal balance on clinical outcomes after lumbar interbody fusion in patients with lumbar degenerative diseases (LDD). A total of 303 patients treated with posterior lumbar interbody fusion surgery for lumbar degenerative disease from January 2012 to December 2019 were enrolled in this retrospective study according to the inclusion criteria. Preoperative and postoperative spinal-pelvic sagittal parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL) of the patients were evaluated and compared. 163 patients whose postoperative PI-LL ≤ 10° were divided into the spinal-pelvic match group (Group M), while 140 patients were divided into the spinal-pelvic mismatch group (Group MM). Preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain of both groups were compared. There was no significant difference between the two groups in demographic and surgical data, except for blood loss in surgery. LL, PI, PT and SS of the patients at final follow-up were all statistically different from the preoperative values in the two groups(P < 0.05). There was no significant difference in LL, PI, PT and SS between the two groups before surgery. At the final follow-up, LL, PI and PT differed significantly between the two groups(P < 0.05). Compared with the preoperative results, ODI and VAS of low back in both groups decreased significantly at the final follow-up (P < 0.05). Significant differences in VAS and ODI were found between the two groups at the final follow-up (P < 0.05). The improvement rates of VAS and ODI of Group M are both significantly higher than Group MM. Regression analysis showed that age and spinal-pelvic match had significant effects on the improvement of patients’ low back pain at the final follow-up. lumbar interbody fusion can significantly improve the prognosis of patients with LDD. In terms of outcomes with an average follow-up time of more than 2 years, the spinal-pelvic match has a positive effect on patients’ quality of life and the release of low back pain.
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