Does sagittal imbalance impact the surgical outcomes of short-segment fusion for lumbar spinal stenosis associated with degenerative lumbar scoliosis?
Adult
Aged
Cohort Studies
Disability Evaluation
Female
Follow-Up Studies
Humans
Linear Models
Low Back Pain
/ diagnosis
Lumbar Vertebrae
/ diagnostic imaging
Male
Middle Aged
Multivariate Analysis
Pain Measurement
Postural Balance
/ physiology
Quality of Life
Radiography, Thoracic
/ methods
Retrospective Studies
Scoliosis
/ diagnostic imaging
Severity of Illness Index
Spinal Fusion
/ adverse effects
Spinal Stenosis
/ complications
Tomography, X-Ray Computed
/ methods
Treatment Outcome
Journal
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
ISSN: 1436-2023
Titre abrégé: J Orthop Sci
Pays: Japan
ID NLM: 9604934
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
23
01
2018
revised:
27
09
2018
accepted:
01
10
2018
pubmed:
6
11
2018
medline:
25
7
2019
entrez:
5
11
2018
Statut:
ppublish
Résumé
The degenerative lumbar scoliosis (DLS) patients who mainly complained about neurogenic claudication due to spinal canal stenosis are well-indicated for short segment fusion (SSF) at the affecting levels. However, it is unclear whether we should consider global sagittal balance or not. The aim of this study was to evaluate the impact of sagittal balance on the surgical outcomes of degenerative lumbar scoliosis (DLS) patients who underwent SSF. We retrospectively reviewed 70 DLS patients who underwent SSF (less than 3 levels) and could be followed for at least 2 years. The PI-LL, PT, SVA, and T1 pelvic angle (TPA) were measured using standing whole spine X-rays preoperatively (PreO) and at final follow-up (FFU). Surgical outcomes were assessed with the improvement in Japanese Orthopaedic Association score (JOAs) for low back pain (LBP), and the level of LBP was measured using the visual analogue scale (LBP-VAS). We analysed the relationships between the radiographic parameters and the surgical outcomes. We divided the patients into the three groups (poor/fair/good) based on the JOAs. The analysis with the Jonckheere-Terpstra trend test indicated that the following radiographic parameters had a significant trend with surgical outcomes in each group: (poor/fair/good; p value); PreO PI-LL (26/20/17°; P = 0.04), SVA (46/75/35.5 mm; P = 0.02), TPA (28/27/23°; p = 0.04), FFU PI-LL (33/25/8.5°; P = 0.004), SVA (93/90.5/32.5 mm; P = 0.001), and TPA (33/29/25°; P = 0.007). Additionally, LBP-VAS had a significant correlation between the three groups at final follow-up (P = 0.004). There were significant correlations between improvement in JOAs and PI-LL, SVA, and TPA both PreO and at FFU (P < 0.05). Sagittal spinal imbalance and spinopelvic malalignment significantly impact the surgical outcomes of SSF for DLS. Preoperative evaluation of spinopelvic alignment and sagittal balance is of critical importance when SSF are performed for DLS patients.
Sections du résumé
BACKGROUND
BACKGROUND
The degenerative lumbar scoliosis (DLS) patients who mainly complained about neurogenic claudication due to spinal canal stenosis are well-indicated for short segment fusion (SSF) at the affecting levels. However, it is unclear whether we should consider global sagittal balance or not. The aim of this study was to evaluate the impact of sagittal balance on the surgical outcomes of degenerative lumbar scoliosis (DLS) patients who underwent SSF.
METHODS
METHODS
We retrospectively reviewed 70 DLS patients who underwent SSF (less than 3 levels) and could be followed for at least 2 years. The PI-LL, PT, SVA, and T1 pelvic angle (TPA) were measured using standing whole spine X-rays preoperatively (PreO) and at final follow-up (FFU). Surgical outcomes were assessed with the improvement in Japanese Orthopaedic Association score (JOAs) for low back pain (LBP), and the level of LBP was measured using the visual analogue scale (LBP-VAS). We analysed the relationships between the radiographic parameters and the surgical outcomes.
RESULTS
RESULTS
We divided the patients into the three groups (poor/fair/good) based on the JOAs. The analysis with the Jonckheere-Terpstra trend test indicated that the following radiographic parameters had a significant trend with surgical outcomes in each group: (poor/fair/good; p value); PreO PI-LL (26/20/17°; P = 0.04), SVA (46/75/35.5 mm; P = 0.02), TPA (28/27/23°; p = 0.04), FFU PI-LL (33/25/8.5°; P = 0.004), SVA (93/90.5/32.5 mm; P = 0.001), and TPA (33/29/25°; P = 0.007). Additionally, LBP-VAS had a significant correlation between the three groups at final follow-up (P = 0.004). There were significant correlations between improvement in JOAs and PI-LL, SVA, and TPA both PreO and at FFU (P < 0.05).
CONCLUSIONS
CONCLUSIONS
Sagittal spinal imbalance and spinopelvic malalignment significantly impact the surgical outcomes of SSF for DLS. Preoperative evaluation of spinopelvic alignment and sagittal balance is of critical importance when SSF are performed for DLS patients.
Identifiants
pubmed: 30391135
pii: S0949-2658(18)30299-9
doi: 10.1016/j.jos.2018.10.005
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Pagination
224-229Informations de copyright
Copyright © 2018. Published by Elsevier B.V.