Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion

被引:146
作者
Aoki, Yasuchika [1 ,4 ]
Nakajima, Arata [2 ]
Takahashi, Hiroshi [2 ]
Sonobe, Masato [2 ]
Terajima, Fumiaki [2 ]
Saito, Masahiko [2 ]
Takahashi, Kazuhisa [3 ]
Ohtori, Seiji [3 ]
Watanabe, Atsuya [1 ,4 ]
Nakajima, Takayuki [1 ,4 ]
Takazawa, Makoto [1 ,4 ]
Orita, Sumihisa [3 ]
Eguchi, Yawara [5 ]
Nakagawa, Koichi [2 ]
机构
[1] Eastern Chiba Med Ctr, Dept Orthopaed Surg, Togane, Chiba 2838686, Japan
[2] Toho Univ, Sakura Med Ctr, Dept Orthopaed Surg, Sakura Ku, Chiba 2858741, Japan
[3] Chiba Univ, Grad Sch Med, Dept Orthopaed Surg, Chuo Ku, Chiba, Chiba 2608677, Japan
[4] Chiba Univ, Grad Sch Med, Dept Gen Med Sci, Chuo Ku, Chiba, Chiba 2608670, Japan
[5] Natl Hosp Org, Shimoshizu Hosp, Dept Orthopaed Surg, Chiba 2840003, Japan
基金
日本学术振兴会;
关键词
Sagittal alignment; Spinopelvic; Flat-back; Pelvic incidence; Lumbar lordosis; Lumbar interbody fusion; ADULT SPINAL DEFORMITY; CLINICAL-OUTCOMES; DEGENERATIVE SPONDYLOLISTHESIS; SAGITTAL BALANCE; PARAMETERS; ANTERIOR; ALIGNMENT; MINIMUM; CAGES;
D O I
10.1186/s12891-015-0676-1
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Background: The importance of pelvic incidence-lumbar lordosis (PI-LL: PI minus LL) mismatch is emphasized in long-segment fusion for adult spinal deformity; however, there are few studies evaluating the influence of PI-LL on surgical outcomes after short-segment fusion. In this study, we have examined the effects of PI-LL mismatch on surgical outcomes of short-segment lumbar intervertebral fusion for lumbar degenerative diseases. Methods: Patients with lumbar degenerative disease treated by short-segment (1 or 2 levels) transforaminal lumbar interbody fusion were divided into Group A (PI-LL <= 10 degrees: n = 22) and Group B (PI-LL >= 11 degrees: n = 30). Pre- and post-operative patient symptoms were assessed by the visual analogue scale (VAS: scores 0-100 mm; for LBP, lower-extremity pain, and lower-extremity numbness), a detailed VAS for LBP while in motion, standing, and sitting, and the Oswestry disability index (ODI). Surgical outcomes were evaluated by the Nakai score (3 = excellent to 0 = poor. Post-operative data were acquired for at least one year following surgery and were compared between the two groups. Multiple regression analyses were used to evaluate the relative influence of PI-LL on each pre- and post-operative parameter (VAS, detailed VAS and ODI) adjusted for age, sex, fusion levels, body mass index, presence of scoliosis, diabetes mellitus and depression. Results: The surgical outcomes in Group A were significantly better than those of Group B. Group A showed better post-operative VAS scores for LBP, particularly LBP while standing (11.9 vs. 25.8). The results of the multivariate analyses showed no significant correlation between PI-LL and pre-operative symptoms, but did show a significant correlation between PI-LL and the post-operative VAS score for LBP, lower extremity pain, and numbness. Conclusions: This study is the first to find that PI-LL mismatch influences post-operative residual symptoms, such as LBP, lower extremity pain and numbness. Among the three types of LBP examined in the detailed VAS, LBP while standing was most strongly related to PI-LL mismatch. The importance of maintaining spinopelvic alignment is emphasized, particularly when treating patients with adult spinal deformity using long-segment fusion surgery. However, our results indicate that surgeons should pay attention to sagittal spinopelvic alignment and avoid post-operative PI-LL mismatch even when treating patients with short-segment lumbar interbody fusion.
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页数:7
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