An Analysis of Spinopelvic Sagittal Alignment After Lumbar Lordosis Reconstruction for Degenerative Spinal Diseases How Much Balance Can Be Obtained?

作者：Liu, Hui; Li, Sibei; Wang, Jiranru; Wang, Taiping; Yang, Hao; Li, Zemin; Li, Xiang; Zheng, Zhaomin^*

来源：Spine, 2014, 39(26B): B52-B59.

DOI：10.1097/BRS.0000000000000500

• degenerative spinal diseases
• lumbar lordosis reconstruction
• sagittal balance
• long fusion
• short fusion

Study Design. A retrospective and radiological study of degenerative spinal diseases. Objective. To explore the changes in spinopelvic sagittal alignment after lumbar instrumentation and fusion of degenerative spinal diseases. Summary of Background Data. Efforts have been paid to clarify the ideal postoperative sagittal profile for degenerative spinal diseases. However, little has been published about the actual changes of sagittal alignment after lumbar lordosis reconstruction. Methods. Radiographical analysis of 83 patients with spinal degeneration was performed by measuring sagittal parameters before and after operations. Comparative studies of sagittal parameters between short (1 level) and long (>= 2 level) instrumentation and fusion were performed. Different variances (Delta) of these sagittal parameters before and after operations were calculated and compared. Correlative study and linear regression were performed to establish the relationship between variances. Results. No significant changes were shown in the short-fusion group postoperatively. In the long-fusion group, postoperative lumbar lordosis (LL) and sacral slope (SS) were significantly increased; pelvic tilt ( PT), sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis, and PT/SS were significantly decreased. Different variances of Delta LL, Delta SS, Delta PT, Delta SVA, Delta(pelvic incidence -LL), and Delta PT/SS were significantly greater in the long-fusion group than the short-fusion group. Close correlations were mainly shown among Delta LL, Delta PT, and Delta SVA. Linear regression equations could be developed (Delta PT = - 0.185 x Delta LL - 7.299 and Delta SVA = - 0.152 Delta LL - 1.145). Conclusion. In degenerative spinal diseases, long instrumentation and fusion (>= 2 levels) provides more efficient LL reconstruction. PT, SS, and SVA improve corresponding to LL in a linear regression model. Linear regression equations could be developed and used to predict PT and SVA change after long instrumentation and fusion for LL reconstruction.

• 出版日期2014-12-15
• 单位中山大学; 成都市第二人民医院