SPINOPELVIC PARAMETERS AFTER POSTERIOR LUMBAR ARTHRODESIS IN DEGENERATIVE SPINAL DISEASES

ABSTRACT Introduction: Spinopelvic parameters related to sagittal balance have become increasinglyimportantamong spine surgeons due to their correlation with patient satisfaction rates. Objective: The goal of this study was to evaluate changes in spinal sagittal balance after lumbar spine surgery using PLIF, the posterior lumbar interbody fusion technique. Methods: The sample consisted of adult patients with degenerative spinal disease submitted to posterior lumbar arthrodesis. Patients between 18 and 70 years of agewho underwent surgeryfrom 2015 to 2017 were included in the study and divided into short (1 level) and long arthrodesis (2 to 4 levels) groups. Radiographic analysis of the spinopelvic parameters, measured before and after lumbar arthrodesis, was conducted using the SURGIMAP software. Then we evaluated the variation between pre- and postoperative measurements and performed correlation and linear regression analyses between the parameters. Results: The sample was composed of 80 patients (48 men). The mean age was lower in the short arthrodesis group than in the long arthrodesis group (52.67 ± 9.66 years versus 59.37 ± 9.30 years, respectively; p<0.0025). Significant variations in lumbar lordosis, pelvic tilt, sagittal vertical axis, T1 pelvic angle, and pelvic incidence minus lumbar lordosis were found in both short and long arthrodesis groups. The variation was significantly larger in the long than in the short arthrodesis group. Conclusion: In adult degenerative spine disease, short and long arthrodesis of the lumbar spine by PLIF allows correction of the spinopelvic parameters. Level of evidence III; Retrospective, comparative study.

摘要
引言：与矢状位平衡相关的脊柱骨盆参数已日益受到脊柱外科医师的重视，因其与患者满意度密切相关。
目的：本研究旨在评估采用后路腰椎椎体间融合术（posterior lumbar interbody fusion, PLIF）进行腰椎手术后的脊柱矢状位平衡变化。
方法：研究样本为罹患退行性脊柱疾病、接受后路腰椎融合术的成年患者。纳入2015年至2017年期间接受手术、年龄介于18至70岁的患者，并将其分为短节段融合（1个节段）组与长节段融合（2至4个节段）组。采用SURGIMAP软件对腰椎融合术前后的脊柱骨盆参数进行影像学测量分析。随后对术前与术后测量值的变化进行评估，并对各参数间的相关性及线性回归关系进行分析。
结果：本研究共纳入80例患者（其中男性48例）。短节段融合组的平均年龄低于长节段融合组（52.67±9.66岁 vs 59.37±9.30岁；p<0.0025）。短节段与长节段融合组的腰椎前凸角、骨盆倾斜角、矢状垂直轴、T1骨盆角以及骨盆入射角减腰椎前凸角均存在显著变化，且长节段融合组的变化幅度显著大于短节段融合组。
结论：对于成人退行性脊柱疾病患者，采用后路腰椎椎体间融合术（PLIF）进行短节段或长节段腰椎融合，均可矫正脊柱骨盆参数。证据等级：Ⅲ级；回顾性对比研究。