IMPACT OF THE GRADE OF DEGENERATIVE LUMBAR DISEASE ON THE OCCURRENCE OF SPINAL DEFORMITY

ABSTRACT Objective: To evaluate the impact of the severity of degenerative lumbar disease (DLD) on the occurrence of spinal deformity, as well as on the choice of treatment, whether conservative or surgical. Methods: This is a retrospective analysis of a prospective database. One hundred and thirty patients with low back pain and/or pain radiating to the lower limbs were included in the study and were graded on a DLD scale that considers total spine (panoramic) X-ray findings. The rates of adult spinal deformity (ASD) for the different degrees of the DLD scale were compared using the Chi-square test. The choice of treatment type, conservative or surgical, was also compared among the degrees of the DLD scale using Fisher's exact test. Results: The ASD rate was zero in grade 0 patients, 24% in grade I, 35% in grade II and 44% in grade III (P = 0.02). Grade III patients were more likely to be diagnosed with ASD (OR = 2.22; P <0.05; 95% CI = 0.90-5.45) compared to the other DLD grades. Only 7.7% of the patients were chosen for surgical treatment and there was no difference by the DLD scale grade. Conclusion: There was correlation between the DLD grading scale and the occurrence of ASD, with at least twice the chance of this diagnosis in DLD scale grade III as compared to the other grades. The treatment of choice was conservative in a very small number of patients analyzed, with no difference between the different grades of the DLD grading scale. Level of Evidence III; Retrospective analysis of prospective database (cohort).

摘要 研究目的：本研究旨在评估退行性腰椎病（Degenerative Lumbar Disease, DLD）的严重程度对脊柱畸形发生的影响，以及其对保守治疗与手术治疗两种治疗方案选择的影响。方法：本研究为基于前瞻性数据库的回顾性分析。共纳入130例腰背痛伴或不伴下肢放射痛的患者，依据考量全脊柱（全景）X线影像的DLD分级标准对患者进行分级。采用卡方检验比较不同DLD分级患者的成人脊柱畸形（Adult Spinal Deformity, ASD）发生率；采用Fisher确切概率法比较不同DLD分级患者的治疗方案（保守治疗或手术治疗）选择差异。结果：DLD 0级患者的ASD发生率为0，I级为24%，II级为35%，III级为44%（P=0.02）。与其余DLD分级患者相比，III级患者被诊断为ASD的风险更高（优势比[OR]=2.22；95%置信区间[CI]=0.90~5.45；P<0.05）。仅7.7%的患者选择手术治疗，且不同DLD分级间的手术治疗选择率无统计学差异。结论：DLD分级标准与ASD的发生存在相关性，DLD III级患者的ASD诊断风险至少为其余分级患者的2倍。本研究纳入的患者中，仅极少数选择手术治疗，且不同DLD分级间的治疗方案选择无显著差异。证据等级：III级；基于前瞻性数据库（队列）的回顾性分析。