Restoration of Spinopelvic Alignment After Reduction of High-grade Spondylolisthesis: Myth or Reality? A Systematic Review of the Literature and Meta-analysis.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2024-12-01 Epub Date: 2024-03-27 DOI:10.1097/BSD.0000000000001593

Giovanni Viroli, Alberto Ruffilli, Marco Ialuna, Francesca Barile, Marco Manzetti, Matteo Traversari, Fabio Vita, Cesare Faldini

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引用次数: 0

Abstract

Study design: Systematic review and meta-analysis of literature.

Objective: The aim of the presented study is to assess whether the reduction of high-grade spondylolisthesis (HGS) through the correction of lumbosacral kyphosis leads to a decrease in the sagittal spinopelvic compensatory mechanisms.

Summary of background data: HGS is as an anterior translation of a vertebra, >50%. It is also characterized by a kyphotic deformity of the affected level. This combination of translation and kyphosis leads to compensatory mechanisms on the sagittal plane [pelvic retroversion, increased lumbar lordosis (LL), reduction in thoracic kyphosis (TK)].

Methods: A systematic search of electronic databases was conducted. Inclusion criteria were diagnosis of HGS (Meyerding >II, Slip% >50%), partial or complete reduction surgery (with a significant decrease in Slip%), and report of spinopelvic parameters (pelvic incidence, pelvic tilt, or sacral slope). Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between preoperative and postoperative spinopelvic alignment measures. P <0.05 was considered significant.

Results: Eighteen studies were included. PT showed a statistically significant decrease of -2.1217 (95% CI: -3.4803 to -0.7630), while SS showed a significant increase of 4.8349 (95% CI: 2.7462-6.9236). Conversely, both LL and TK showed nonsignificant changes, -4.7043 (95% CI: -10.4535 to 1.0449) and 6.3881 (95% CI: -0.8344 to 13.6106), respectively. VAS significantly decreased by -3.1950 (95% CI: -4.9462 to -1.4439).

Conclusions: The meta-analysis showed mild, yet statistically significant, decrease of PT and an increase in SS after HGS reduction. Conversely, nonstatically significant decrease in LL and an increase in TK occurred. The clinical significance of these results remains questionable.

Level of evidence: Level IV.

查看原文本刊更多论文

高度脊柱滑脱矫正术后脊柱骨对齐的恢复：神话还是现实？文献的系统回顾和元分析。

研究设计系统回顾和文献荟萃分析：本研究旨在评估通过矫正腰骶椎后凸减轻高位脊柱滑脱（HGS）是否会导致矢状脊柱骨代偿机制的减少：HGS 是指椎体前移，移位率大于 50%。其特征还包括受影响水平的畸形。这种移位和后凸的结合会导致矢状面上的代偿机制[骨盆后倾，腰椎前凸（LL）增加，胸椎后凸（TK）减少]：方法：对电子数据库进行系统检索。纳入标准为：HGS 诊断（Meyerding >II，Slip% >50%）、部分或完全缩窄手术（Slip% 显著下降）、脊柱骨盆参数报告（骨盆入射角、骨盆倾斜或骶骨斜度）。提取并总结了临床和影像学结果。进行了 Meta 分析，以估计术前和术后脊柱骨盆对齐测量值之间的差异。结果：共纳入 18 项研究。在统计学上，PT 显著下降-2.1217（95% CI：-3.4803 至-0.7630），而 SS 显著增加 4.8349（95% CI：2.7462 至 6.9236）。相反，LL 和 TK 的变化不明显，分别为-4.7043（95% CI：-10.4535 至 1.0449）和 6.3881（95% CI：-0.8344 至 13.6106）。VAS明显下降了-3.1950（95% CI：-4.9462 至-1.4439）：荟萃分析表明，在减少 HGS 后，PT 下降幅度轻微，但具有统计学意义，SS 上升。相反，LL 出现了无统计学意义的下降，TK 出现了上升。这些结果的临床意义仍值得怀疑：证据等级：IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.