Is Restoration of Sagittal Spinopelvic Parameters Necessary in Spinal Tuberculosis of Lumbar and Lumbosacral Spine? Conservative versus Operative Management.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2024-11-01 Epub Date: 2024-09-07 DOI:10.1016/j.wneu.2024.08.093

Gagandeep Yadav, Siddharth Sekhar Sethy, Nikhil Goyal, Aakash Jain, Aman Verma, Bhaskar Sarkar, Pankaj Kandwal

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引用次数: 0

Abstract

Background: The relationship of spinopelvic parameters with spondylolisthesis is widely explored. However, there is scarce evidence on correlation of tuberculosis of lumbar spine with respect to spinopelvic harmony. The current study aims to find the association between functional outcomes and spinopelvic parameters in lumbar spine tuberculosis treatment.

Methods: A total of 47 patients with active tuberculosis confined to lumbar spine were prospectively analyzed and divided into 2 groups according to mode of intervention. Group A included 26 operatively managed patients and group B had 21 conservatively managed cases. Functional parameters comprising Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) along with spinopelvic radiologic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], lumbar lordosis [LL], PI-LL, sagittal vertical axis) in both groups were analyzed at 0 and 6 months of follow-up.

Results: Both the groups showed significant improvement from initial presentation to final follow-up in ODI (Group A: 85.4 ± 12.1-12.3 ± 3.2, P = 0.02; Group B: 82.5 ± 10.06-36.8 ± 11.9, P = 0.04) and VAS (Group A: 8.1 ± 1.2-1.4 ± 0.9, P = 0.02; Group B: 8.5 ± 0.09-3.5 ± 1.1, P = 0.02). Statistically significant (P < 0.05) difference was observed in both functional outcome parameters between the 2 groups at 2-month and 6-month follow-up, compared with nonsignificant difference (P > 0.05) at presentation. Better improvements of spinopelvic parameters of PT, SS, LL, PI-LL were observed in Group A and in both groups the difference of these parameters correlated with differences of functional outcome parameters, though PI showed no correlation.

Conclusions: The spinopelvic parameters played significant role in functional outcome. There is better functional outcome when LL is adequately restored. Surgical correction offered betterment of spinopelvic parameters like PT, SS, an sagittal vertical axis, which in turn leads to improvement in functional outcome.

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腰椎和腰骶部脊柱结核是否必须恢复矢状脊柱骨参数？保守治疗与手术治疗

目的：脊柱骨盆参数与脊柱滑脱症的关系已被广泛探讨。然而，关于腰椎结核与脊柱骨盆和谐的相关性的证据却很少。本研究旨在找出腰椎结核治疗中功能结果与脊柱骨盆参数之间的关联。方法：对 47 名活动性腰椎结核患者进行前瞻性分析，并根据干预方式分为两组。A 组包括 26 名手术治疗患者，B 组有 21 名保守治疗病例。在 0 个月和 6 个月的随访中，对两组患者的功能参数（包括 ODI 和 VAS）以及脊柱骨放射学参数（PI、PT、SS、LL、PI-LL、SVA）进行了分析：两组患者的 ODI（Gr-A：85.4±12.1 至 12.3±3.2，P=0.02；Gr-B：82.5±10.06 至 36.8±11.9，P=0.04）和 VAS（Gr-A：8.1±1.2 至 1.4±0.9，P=0.02；Gr-B：8.5±0.09 至 3.5±1.1，P=0.02）均有明显改善。发病时有统计学意义（p0.05）。手术组患者的脊柱参数PT、SS、LL、PI-LL有更好的改善，两组患者这些参数的差异与功能结果参数的差异相关，但PI没有相关性。结论--脊柱参数在功能预后中起着重要作用。当 LL 得到充分恢复时，功能结果会更好。手术矫正能更好地改善脊柱参数，如 PT、SS 和 SVA，进而改善功能预后。

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

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS