José Poblete Carrizo, Jesús Martínez, Julio González, Alejandra Mosteiro, Ramon Torné, Alberto Di Somma, José Ríos, Joaquim Enseñat, Salvador Fuster
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引用次数: 0
Abstract
Purpose: Spine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explores them as prognostic factors in patients undergoing lumbar microdiscectomy, which could help identify those at higher risk of surgical failure.
Methods: Prospective analysis of patients treated with lumbar microdiscectomy (n = 52) and healthy control subjects (n = 45) in a single tertiary centre. Follow up of 12 and 24 months after surgery, with radicular and lumbar pain evaluation according to the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Comparison of several objective spinal biomechanic factors, measured by a single experienced radiologist. Assessment of spinal sagittal balance as a prognostic factor after lumbar discectomy.
Results: Compared to healthy individuals, patients with symptomatic lumbar disc herniation showed lower thoracic kyphosis (39.03 vs. 34.42° p = 0.034), lower thoraco-lumbar transition T10-L2 angulation (6.79 vs. 2.08° p = 0.005), lower lumbar lordosis (59.54 vs. 48.36° p < 0.001) and lumbo-sacral angulation L4-S1 (40.20 vs. 29.16° p < 0.001), lower pelvic incidence (54.71vs 49.86° p = 0.014) and lower sacral slope (42.07 vs. 33.34° p < 0.001). Sagittal balance (SVA) was negative in healthy subjects -3.09 mm and positive lumbar-disc patients 15.04 (p = 0.013). Noteworthy, the radicular and lumbar pain and disability outcomes 12 and 24 months after surgery were significantly better in the group with normal sagittal balance (ODI 14.52 vs. 40.06 p < 0.001; radicular VAS 2.74 vs. 5.58 p < 0.001; lumbar VAS 3.61 vs. 4.06 p < 0.001).
Conclusion: Lumbar degenerative disc disease represents a major burden for healthcare systems; thus, its management is determinant. Lumbar discectomy shows overall positive results, with a significant reduction of pain and disability in the majority of cases. However, a subgroup of patients, still not well defined, may experience persistent pain after the intervention. The use of objective measurements of sagittal balance may help identify these patients for which simple discectomy may not suffice and contribute to treatment planification.
目的：脊柱生物力学，特别是矢状面平衡和脊柱-骨盆成角是理解腰椎退行性疾病的决定性因素。这些转化为客观测量的概念正逐步融入临床实践。本研究探讨了它们作为腰椎微椎间盘切除术患者的预后因素，可以帮助识别手术失败风险较高的患者。方法：前瞻性分析在单一三级中心接受腰椎微椎间盘切除术的患者（n = 52）和健康对照者（n = 45）。术后随访12个月和24个月，根据视觉模拟评分（VAS）和Oswestry残疾指数（ODI）评估神经根和腰椎疼痛。由一位经验丰富的放射科医生测量的几个客观脊柱生物力学因素的比较。评估腰椎矢状面平衡作为腰椎间盘切除术后的预后因素。结果：与健康个体相比，有症状的腰椎间盘突出患者表现为下胸后凸（39.03比34.42°p = 0.034）、下胸腰椎过渡T10-L2成角（6.79比2.08°p = 0.005）、下腰椎前凸（59.54比48.36°p p = 0.014）和下骶骨斜度（42.07比33.34°p p = 0.013）。值得注意的是，矢状位平衡正常组术后12个月和24个月的神经根和腰椎疼痛和残疾结局明显更好（ODI 14.52 vs. 40.06 p p p p）。因此，它的管理是决定性的。腰椎间盘切除术总体上显示出积极的结果，在大多数病例中疼痛和残疾显著减少。然而，一个亚组的患者，仍然没有明确的定义，可能会经历持续的疼痛干预后。使用矢状面平衡的客观测量可以帮助识别简单的椎间盘切除术可能不够的患者，并有助于治疗平面化。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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