微创下腰椎融合术后的脊柱骨盆失衡是否使患者易于进行后续微创骶髂关节融合术?病例对照研究。

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Roxana Beladi, Ammar Alsalahi, Gustavo Anton, Heather Lucke, Clifford Houseman, Chad Claus, Boyd Richards, Doris Tong, Teck Soo
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引用次数: 0

摘要

目的:骶髂关节(SIJ)功能障碍是下腰椎手术后持续腰痛的一个经常被忽视的原因。SIJ是下腰椎的相邻关节,因此在下腰椎融合术后可发生相邻节段疾病(ASD)。脊柱骨盆失衡可能使患者易患SIJ的ASD,导致SIJ功能障碍。然而,微创(MIS)下腰椎融合术后脊柱骨盆失衡对SIJ功能障碍的影响以及随后的融合术仍然没有定论。我们试图确定下腰椎融合术后脊柱骨盆失衡是否会使患者易发生MIS SIJ融合术(SIJF)。方法:我们回顾性地回顾了连续选择性下腰椎融合术患者(结束水平L5/S1),以1:1的比例选择我们的病例和对照组。我们纳入了2005年10月至2021年5月在单一机构接受MIS下腰椎融合术的患者,其结束节段包括L5或S1,起始节段在T12或以下,并且至少有两年的随访。我们排除了术后x光片不充分或缺失的患者、因创伤或感染而行腰椎融合、骨盆固定、腰椎翻修手术和既往SIJF的患者。我们进行了一项初步研究,确定每组190人的样本量。包括怀孕数量在内的混杂因素被收集起来。与先前文献一致,我们将脊柱-骨盆失衡定义为PI-LL失配10°[1-5]。我们使用单变量分析对两组进行比较。采用卡方法计算PI-LL失配相关SIJF的发生几率。我们在SIJF上进行多变量分析建模以调整协变量。结果:我们纳入了488例患者(SIJF组203例,对照组285例)。两组间SIJF患者明显年轻化(52.55±12.81∶55.84±14.71;P = 0.005),女性比例较高(67.5% vs. 55.1%;P = 0.006),升高的水平融合(1.78±0.97∶1.38±0.64;结论:MIS下腰椎融合术后PI-LL失配与需要后续SIJF的显著几率独立相关。优化脊柱骨盆不平衡可以降低MIS下腰椎手术后需要后续SIJF的几率。考虑到与我们研究设计的回顾性和观察性有关的偏倚,需要进一步的前瞻性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does spinopelvic imbalance after minimally invasive lower lumbar fusion predispose patients to subsequent minimally invasive sacroiliac joint fusions? a case-control study.

Purpose: Sacroiliac joint (SIJ) dysfunction is a frequently overlooked source of persistent low back pain after lower lumbar surgery. The SIJ is an adjacent joint to the lower lumbar spine and can thus be subject to adjacent segment disease (ASD) after lower lumbar fusion. Spinopelvic imbalance can potentially predispose a patient to ASD in the SIJ, causing SIJ dysfunction. However, the impact of spinopelvic imbalance following minimally invasive (MIS) lower lumbar fusion on SIJ dysfunction and, thus, subsequent fusion remains inconclusive. We sought to determine whether spinopelvic imbalance after lower lumbar fusion predisposes patients to subsequent MIS SIJ fusion (SIJF).

Methods: We retrospectively reviewed consecutive elective lower lumbar fusion patients (ending levels L5/S1) to select our cases and controls in a 1:1 match. We included patients who underwent MIS lower lumbar fusion from 10/2005 to 05/2021 at a single institution with an ending level including L5 or S1, a starting level at or below T12, and had at least two years of follow-up. We excluded patients with inadequate or absent postoperative X-rays, those who underwent lumbar fusion for trauma or infection, pelvic fixation, revision lumbar surgery, and prior SIJF. We performed a pilot study to determine the sample size as 190 per group. Confounders, including the number of pregnancies, were collected. Consistent with prior literature, we defined spinopelvic imbalance as a PI-LL mismatch of <-10° or > 10° [1-5]. We compared the groups using univariate analysis. The odds of developing SIJF related to PI-LL mismatch were calculated using Chi-Square. We performed multivariable analysis modeling on SIJF to adjust for covariates.

Results: We included 488 patients (203 SIJF vs. 285 control). Between groups, the SIJF patients were significantly younger (52.55 ± 12.81 vs. 55.84 ± 14.71; P = 0.005), had a higher proportion of females (67.5% vs. 55.1%; P = 0.006), and increased levels fused (1.78 ± 0.97 vs. 1.38 ± 0.64; P < 0.001). Interestingly, number of pregnancies was not significantly different (P = 0.791). PI-LL mismatch demonstrated a 3.54 increased odds of requiring subsequent SIJF (p < 0.001). Multiple logistic regression adjusting for age at lumbar fusion, female sex, and number of levels demonstrated that PI-LL mismatch (OR 1.10; 95% CI 1.06-1.15; p < 0.001) and operative levels (OR 1.84; 95% CI 1.42-2.39; p < 0.001) were independently associated with significantly increased odds of requiring SIJF, while age (OR 0.98; 95% CI 0.96-0.99; p < 0.001) and female sex (OR 0.54; 95% CI 0.36-0.81; p = 0.003) were associated with significantly decreased odds of requiring SIJF.

Conclusion: PI-LL mismatch following MIS lower lumbar fusion was independently associated with significant odds of requiring subsequent SIJF. Optimizing spinopelvic imbalance can decrease the odds of requiring subsequent SIJF after MIS lower lumbar surgery. Given the biases associated with the retrospective and observational nature of our study design, further prospective studies are needed.

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来源期刊
European Spine Journal
European Spine Journal 医学-临床神经学
CiteScore
4.80
自引率
10.70%
发文量
373
审稿时长
2-4 weeks
期刊介绍: "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe
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