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Abstract：
OBJECTIVE: To retrospectively investigate the postoperative clinical and radiographic outcomes in elderly patients with degenerative lumbar spinal stenosis (DLSS) and severe global sagittal imbalance who underwent different fusion levels.
METHODS: A total of 214 patients with DLSS and severe global sagittal imbalance were included. Sagittal imbalance syndrome was defined as the severe decompensated radiographic global sagittal imbalance accompanied with the following symptoms: severe back pain in naturel posture that disappears or significantly relieves in support position, living disability with ODI score > 40% and dynamic sagittal imbalance. Thereinto, 54 patients were found with sagittal imbalance syndrome and were performed the lumbar decompression with a long thoracolumbar fusion (Group A) or a short lumbar fusion (Group B). Thirty patients without sagittal imbalance syndrome who underwent short lumbar decompression and fusion were selected as the control (Group C).
RESULTS: Patients with sagittal imbalance syndrome were detected to have more paraspinal muscle degeneration and less compensatory potentials for sagittal imbalance (smaller thoracic kyphosis and larger pelvic tilt) than those without this diagnosis. Postoperative comparisons revealed significant restoration of global sagittal alignment and balance and improvement of living quality in Groups A and C at the final follow-up. Six patients in Group B and one in Group A were found to have proximal junctional complication during follow-up.
CONCLUSIONS: Our results indicated that DLSS patients with sagittal imbalance syndrome had inferior surgical outcomes in terms of living quality and proximal junctional complication after lumbar decompression with a short fusion.
METHODS: A total of 214 patients with DLSS and severe global sagittal imbalance were included. Sagittal imbalance syndrome was defined as the severe decompensated radiographic global sagittal imbalance accompanied with the following symptoms: severe back pain in naturel posture that disappears or significantly relieves in support position, living disability with ODI score > 40% and dynamic sagittal imbalance. Thereinto, 54 patients were found with sagittal imbalance syndrome and were performed the lumbar decompression with a long thoracolumbar fusion (Group A) or a short lumbar fusion (Group B). Thirty patients without sagittal imbalance syndrome who underwent short lumbar decompression and fusion were selected as the control (Group C).
RESULTS: Patients with sagittal imbalance syndrome were detected to have more paraspinal muscle degeneration and less compensatory potentials for sagittal imbalance (smaller thoracic kyphosis and larger pelvic tilt) than those without this diagnosis. Postoperative comparisons revealed significant restoration of global sagittal alignment and balance and improvement of living quality in Groups A and C at the final follow-up. Six patients in Group B and one in Group A were found to have proximal junctional complication during follow-up.
CONCLUSIONS: Our results indicated that DLSS patients with sagittal imbalance syndrome had inferior surgical outcomes in terms of living quality and proximal junctional complication after lumbar decompression with a short fusion.
摘要：
目的：回顾性研究退变性腰椎管狭窄症（DLSS）和严重整体矢状面失衡的老年患者接受不同程度融合后的临床和影像学结果。
方法：共纳入214例DLSS和重度矢状面失衡患者。矢状失衡综合征被定义为严重的失代偿的放射学整体矢状失衡，伴有以下症状：自然姿势的严重背痛消失或在支撑位置显着缓解，ODI评分>40%和动态矢状面失衡的生活残疾。其中，发现有矢状面失衡综合征的54例患者，并进行了腰椎减压及长胸腰椎融合术（A组）或短腰椎融合术（B组）。选择30例无矢状面失衡综合征患者行腰椎短减压融合术作为对照组(C组)。
结果：与没有这种诊断的患者相比，矢状面失衡综合征患者的椎管旁肌肉变性更多，矢状面失衡代偿潜能更低（胸椎后凸和骨盆倾斜更小）。术后比较显示，在最后的随访中，A组和C组的整体矢状位显着恢复，平衡和生活质量改善。随访期间发现B组中的6例患者和A组中的1例患者有近端交界并发症。
结论：我们的结果表明，矢状面失衡综合征的DLSS患者在腰椎减压和短融合术后的生活质量和近端交界并发症方面的手术效果较差。
方法：共纳入214例DLSS和重度矢状面失衡患者。矢状失衡综合征被定义为严重的失代偿的放射学整体矢状失衡，伴有以下症状：自然姿势的严重背痛消失或在支撑位置显着缓解，ODI评分>40%和动态矢状面失衡的生活残疾。其中，发现有矢状面失衡综合征的54例患者，并进行了腰椎减压及长胸腰椎融合术（A组）或短腰椎融合术（B组）。选择30例无矢状面失衡综合征患者行腰椎短减压融合术作为对照组(C组)。
结果：与没有这种诊断的患者相比，矢状面失衡综合征患者的椎管旁肌肉变性更多，矢状面失衡代偿潜能更低（胸椎后凸和骨盆倾斜更小）。术后比较显示，在最后的随访中，A组和C组的整体矢状位显着恢复，平衡和生活质量改善。随访期间发现B组中的6例患者和A组中的1例患者有近端交界并发症。
结论：我们的结果表明，矢状面失衡综合征的DLSS患者在腰椎减压和短融合术后的生活质量和近端交界并发症方面的手术效果较差。
