Abstract：
OBJECTIVE: Prior studies investigating the use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for treatment of degenerative lumbar conditions and concomitant sagittal deformity have not stratified patients by preoperative pelvic incidence (PI)-lumbar lordosis (LL) mismatch, which is the earliest parameter to deteriorate in mild sagittal deformity. Thus, the aim of the present study was to determine the impact of preoperative PI-LL mismatch on clinical outcomes and sagittal balance restoration among patients undergoing MI-TLIF for degenerative spondylolisthesis (DS).
METHODS: Consecutive adult patients undergoing primary 1-level MI-TLIF between April 2017 and April 2022 for DS with ≥ 6 months radiographic follow-up were included. Patient-reported outcome measures (PROMs) included the Oswestry Disability Index, visual analog scale (VAS), 12-Item Short-Form Health Survey (SF-12), and Patient-Reported Outcomes Measurement Information System at preoperative, early postoperative (< 6 months), and late postoperative (≥ 6 months) time points. The minimal clinically important difference (MCID) for PROMs was also evaluated. Radiographic parameters included PI, LL, pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were categorized into balanced and unbalanced groups based on preoperative PI-LL mismatch according to age-adjusted alignment goals. Changes in radiographic parameters and PROMs were evaluated.
RESULTS: Eighty patients were included (L4-5 82.5%, grade I spondylolisthesis 82.5%, unbalanced 58.8%). Mean clinical and radiographic follow-up were 17.0 and 8.3 months, respectively. The average preoperative PI-LL was 18.8° in the unbalanced group and -3.3° in the balanced group. Patients with preoperative PI-LL mismatch had significantly worse preoperative PT (26.2° vs 16.4°, p < 0.001) and SVA (53.2 vs 9.0 mm, p = 0.001) compared with balanced patients. Patients with preoperative PI-LL mismatch also showed significantly worse PI-LL (16.0° vs 0.54°, p < 0.001), PT (25.9° vs 18.7°, p < 0.001), and SVA (49.4 vs 22.8 mm, p = 0.013) at long-term follow-up. No significant radiographic improvement was observed among unbalanced patients. All patients demonstrated significant improvements in all PROMs (p < 0.05) except for SF-12 mental component score. Achievement of MCID for VAS back score was significantly greater among patients with preoperative PI-LL mismatch (85.7% vs 65.5%, p = 0.045).
CONCLUSIONS: Although 1-level MI-TLIF did not restore sagittal alignment in patients with preoperative PI-LL mismatch, patients presenting with DS can expect significant improvement in PROMs following 1-level MI-TLIF regardless of preoperative alignment or extent of correction. Thus, attaining good clinical outcomes in patients with mild sagittal imbalance may not require addressing imbalance directly.
METHODS: Consecutive adult patients undergoing primary 1-level MI-TLIF between April 2017 and April 2022 for DS with ≥ 6 months radiographic follow-up were included. Patient-reported outcome measures (PROMs) included the Oswestry Disability Index, visual analog scale (VAS), 12-Item Short-Form Health Survey (SF-12), and Patient-Reported Outcomes Measurement Information System at preoperative, early postoperative (< 6 months), and late postoperative (≥ 6 months) time points. The minimal clinically important difference (MCID) for PROMs was also evaluated. Radiographic parameters included PI, LL, pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were categorized into balanced and unbalanced groups based on preoperative PI-LL mismatch according to age-adjusted alignment goals. Changes in radiographic parameters and PROMs were evaluated.
RESULTS: Eighty patients were included (L4-5 82.5%, grade I spondylolisthesis 82.5%, unbalanced 58.8%). Mean clinical and radiographic follow-up were 17.0 and 8.3 months, respectively. The average preoperative PI-LL was 18.8° in the unbalanced group and -3.3° in the balanced group. Patients with preoperative PI-LL mismatch had significantly worse preoperative PT (26.2° vs 16.4°, p < 0.001) and SVA (53.2 vs 9.0 mm, p = 0.001) compared with balanced patients. Patients with preoperative PI-LL mismatch also showed significantly worse PI-LL (16.0° vs 0.54°, p < 0.001), PT (25.9° vs 18.7°, p < 0.001), and SVA (49.4 vs 22.8 mm, p = 0.013) at long-term follow-up. No significant radiographic improvement was observed among unbalanced patients. All patients demonstrated significant improvements in all PROMs (p < 0.05) except for SF-12 mental component score. Achievement of MCID for VAS back score was significantly greater among patients with preoperative PI-LL mismatch (85.7% vs 65.5%, p = 0.045).
CONCLUSIONS: Although 1-level MI-TLIF did not restore sagittal alignment in patients with preoperative PI-LL mismatch, patients presenting with DS can expect significant improvement in PROMs following 1-level MI-TLIF regardless of preoperative alignment or extent of correction. Thus, attaining good clinical outcomes in patients with mild sagittal imbalance may not require addressing imbalance directly.
摘要：
目的：先前研究了使用微创经椎间孔腰椎椎间融合术（MI-TLIF）治疗退行性腰椎疾病和伴随矢状位畸形的研究，并没有根据术前骨盆发生率（PI）-腰椎前凸（LL）不匹配对患者进行分层，这是轻度矢状畸形恶化的最早参数。因此，本研究的目的是确定在接受MI-TLIF治疗退行性腰椎滑脱(DS)的患者中,术前PI-LL不匹配对临床结局和矢状面平衡恢复的影响.
方法：纳入2017年4月至2022年4月期间接受原发性1级MI-TLIF治疗DS且影像学随访≥6个月的连续成年患者。患者报告的结局指标(PROM)包括Oswestry残疾指数，视觉模拟量表(VAS)，12项简式健康调查(SF-12)，和术前患者报告结果测量信息系统，术后早期（<6个月），和术后晚期（≥6个月）时间点。还评估了PROM的最小临床重要差异(MCID)。射线照相参数包括PI，LL,骨盆倾斜(PT),和矢状垂直轴（SVA）。根据年龄调整后的对齐目标，根据术前PI-LL不匹配将患者分为平衡组和不平衡组。评估了射线照相参数和PROM的变化。
结果：纳入80例患者（L4-582.5%，I级脊椎滑脱82.5%,不平衡58.8%)。平均临床和影像学随访时间分别为17.0和8.3个月，分别。术前平均PI-LL不平衡组为18.8°,平衡组为-3.3°。术前PI-LL不匹配的患者术前PT明显更差(26.2°vs16.4°,p<0.001）和SVA（53.2对9.0mm，p=0.001）与平衡患者相比。术前PI-LL不匹配的患者也表现出明显更差的PI-LL（16.0°vs0.54°，p<0.001)，PT(25.9°vs18.7°,p<0.001)，和SVA（49.4对22.8毫米，长期随访时p=0.013)。在不平衡的患者中没有观察到显着的影像学改善。除SF-12心理分量评分外，所有患者的所有PROM均有显着改善（p<0.05）。在术前PI-LL不匹配的患者中，VAS背部评分的MCID明显更高（85.7％vs65.5％，p=0.045)。
结论：尽管1级MI-TLIF在术前PI-LL不匹配患者中不能恢复矢状面对齐，无论术前对齐或矫正程度如何,出现DS的患者在1级MI-TLIF后的PROM均有望得到显著改善.因此，在轻度矢状面失衡患者中获得良好的临床结局可能不需要直接解决失衡问题.
方法：纳入2017年4月至2022年4月期间接受原发性1级MI-TLIF治疗DS且影像学随访≥6个月的连续成年患者。患者报告的结局指标(PROM)包括Oswestry残疾指数，视觉模拟量表(VAS)，12项简式健康调查(SF-12)，和术前患者报告结果测量信息系统，术后早期（<6个月），和术后晚期（≥6个月）时间点。还评估了PROM的最小临床重要差异(MCID)。射线照相参数包括PI，LL,骨盆倾斜(PT),和矢状垂直轴（SVA）。根据年龄调整后的对齐目标，根据术前PI-LL不匹配将患者分为平衡组和不平衡组。评估了射线照相参数和PROM的变化。
结果：纳入80例患者（L4-582.5%，I级脊椎滑脱82.5%,不平衡58.8%)。平均临床和影像学随访时间分别为17.0和8.3个月，分别。术前平均PI-LL不平衡组为18.8°,平衡组为-3.3°。术前PI-LL不匹配的患者术前PT明显更差(26.2°vs16.4°,p<0.001）和SVA（53.2对9.0mm，p=0.001）与平衡患者相比。术前PI-LL不匹配的患者也表现出明显更差的PI-LL（16.0°vs0.54°，p<0.001)，PT(25.9°vs18.7°,p<0.001)，和SVA（49.4对22.8毫米，长期随访时p=0.013)。在不平衡的患者中没有观察到显着的影像学改善。除SF-12心理分量评分外，所有患者的所有PROM均有显着改善（p<0.05）。在术前PI-LL不匹配的患者中，VAS背部评分的MCID明显更高（85.7％vs65.5％，p=0.045)。
结论：尽管1级MI-TLIF在术前PI-LL不匹配患者中不能恢复矢状面对齐，无论术前对齐或矫正程度如何,出现DS的患者在1级MI-TLIF后的PROM均有望得到显著改善.因此，在轻度矢状面失衡患者中获得良好的临床结局可能不需要直接解决失衡问题.
