目的:确定成人脊柱畸形(ASD)患者基线矢状面失衡严重程度的临床影响。
方法:我们回顾性回顾了接受≥5级融合的患者,包括骨盆,对于随访≥2年的ASD。使用脊柱侧弯研究学会-施瓦布分类系统,根据术前矢状面失衡的严重程度将患者分为3组:轻度,中度,和严重。比较3组患者术后临床及影像学检查结果。
结果:最终纳入了259例患者。有42、62和155名轻度患者,中度,和严重的群体,分别。重症组的围手术期手术负担最大。术后,该组还显示最大的骨盆发病率减去腰椎前凸不匹配,表明有纠正不足的倾向。近端交界性脊柱后凸无统计学差异,近端交界失败,或者群体之间的杆状骨折。背痛和脊柱侧弯研究协会22评分的视觉模拟评分在各组之间相似。然而,重度组的末次随访Oswestry残疾指数(ODI)评分明显低于重度组。
结论:严重矢状面失衡的患者在增加围手术期手术负担的同时,接受更多侵入性手术治疗。所有患者在手术后均表现出显着的放射学和临床改善。然而,关于ODI,严重组的临床结果比其他组稍差,可能是由于纠正不足的比例相对较高。因此,更严格的校正对于实现最佳矢状面对齐是必要的,特别是在有严重基线矢状面失衡的患者中.
OBJECTIVE: To determine the clinical impact of the baseline sagittal imbalance severity in patients with adult spinal deformity (ASD).
METHODS: We retrospectively reviewed patients who underwent ≥ 5-level fusion including the pelvis, for ASD with a ≥ 2-year follow-up. Using the Scoliosis Research Society-Schwab classification system, patients were classified into 3 groups according to the severity of the preoperative sagittal imbalance: mild, moderate, and severe. Postoperative clinical and radiographic results were compared among the 3 groups.
RESULTS: A total of 259 patients were finally included. There were 42, 62, and 155 patients in the mild, moderate, and severe groups, respectively. The perioperative surgical burden was greatest in the severe group. Postoperatively, this group also showed the largest pelvic incidence minus lumbar lordosis mismatch, suggesting a tendency towards undercorrection. No statistically significant differences were observed in proximal junctional kyphosis, proximal junctional failure, or rod fractures among the groups. Visual analogue scale for back pain and Scoliosis Research Society-22 scores were similar across groups. However, severe group\'s last follow-up Oswestry Disability Index (ODI) scores significantly lower than those of the severe group.
CONCLUSIONS: Patients with severe sagittal imbalance were treated with more invasive surgical methods along with increased the perioperative surgical burden. All patients exhibited significant radiological and clinical improvements after surgery. However, regarding ODI, the severe group demonstrated slightly worse clinical outcomes than the other groups, probably due to relatively higher proportion of undercorrection. Therefore, more rigorous correction is necessary to achieve optimal sagittal alignment specifically in patients with severe baseline sagittal imbalance.