目的:腰椎退行性疾病降低腰椎前凸度(LL)。L5-S1椎间盘间隙前路腰椎椎间融合术(ALIF)可改善节段前凸,LL,和矢状平衡。这项研究调查了L5-S1ALIF后脊柱骨盆排列的相互变化。
方法:回顾性图表审查确定了在单个机构(2016年11月1日至2021年10月1日)接受L5-S1ALIF且有或没有后路固定的患者。骨盆倾斜的变化,骶骨斜坡,近端LL(L1-L4),远端LL(L4-S1),总LL(L1-S1),节段前凸,骨盆发病率-LL不匹配,胸椎后凸,宫颈前凸,在术前和术后的X线片上测量矢状纵轴。
结果:确认48例患者。在手术后17(20)天的平均(SD)获得立即的术后X光片;手术后184(82)天获得延迟的X光片。手术后,患者骨盆倾斜明显下降(15.71°[7.25°]vs17.52°[7.67°],p=0.003)和近端LL(11.86°[10.67°]vs16.03°[10.45°],p<0.001)和增加的骶骨斜率(39.49°[9.27°]vs36.31°[10.39°],p<0.001),LL(55.35°[13.15°]vs51.63°[13.38°],p=0.001),和远端LL(43.17°[9.33°]与35.80°[8.02°],p<0.001)。节段前凸在L5-S1处显着增加,在L2-3,L3-4和L4-5处显着降低。前凸分布指数从72.55(19.53)增加到81.38(22.83)(p<0.001)。
结论:L5-S1ALIF与L5-S1节段前凸增加并伴有骨盆前倾和腰椎近端前凸减少相关。这些变化可能代表着补偿机制的逆转,提示L5-S1ALIF后脊柱骨盆排列的整体松弛。
OBJECTIVE: Degenerative diseases of the lumbar spine decrease lumbar lordosis (LL). Anterior lumbar interbody fusion (ALIF) at the L5-S1 disc space improves segmental lordosis, LL, and sagittal balance. This study investigated reciprocal changes in spinopelvic alignment after L5-S1 ALIF.
METHODS: A retrospective chart review identified patients who underwent L5-S1 ALIF with or without posterior fixation at a single institution (November 1, 2016 to October 1, 2021). Changes in pelvic tilt, sacral slope, proximal LL (L1-L4), distal LL (L4-S1), total LL (L1-S1), segmental lordosis, pelvic incidence-LL mismatch, thoracic kyphosis, cervical lordosis, and sagittal vertical axis were measured on preoperative and postoperative radiographs.
RESULTS: Forty-eight patients were identified. Immediate postoperative radiographs were obtained at a mean (SD) of 17 (20) days after surgery; delayed radiographs were obtained 184 (82) days after surgery. After surgery, patients had significantly decreased pelvic tilt (15.71° [7.25°] vs. 17.52° [7.67°], P = 0.003) and proximal LL (11.86° [10.67°] vs. 16.03° [10.45°], P < 0.001) and increased sacral slope (39.49° [9.27°] vs. 36.31° [10.39°], P < 0.001), LL (55.35° [13.15°] vs. 51.63° [13.38°], P = 0.001), and distal LL (43.17° [9.33°] vs. 35.80° [8.02°], P < 0.001). Segmental lordosis increased significantly at L5-S1 and decreased significantly at L2-3, L3-4, and L4-5. Lordosis distribution index increased from 72.55 (19.53) to 81.38 (22.83) (P < 0.001).
CONCLUSIONS: L5-S1 ALIF was associated with increased L5-S1 segmental lordosis accompanied by pelvic anteversion and a reciprocal decrease in proximal LL. These changes may represent a reversal of compensatory mechanisms, suggesting an overall relaxation of spinopelvic alignment after L5-S1 ALIF.