Functional outcomes correlate with sagittal spinal balance in degenerative lumbar spondylolisthesis surgery.
Spine J
; 23(10): 1512-1521, 2023 10.
Article
en En
| MEDLINE
| ID: mdl-37307882
ABSTRACT
BACKGROUND CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a debilitating condition associated with poor preoperative functional status. Surgical intervention has been shown to improve functional outcomes in this population though the optimal surgical procedure remains controversial. The importance of maintaining and/or improving sagittal and pelvic spinal balance parameters has received increasing interest in the recent DLS literature. However, little is known about the radiographic parameters most associated with improved functional outcomes among patients undergoing surgery for DLS. PURPOSE:
To identify the effect of postoperative sagittal spinal alignment on functional outcome after DLS surgery. STUDYDESIGN:
Retrospective cohort study. PATIENT SAMPLE Two-hundred forty-three patients in the Canadian Spine Outcomes and Research Network (CSORN) prospective DLS study database. OUTCOMEMEASURES:
Baseline and 1-year postoperative leg and back pain on the 10-point Numeric Rating Scale and baseline and 1-year postoperative disability on the Oswestry Disability Index (ODI).METHODS:
All enrolled study patients had a DLS diagnosis and underwent decompression in isolation or with posterolateral or interbody fusion. Global and regional radiographic alignment parameters were measured at baseline and 1-year postoperatively including sagittal vertical axis (SVA), pelvic incidence and lumbar lordosis (LL). Both univariate and multiple linear regression was used to assess for the association between radiographic parameters and patient-reported functional outcomes with adjustment for possible confounding baseline patient factors.RESULTS:
Two-hundred forty-three patients were available for analysis. Among participants, the mean age was 66 with 63% (153/243) female with the primary surgical indication of neurogenic claudication in 197/243 (81%) of patients. Worse pelvic incidence-LL mismatch was correlated with more severe disability [ODI, 0.134, p<.05), worse leg pain (0.143, p<.05) and worse back pain (0.189, p<.001) 1-year postoperatively. These associations were maintained after adjusting for age, BMI, gender, and preoperative presence of depression (ODI, R2 0.179, ß, 0.25, 95% CI 0.08, 0.42, p=.004; back pain R2 0.152 (ß, 0.05, 95% CI 0.022, 0.07, p<.001; leg pain score R2 0.059, ß, 0.04, 95% CI 0.008, 0.07, p=.014). Likewise, reduction of LL was associated with worse disability (ODI, R2 0.168, ß, 0.04, 95% CI -0.39, -0.02, p=.027) and worse back pain (R2 0.135, ß, -0.04, 95% CI -0.06, -0.01, p=.007). Worsened SVA correlated with worse patient reported functional outcomes (ODI, R2 0.236, ß, 0.12, 95% CI 0.05, 0.20, p=.001). Similarly, an increase (worsening) in SVA resulted in a worse NRS back pain (R2 0.136, ß, 0.01, 95% CI .001, 0.02, p=.029) and worse NRS leg pain (R2 0.065, ß, 0.02, 95% CI 0.002, 0.02, p=.018) scores regardless of surgery type.CONCLUSIONS:
Preoperative emphasis on regional and global spinal alignment parameters should be considered in order to optimize functional outcome in lumbar degenerative spondylolisthesis treatment.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Fusión Vertebral
/
Espondilolistesis
/
Lordosis
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
/
Female
/
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Spine J
Asunto de la revista:
ORTOPEDIA
Año:
2023
Tipo del documento:
Article
País de afiliación:
Canadá