Comparative analysis of changes in spinal dimensions following different correction methods in adult spinal deformity surgery.

IF 1.6 4区 医学 Journal of Orthopaedic Surgery Pub Date : 2024-09-01 DOI:10.1177/10225536241289313
Hoai Tp Dinh, Hiroki Ushirozako, Tomohiko Hasegawa, Yu Yamato, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Tomohiro Yamada, Koichiro Ide, Kenta Kurosu, Yukihiro Matsuyama
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Abstract

Background: Adult spinal deformity (ASD) surgery has gained popularity, with significant improvements in patient-reported outcomes. Posterior lumbar interbody fusion with multiple grade II osteotomies (PLIF + MOs) and lateral lumbar interbody fusion (LLIF) have been utilized to correct ASD; however, no studies have compared these methods with regard to the pre- and postoperative changes in length and volume of the spinal canal. This study aimed to investigate the 3-dimensional changes in the anterior vertical column length (AVCL), spinal canal length (SCL), and spinal canal volume (SCV) in patients with ASD after surgery, employing LLIF and PLIF + MOs. Methods: This retrospective study examined 44 patients with ASD who underwent surgery between 2010 and 2021 using two corrective surgical methods, LLIF and PLIF + MOs. Radiographic parameters and clinical outcomes were assessed, and three-dimensional models were created from computed tomography images to analyze changes in AVCL, SCL, and SCV. Results: We compared the effects of LLIF and PLIF + MOs on spinal canal dimensions during ASD surgery. LLIF demonstrated an increase in lumbar segment (L1-S1) AVCL and whole spine (T1-S1) SCL by 6.5 ± 8.0 mm and 13.8 ± 7.6 mm, respectively, compared with PLIF + MOs. However, PLIF + MOs exhibited a reduction in the lengths of the lumbar segment AVCL. Postoperative differences were significant for AVCL (L1-S1), SCL fusion level, and first-standing lumbar lordosis between the groups (p < 0.0001, 0.002, and 0.016, respectively). LLIF significantly increased the SCV at the fusion level and whole spine T1-S1 by 14.5% and 10.6%, respectively, outperforming PLIF + MOs. Despite changes in dimensions, the postoperative Oswestry disability index scores showed no significant difference between the two groups. Conclusions: Our study suggests that LLIF can increase spinal canal space, lumbar lordosis, and anterior column length in the lumbar spinal segment. Knowledge of these variations may be critical for enhancing surgical outcomes and preventing neurological complications.

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成人脊柱畸形手术中不同矫正方法后脊柱尺寸变化的比较分析。
背景:成人脊柱畸形(ASD)手术越来越受欢迎,患者报告的疗效有了显著改善。后腰椎椎体间融合术加多处二级截骨(PLIF + MOs)和侧腰椎椎体间融合术(LLIF)已被用于矫正脊柱畸形;然而,还没有研究对这些方法术前和术后椎管长度和容积的变化进行比较。本研究旨在探讨采用 LLIF 和 PLIF + MOs 的 ASD 患者术后前垂直柱长度(AVCL)、椎管长度(SCL)和椎管容积(SCV)的三维变化。方法:这项回顾性研究对 2010 年至 2021 年间接受手术的 44 例 ASD 患者进行了检查,采用了两种矫正手术方法:LLIF 和 PLIF + MOs。对放射学参数和临床结果进行了评估,并通过计算机断层扫描图像创建了三维模型,以分析AVCL、SCL和SCV的变化。结果:我们比较了 LLIF 和 PLIF + MO 对 ASD 手术中椎管尺寸的影响。与 PLIF + MOs 相比,LLIF 显示腰椎段(L1-S1)AVCL 和整个脊柱(T1-S1)SCL 分别增加了 6.5 ± 8.0 毫米和 13.8 ± 7.6 毫米。然而,PLIF + MOs 的腰椎节段 AVCL 长度有所减少。术后各组间的AVCL(L1-S1)、SCL融合水平和初立腰椎前凸差异显著(P分别<0.0001、0.002和0.016)。LLIF 使融合水平和整个脊柱 T1-S1 的 SCV 分别增加了 14.5% 和 10.6%,明显优于 PLIF + MOs。尽管尺寸发生了变化,但两组患者术后的 Oswestry 残疾指数评分并无明显差异。结论:我们的研究表明,LLIF 可以增加腰椎段的椎管空间、腰椎前凸和前柱长度。了解这些变化对于提高手术效果和预防神经系统并发症至关重要。
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期刊介绍: Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. It is the official journal of the Asia Pacific Orthopaedic Association. The journal welcomes and will publish materials of a diverse nature, from basic science research to clinical trials and surgical techniques. The journal encourages contributions from all parts of the world, but special emphasis is given to research of particular relevance to the Asia Pacific region.
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