脊柱-骨盆矢状位参数与腰椎退行性疾病术后持续性下腰痛的关系

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Objective To analyze the relationship between spinal and pelvic sagittal sequence parameters and persistent low back pain in patients with degenerative lumbar disease (DLD) after lumbar surgery.Methods Based on whether persistent low back pain occurred after surgery，86 patients with DLD who underwent single-level lumbar fusion and internal fixation in Tianjin People’s Hospital from June 2019 to June 2022 were divided into a low back pain group and a non-low back pain group.The low back pain group included 34 patients，including 10 males and 24 females，with an average age of (59.36±8.65) years ranging from 32 to 77 years old.The non-low back pain group included 52 patients，including 21 males and 31 females，with an average age of (56.81±8.03) years ranging from 30 to 78 years old.By comparing the general data before surgery，the pain levels before and after surgery［visual analogue score (VAS)］，lumbar function［Japanese orthopaedic association (JOA) score］，and spine-pelvis sagittal sequence parameters［lumbar lordosis (LL)，pelvic incidence (PI)，pelvic tilt (PT)，sacral slope (SS)］ between the two groups，we analyzed the influencing factors of persistent low back pain after surgery，and analyzed the correlation between the changes in spine-pelvis sagittal sequence parameters and VAS，JOA scores before and after surgery，and the value of predicting persistent low back pain after surgery by analyzing the changes in spine-pelvis sagittal sequence parameters and related influencing factors before and after surgery.Results The incidence of osteoporosis and intraoperative bone endplate injury in lumbago group (47.06%，23.53%) was higher than that in non-lumbago group (15.38%，1.92%).At 3 months after operation，VAS score and PT in low back pain group were higher than those in non-low back pain group，JOA score，LL and SS were lower than those in non-low back pain group，and ΔVAS，ΔJOA，ΔLL，ΔPI，ΔPT and ΔSS were lower than those in non-low back pain group (all P ＜0.05).In DLD patients，ΔLL，ΔPT，ΔSS were positively correlated with ΔVAS and ΔJOA ( P ＜0.05)，while ΔPI was not significantly correlated with ΔVAS and ΔJOA ( P＞0.05).Osteoporosis，intraoperative bone endplate injury，ΔLL，ΔPT，ΔSS were the influencing factors of postoperative persistent low back pain in DLD patients ( P＜0.05).The area under the curve (AUC) of ΔLL，ΔPT and ΔSS for predicting postoperative persistent low back pain in DLD patients were 0.776，0.825 and 0.731，respectively.Compared with the single prediction of ΔLL，ΔPT and ΔSS，the AUC (0.939) of ΔLL，ΔPT and ΔSS combined prediction was significantly increased，and the net reclassification improvement (NRI) and inte-grated discrimination improvement (IDI) were both>0( P ＜0.05).Conclusion The variation of spinal and pelvic sagittal position sequence parameters is associated with the occurrence of persistent low back pain after lumbar surgery in DLD patients，and has good application value in predicting the occurrence of persistent low back pain after lumbar surgery.

Key words： lumbar degenerative diseases persistent low back pain spinal and pelvic sagittal sequence parameters correlation analysis forecast

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	Yuan Jianjun
	Li Guang
	Zhang Quan
	Ren Zhishuai
	Liu Yan
	Tian Rong

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Yuan Jianjun,Li Guang,Zhang Quan, et al. The Relationship Between Spinal-Pelvic Sagittal Parameters and Persistent Low Back Pain After Degenerative Lumbar Disease Surgery[J]. sygkzz, 2024, 30(2): 115-.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2024/V30/I2/115

［1］ Kim HS，Wu PH，Jang IT.Lumbar degenerative disease part 1：Anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain：A prospective case series and review of literature［J］.Int J Mol Sci，2020，21(4)：1483.
［2］ Yasuhara T，Sasada S，Date I.Lumbar degenerative disease：Key for diagnosis［J］.No Shinkei Geka，2021，49(6)：1233-1245.
［3］贾瑞平，蔡然泽，顾宇彤.PTES脊柱内镜技术治疗多节段腰椎退行性疾病的疗效研究［J］.中国疼痛医学杂志，2020，26(12)：948-951；954.
［4］ Musso S，Buscemi F，Bonossi L， et al .Lumbar facet joint stabilization for symptomatic spinal degenerative disease：A systematic review of the literature［J］.J Craniovertebr Junction Spine，2022，13(4)：401-409.
［5］ Moses ZB，Razvi S，Oh SY， et al .A retrospective comparison of radiographic and clinical outcomes in single-level degenerative lumbar disease undergoing anterior versus transforaminal lumbar interbody fusion［J］.J Spine Surg，2021，7(2)：170-180.
［6］ Rathbone J，Rackham M，Nielsen D， et al .A systematic review of anterior lumbar interbody fusion (ALIF) versus posterior lumbar interbody fusion (PLIF)，transforaminal lumbar interbody fusion (TLIF)，posterolateral lumbar fusion (PLF)［J］.Eur Spine J，2023，32(6)：1911-1926.
［7］李晓君，姜鸿南，樊知昌，等.脊柱-骨盆影像学指标在腰椎退行性病变中的变化及意义［J］.影像科学与光化学，2022，40(3)：584-589.
［8］ Darnis A，Grobost P，Roussouly P.Very long-term clinical and radiographic outcomes after posterior spinal fusion with pedicular screws for thoracic adolescent idiopathic scoliosis［J］.Spine Deform，2021，9(2)：441-449.
［9］ He S，Renne A，Argandykov D， et al .Comparison of an emoji-based visual analog scale with a numeric rating scale for pain assessment［J］.JAMA，2022，328(2)：208-209.
［10］ Goh GS，Soh RCC，Yue WM， et al .Determination of the patient acceptable symptom state for the japanese orthopaedic association score in patients undergoing anterior cervical discectomy and fusion for cervical spondylotic myelopathy［J］.Spine J，2020，20(11)：1785-1794.
［11］ Kirnaz S，Capadona C，Wong T， et al .Fundamentals of intervertebral disc degeneration［J］.World Neurosurg，2022，157(1)：264-273.
［12］ Xu W，Ran B，Luo W， et al .Is Lumbar fusion necessary for chronic low back pain associated with degenerative disk disease?A meta-analysis［J］.World Neurosurg，2021，146(1)：298-306.
［13］ He S，Zhang Y，Ji W， et al .Analysis of spinopelvic sagittal balance and persistent low back pain (PLBP) for degenerative spondylolisthesis (DS) following posterior lumbar interbody fusion (PLIF)［J］.Pain Res Manag，2020(2020)：5971937.
［14］周志化，邓哲，周晓，等.脊柱骨盆矢状面形态与腰椎间盘突出症经椎间孔镜术后复发关系研究［J］.实用骨科杂志，2021，27(6)：512-516；527.
［15］张成，马超，陈涛.退变性腰椎滑脱与脊柱-骨盆矢状位参数的相关性研究［J］.徐州医科大学学报，2021，41(1)：35-38.
［16］马钧峰.腰椎融合术后脊柱-骨盆矢状位参数与手术疗效及术后腰痛的相关性研究［D］.天津：天津医科大学，2020.
［17］刘步云，沈海，吴忌，等.腰痛的髋关节骨关节炎患者腰椎-骨盆矢状位参数的研究［J］.颈腰痛杂志，2022，43(3)：348-351.
［18］ Li J，Zhang D，Shen Y， et al .Lumbar degenerative disease after oblique lateral interbody fusion：Sagittal spinopelvic alignment and its impact on low back pain［J］.J Orthop Surg Res，2020，15(1)：326.
［19］ Guo S，Zhu K，Yan MJ， et al .Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis［J］.World J Clin Cases，2022，10(36)：13179-13188.
［20］高显达，马雷，赵若宇，等.单节段斜外侧腰椎间融合术后腰痛的危险因素分析［J］.中华骨科杂志，2021，41(18)：1342-1349.
［21］唐烨，卢圆圆，贾真.脊柱-骨盆矢状面参数对腰椎间盘手术临床疗效的预测价值［J］.中国现代医学杂志，2020，30(13)：80-83.