Abstract

Purpose

The global alignment and proportion (GAP) score was recently developed to consider proportional analysis of spinopelvic alignment and has been indicated for setting surgical goals to decrease the prevalence of mechanical complications. The goal of this study was to clarify the limitations and problems with spinal corrective surgery with minimally invasive lateral lumbar interbody fusion (LLIF) without osteotomy using GAP score, and to establish a preoperative radiographical evaluation to understand the necessity for three-column osteotomy.

Methods

We included data from 57 consecutive patients treated with spinal corrective surgery with LLIF and without Schwab grade 3–6 osteotomy for ASD. To evaluate flexibility of the pelvis and lumbar spine, we examined full-length lateral radiographs with patients standing and prone. Correlations between pre- and postoperative radiographic parameters and GAP score were determined.

Results

Most patients achieved a sufficiently ideal lumbar lordosis (87.7%), but ideal sacral slope (SS) was achieved in only 50.8% of patients. Preoperative prone SS showed a significant positive correlation with postoperative SS and a significant negative correlation with GAP score. Patients whose preoperative prone SS was larger than pelvic incidence × 0.59–7.5 tended to achieve proportioned spinopelvic alignment by using LLIF.

Conclusions

The cause of poor outcome of GAP score for ASD corrective surgery with LLIF without osteotomy is a postoperative small SS. Preoperative prone SS is useful for predicting postoperative SS. When preoperative SS in prone patients is relatively small to ideal as calculated using PI, osteotomy or other correctors should be considered to achieve satisfactory spinopelvic parameters.

Level of evidence

III.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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成人脊柱畸形的微创外侧腰椎椎间融合术的适应症和局限性。

摘要

目的

全球对准和比例（GAP）评分是最近开发的，用于考虑脊椎骨盆对准的比例分析，并已被指定用于设定手术目标以降低机械并发症的患病率。这项研究的目的是通过使用GAP评分来明确采用无创截骨术的微创外侧腰椎椎间融合术（LLIF）进行的脊柱矫正手术的局限性和问题，并建立术前放射影像学评估以了解三柱截骨术的必要性。

方法

我们纳入了来自57例接受LLIF且无施瓦布3-6级ASD截骨术的脊柱矫正手术患者的数据。为了评估骨盆和腰椎的柔韧性，我们检查了站立和俯卧患者的全身侧位X线照片。确定了术前和术后影像学参数与GAP评分之间的相关性。

结果

大多数患者达到了足够理想的腰椎前凸（87.7％），但只有50.8％的患者达到了理想的ac骨坡度（SS）。术前俯卧撑与术后SS呈显着正相关，与GAP评分呈显着负相关。术前俯卧SS大于盆腔发生率×0.59–7.5的患者倾向于通过LLIF来实现成比例的脊柱盆腔对齐。

结论

没有截骨的LLIF进行ASD矫正手术的GAP评分结果差的原因是术后小SS。术前俯卧撑可用于预测术后SS。如使用PI计算，当俯卧患者的术前SS相对较小至理想水平时，应考虑截骨术或其他矫正器以获得满意的脊柱盂参数。

证据水平

三，

图形摘要

这些幻灯片可以在电子补充材料下找到。