The study design is case–control. To evaluate the impact of preoperative coronal patterns based on the relationship between orientation of L4 coronal tilt and C7 plumb line on immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients. Although lumbosacral fractional curve has been long stressed in correction surgery of DLS, there is paucity of literature focusing on preoperative coronal pattern based on the relationship between orientation of L4 coronal tilt and C7 plumb line and its impact on immediate postoperative coronal imbalance in DLS patients. A consecutive series of DLS patients who underwent deformity correction surgery via posterior-only approach were reviewed. According to the relationship between orientation of L4 coronal tilt and C7 plumb line preoperatively, a total of 77 DLS patients who underwent posterior spinal corrective surgery were classified into: 1. Coronal consistency pattern, L4 coronally tilts toward C7 plumb line; 2. Coronal opposition pattern, L4 coronally tilts opposite C7 plumb line. Coronal imbalance was defined as global coronal malalignment (GCM) on either side more than or equal to 20 mm. Whole-spine standing radiographs of both pattern groups were assessed preoperatively and postoperatively. There were 37 patients with coronal consistency pattern and 40 patients with coronal opposition pattern. Compared to patients with coronal opposition pattern, patients with coronal consistency pattern had significantly higher postoperative GCM (P = 0.028), lower amount of GCM correction (P = 0.013) and higher incidence of postoperative coronal imbalance (P = 0.001); further logistic regression analysis revealed coronal consistency pattern was associated with increased odds of postoperative coronal imbalance (odds ratio: 5.981; 95% confidence interval 2.029–17.633; P = 0.001). DLS patients with preoperative coronal consistency pattern carried greater risk for immediate postoperative coronal imbalance following posterior long correction surgery.

Level of evidence 3

研究设计是病例对照。基于 L4 冠状倾斜方向和 C7 铅垂线之间的关系评估术前冠状模式对退行性腰椎侧弯 (DLS) 患者术后即刻冠状失衡的影响。尽管长期以来在DLS的矫正手术中一直强调腰骶分数曲线，但缺乏基于L4冠状倾斜方向和C7铅垂线之间关系的术前冠状图案及其对DLS患者术后即刻冠状失衡的影响的文献。回顾了一系列通过仅后路入路接受畸形矫正手术的连续 DLS 患者。根据术前L4冠状倾斜方向与C7铅垂线的关系，77例行后路脊柱矫正手术的DLS患者分为：1.冠状一致性模式，L4冠状向C7铅垂线倾斜；2. 冠状对冲，L4 冠状与 C7 铅垂线相反。冠状不平衡被定义为任一侧的全局冠状排列不正 (GCM) 大于或等于 20 毫米。术前和术后评估两个模式组的全脊柱站立位 X 光片。冠状面一致型37例，冠状对合型40例。与冠状对合型患者相比，冠状一致型患者术后 GCM 显着升高。冠状对冲模式，L4 冠状倾斜与 C7 铅垂线相反。冠状不平衡被定义为任一侧的全局冠状排列不正 (GCM) 大于或等于 20 毫米。术前和术后评估两个模式组的全脊柱站立位 X 光片。冠状面一致型37例，冠状对合型40例。与冠状对合型患者相比，冠状一致型患者术后 GCM 显着升高。冠状对冲模式，L4 冠状倾斜与 C7 铅垂线相反。冠状不平衡被定义为任一侧的全局冠状排列不正 (GCM) 大于或等于 20 毫米。术前和术后评估两个模式组的全脊柱站立位 X 光片。冠状面一致型37例，冠状对合型40例。与冠状对合型患者相比，冠状一致型患者术后 GCM 显着升高。冠状面一致型37例，冠状对合型40例。与冠状对合型患者相比，冠状一致型患者术后 GCM 显着升高。冠状面一致型37例，冠状对合型40例。与冠状对合型患者相比，冠状一致型患者术后 GCM 显着升高。P  = 0.028），GCM 矫正量较低（P  = 0.013），术后冠状不平衡发生率较高（P  = 0.001）；进一步的逻辑回归分析显示冠状一致性模式与术后冠状不平衡的几率增加有关（几率比：5.981；95% 置信区间 2.029–17.633；P  = 0.001）。具有术前冠状一致性模式的 DLS 患者在后路长期矫正手术后立即出现术后冠状不平衡的风险更大。

证据等级3