The Relationship Between Spinal-Pelvic Sagittal Parameters and Persistent Low Back Pain After Degenerative Lumbar Disease Surgery
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,JO A score,LL and SS were lower than those in non-low back pain group,and △VAS,△JOA,△LL,△PI,△PT and △SS were lower than those in non-low back pain group(all P＜0.05).In DLD patients,△LL,△PT,△SS were positively correlated with △VAS and △JOA(P＜0.05),while △PI was not significantly correlated with △VAS and △JOA(P＞0.05).Osteoporosis,intraoperative bone endplate injury,△LL,△PT,△SS were the influencing factors of postoperative persistent low back pain in DLD patients(P＜0.05).The area under the curve(AUC)of △LL,△PT and △SS 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 △LL,△PT and △SS,the AUC(0.939)of △LL,△PT and △SS 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.
lumbar degenerative diseasespersistent low back painspinal and pelvic sagittal sequence parameterscorrelation analysisforecast
万方数据
维普
