Objective To evaluate the significance of the lumbar bowstring ratio(LBR)and sagittal spine-pelvis parame-ters in predicting postoperative neurogenic pain in adult patients with high-grade lumbar isthmic spondylolisthesis following spinal fusion surgery.Methods A retrospective analysis was conducted on the clinical and imaging data of 95 adult patients with high-grade lumbar isthmic spondylolisthesis treated by spinal surgery at Xiangya Hospital of Central South University from August 2012 to January 2023.Each patient was followed for a minimum of six months.Participants were categorized into pain and non-pain groups based on the presence of persistent radicular pain(≥8 weeks)and a visual analogue scale(VAS)score of ≥3 postoper-atively.The pain group comprised 15 patients(5 males,10 females;mean age 55.47±6.42 years,range 46-71 years),while the non-pain group included 80 patients(20 males,60 females;mean age 60.98±11.50 years,range 40-85 years).Clinical outcomes were assessed using the Oswestry Disability Index(ODI)and VAS scores.LBR was defined as the ratio of the vertical distance from the anterior convexity of the L1-L5 anterior longitudinal ligament to a line connecting the posterior superior margin of the L1 vertebra and the posterior margin of the S1 vertebra,to the distance between these two points.Spinal-pelvic parameters measured included pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),PT/SS ratio,and changes in LBR before and after sur-gery(ΔLBR).Statistical comparisons of demographic and imaging parameters were performed between the two groups,and vari-ables showing significant differences were subjected to binary logistic regression analysis to identify independent risk factors for postoperative neurogenic pain.Results All 95 patients achieved complete anatomical reduction of the dislocation without re-ported wound infections.Follow-up was completed at 7.68±2.98 months(range 6-12 months)postoperatively.Among the pa-tients,15 developed iatrogenic radicular pain.Postoperative complications included pulmonary infection(4 cases:1 in the pain group,3 in the non-pain group),cerebrospinal fluid leakage(8 cases:2 in the pain group,6 in the non-pain group),and deliri-um(5 cases:2 in the pain group,3 in the non-pain group).No significant differences were observed in demographic data be-tween the groups(P＞0.05).Both groups demonstrated significant improvements in ODI(pain group Z=-3.413,P=0.001;non-pain group Z=-7.772,P＜0.001)and VAS scores(pain group Z=-3.426,P=0.001;non-pain group Z=-7.838,P＜0.001)at the 6-month follow-up compared to preoperative values.Significant differences were found between the pain and non-pain groups in PI(t=3.315,P=0.004),PT(t=5.087,P＜0.001),SS(t=7.431,P＜0.001),LL(t=3.764,P＜0.001),PT/SS(t=7.267,P＜0.001),LBR(t=6.455,P＜0.001),and ΔLBR(Z=5.362,P＜0.001)before and after surgery.Binary logistic regression analysis identified smaller preoperative PT/SS[OR=0.760,95％CI(0.601,0.961),P=0.022]and larger preoperative LBR[0R=5.721,95％CI(1.068,30.634),P=0.042]as independent risk factors for postoperative neurogenic pain.Conclusion High LBR and reduced PT/SS are significant risk factors for neurogenic pain following complete discectomy and fusion in adult patients with high-grade lumbar isthmic spondylolisthesis.For such patients,careful consideration is warranted regarding anatomical complete reduction during surgical intervention.
关键词
腰椎/脊椎滑脱/脊柱融合术/手术后并发症/复位/脊柱-骨盆矢状面参数
Key words
Lumbar vertebrae/Spondylolysis/Spinal fusion/Postoperative complications/Resetting/Sagittal parameters of the spine-pelvis
维普
万方数据