Journal of pediatric orthopedics · 2025
A Normal PI-LL Relationship is Associated With Pain Improvement Following Posterior Spinal Fusion for Scheuermann Kyphosis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Fano Adam N, Matsumoto Hiroko, Weintraub Matthew J, Herman Elizabeth T, Rymond Christina, Roye Benjamin D, Boby Afrain Z, Newton Peter O, Fields Michael W, Lenke Lawrence G, Lonner Baron S, Vitale Michael G
Аннотация
BACKGROUND: Pelvic incidence-lumbar lordosis (PI-LL) mismatch is a validated marker of sagittal balance that correlates with pain and HRQoL in adult spinal deformity. The purpose of this study was to investigate whether there is an association between a normal postoperative pelvic incidence-lumbar lordosis (PI-LL) relationship and pain improvement at 2 years following PSF for SK.
METHODS: SK patients who underwent PSF and reached 2 years postoperative were identified in a multicenter registry. Patients with anterior release, prior spine surgery, neuromuscular comorbidity, or posttraumatic/postlaminectomy kyphosis were excluded. A normal PI-LL relationship (<10° difference; either correction of mismatch OR maintenance of normal) was determined at 2 years. Improvement in pain was defined as a 2-year postoperative increase in SRS-22 pain score of more than or equal to the minimal clinically important difference.
RESULTS: Of the 91 patients who were eligible, 50 (16.2±1.6 y/o, 68% male) had radiographic and health-related quality of life (HRQoL) data available for analysis. Preoperative and 2-year postoperative major kyphosis were 74±11° and 48±9°, respectively. The average pain score was 3.9 [interquartile range (IQR): 3.4 to 4.4] at preoperative and 4.4 (IQR: 4.0 to 5.0) at 2-year postoperative ( P =0.002). Only 4 (8%) patients had normal PI-LL at preoperative, increasing to 19 (38%) patients at 2 years postoperative. In those with normal postoperative PI-LL, 68% (N=13) had improvement in pain, compared with 42% (N=13) in those with PI-LL mismatch ( P =0.069). Patients with normal postoperative PI-LL had an increased likelihood of pain improvement by 1.63 (95% CI=0.98, 2.73) times when compared with those with PI-LL mismatch ( P =0.062).
CONCLUSION: Improvements are observed in both PI-LL measures and pain scores following PSF for SK at 2 years postoperatively. Patients with normal PI-LL postoperatively (corrected or maintained) had an increased likelihood of pain improvement.
LEVEL OF EVIDENCE: Level III-retrospective case-control study.
METHODS: SK patients who underwent PSF and reached 2 years postoperative were identified in a multicenter registry. Patients with anterior release, prior spine surgery, neuromuscular comorbidity, or posttraumatic/postlaminectomy kyphosis were excluded. A normal PI-LL relationship (<10° difference; either correction of mismatch OR maintenance of normal) was determined at 2 years. Improvement in pain was defined as a 2-year postoperative increase in SRS-22 pain score of more than or equal to the minimal clinically important difference.
RESULTS: Of the 91 patients who were eligible, 50 (16.2±1.6 y/o, 68% male) had radiographic and health-related quality of life (HRQoL) data available for analysis. Preoperative and 2-year postoperative major kyphosis were 74±11° and 48±9°, respectively. The average pain score was 3.9 [interquartile range (IQR): 3.4 to 4.4] at preoperative and 4.4 (IQR: 4.0 to 5.0) at 2-year postoperative ( P =0.002). Only 4 (8%) patients had normal PI-LL at preoperative, increasing to 19 (38%) patients at 2 years postoperative. In those with normal postoperative PI-LL, 68% (N=13) had improvement in pain, compared with 42% (N=13) in those with PI-LL mismatch ( P =0.069). Patients with normal postoperative PI-LL had an increased likelihood of pain improvement by 1.63 (95% CI=0.98, 2.73) times when compared with those with PI-LL mismatch ( P =0.062).
CONCLUSION: Improvements are observed in both PI-LL measures and pain scores following PSF for SK at 2 years postoperatively. Patients with normal PI-LL postoperatively (corrected or maintained) had an increased likelihood of pain improvement.
LEVEL OF EVIDENCE: Level III-retrospective case-control study.