| Degenerative lumbar scoliosis(DLS)is the three-dimensional deformity of skeletal mature individuals,and spinal pelvic parameters are the focus of its research,and pelvic incidence Angle(PI)minus lumbar lordosis Angle(LL)(PI-LL)is one of the very important parameters.Paravertebral muscle(PVMs)is strongly associated with spinal deformities and health-related quality of life(HRQOL).The paravertebral muscle is receiving increasing attention as a promising target for optimizing spinal health-related quality of life in patients with and without LBP.However,a direct relationship between PI-LL and PVMs has not been reported,and few published reports have investigated the correlation between PVMs degeneration and quality of life in DLS.Posterior decompression and internal fixation are considered to be the most common surgical method for degenerative lumbar scoliosis.Screw loosening is one of the common complications of pedicle screw fixation.While previous reports have alerted spinal surgeons to the problem of screw loosening after surgery,few have described specific risk factors to consider.The research paper will be elaborated from three parts.The first part mainly discusses the characteristics of PVMs in the PI-LL match group and the mismatch group in DLS through imaging parameters,and discusses and determines the risk factors of PI-LL mismatch.In the second part,the correlation between paravertebral muscle degeneration and quality of life in patients with degenerative lumbar scoliosis was analyzed by VAS score,pain duration and ODI.The third part is to investigate the incidence and possible risk factors of distal pedicle screw(DPSL)after posterior decompression and internal fixation fusion with DLS,in order to provide reference for decision making and surgical planning of spinal surgeons.Part One Characteristics of Paravertebral Muscles in Degenerative lumbar scoliosis with PI-LL Match or Mismatch and risk factors of PI-LL MismatchObjective: PI-LL correlates with function and disability,and is associated with PVMs degeneration and is a valuable tool for surgical planning of DLS.The study was to explore the characteristics of PVMs in DLS with PI-LL match or mismatch and to identify the risk factors for PI-LL mismatch.Methods: 67 patients with DLS were divided into PI-LL match and mismatch group.VAS,Symptom duration and ODI were used to assess patient’s clinical symptom and quality of life.Percentage of fat infiltration area(FIA%)of multifidus at L1～S1 disc level was measured by MRI,using Image-J software.SVA,LL,PT,PI,SS,asymmetric and average degeneration degree of multifidus were recorded.Logistic regression analysis was to identify the risk factors of PI-LL mismatch.Results: In PI-LL match and mismatch group,average FIA% of multifidus on convex side was less than on concave side(P<0.05).There was no statistical difference of asymmetric degeneration degree of multifidus between the two groups(P>0.05).In PI-LL mismatch group,average degeneration degree of multifidus,VAS,symptom duration and ODI were significantly higher than PI-LL match group respectively(32.22±6.98vs26.28±6.23(%),4.33±1.60vs3.52±1.46,10.81±4.83vs6.58±4.23(month),21.06±12.58vs12.97±6.49,P<0.05).The average degeneration degree of multifidus muscle was positively correlated with VAS,symptom duration and ODI respectively(r=0.515,0.614,and 0.548,P<0.05).Sagittal plane balance,LL,PT and average degeneration degree of multifidus were the risk factors of PI-LL mismatch(OR:15.447,95%CI:1.274～187.269;OR:0.001,95%CI:0.000～0.099;OR:107.540,95%CI:5.195～2 2 2 5.9 7 5;O R : 5 2.5 3 1,9 5 % C I : 3 4 1.7 9 7 ～ 1 5 3 5.5 5 1,P < 0.0 5).Conclusions: PVMs on concave side was larger than on convex side in DLS whether PI-LL was match or not.PI-LL mismatch could aggravate the average degree of degeneration of the paraverteinal muscle that was an important reason for pain and disability in DLS.Sagittal plane imbalance,decreased LL,higher PT and larger average degeneration degree of multifidus were independent risk factors of PI-LL mismatch.Part Two The study of correlation between paravertebral muscle degeneration and quality of life in degenerative lumbar scoliosisObjective: The aim of this study was to investigate the mechanism by which degenerative lumbar scoliosis(DLS)leads to lower back pain(LBP)and lower back dysfunction,which seriously affect quality of life in patients with DLS.Methods: According to visual analog scale(VAS),67 patients with DLS were divided into mild pain group and moderate to severe pain group,pain symptom duration was divided into acute pain group,subacute pain group and chronic pain group,and lower back Oswestry Disability index score(ODI)was divided into mild and moderate to severe dysfunction group.percent of fat infiltration area(FIA%)of the multifidus muscle infiltration area at the intervertebral disc level of L1-S1 was measured by Image-J software,and the asymmetry and average degree of degeneration of the multifidus muscle were recorded.Statistical methods were used to analyze the differences in asymmetry degree and mean degree of multifidus muscle degeneration and the correlation between asymmetry degree and mean degree of multifidus muscle degeneration and VAS score,duration of pain symptoms and ODI.Results: 1.The asymmetry degree of paravertebral muscle degeneration in degenerative lumbar scoliosis was not significantly correlated with the degree of pain,but was correlated with the average degree of paravertebral muscle degeneration.The average degree of paravertebral muscle degeneration in moderate to severe pain group was significantly greater than that in mild pain group.2.The asymmetry degree of paravertebral muscle degeneration in chronic pain was significantly greater than that in acute pain group and subacute pain group(P<0.05),and the average degree of paravertebral muscle degeneration was positively correlated with pain duration(P<0.05),that is,chronic pain group > subacute pain group > acute pain group;3.The asymmetry degree of paravertebral muscle degeneration in degenerative lumbar scoliosis was not significantly correlated with the severity of lumbar dysfunction,but was significantly correlated with thea verage degree of paravertebral muscle degeneration.The average degree of paravertebral muscle degeneration in moderate to severe dysfunction group was significantly greater than that in mild dysfunction group.Conclusions: The average degree of paravertebral muscle degeneration in patients with degenerative lumbar scoliosis is positively correlated with the degree of lumbar pain,the duration of pain symptoms,and lumbar dysfunction,which is an important imaging indicator to evaluate the quality of life of degenerative lumbar scoliosis.Part Three Risk factors of distal pedicle screw loosening followed posterior corrective surgery for degenerative lumbar scoliosisObjective: To explore incidence and risk factors for distal pedicle screw loosening(DPSL)followed posterior corrective surgery for degenerative lumbar scoliosis(DLS).Methods: The diagnostic criteria for DPSL developed by X-ray including radiolucent area around screw and “double halo” sign.According to occurrence of DPSL at least one-year follow-up,153 patients were divided into two groups: study group(screw loosening)and control group(without screw loosening).To investigate risk factors for DPSL,three categorized factors including general data,surgical data and radiological data were analyzed statistically.Results: DPSL was detected in 72 patients at least one-year follow up(study group).Hounsfield unit(HU)value was lower in study group than that in control group.Fusion level was longer in study group than that in control group.Lower instrumented vertebrae on L5 was less in study group than that in control group.Preoperative Cobb angle,postoperative Cobb angle,Cobb angle correction,preoperative lumbosacral coronal angle(LSCA),LSCA correction,preoperative thoracolumbar junction(TL),postoperative TL were larger in study group than those in control group.Logistic regression analysis revealed that low Bone mineral density(BMD)(<169 HU),Cobb angle correction(>16 degrees),LSCA correction(>9 degrees)were independently associated with DPSL.Conclusions: The incidence of DPSL following posterior decompression and instrumented fusion for DLS is 47.1%.Low BMD,large correction of both main curve and fractional curve are risk factors for DPSL. |
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