Comparison Of Curative Effects Of ACR,PSO And SPO In The Treatment Of Lumbar Sagittal Imbalance

Objective: To compare and analyze the therapeutic effects of different surgical procedures in patients with lumbar sagittal imbalance,in order to clarify ACR(anterior column reconstruction)(L2-L5 segment OLIF and cut off the anterior longitudinal ligament and L5/S1 segment ALIF.The oblique lateral approach is not suitable for L5/S1 segment because the position of iliac crest hinders the transverse access,so as to provide some reference for improving the clinical treatment level.Methods: In this study,20 patients underwent ACR surgery in the Second Affiliated Hospital of Dalian Medical University from October 2021 to October 2022,18 patients underwent pso surgery and 18 patients underwent spo surgery from January 2017 to October 2022,and relevant clinical data were collected.According to the case-control analysis,the curative effects of ACR,PSO and SPO on patients with lumbar sagittal imbalance were compared,in order to better treat lumbar sagittal imbalance.The perioperative indexes of various surgical procedures were compared,including intraoperative blood loss,operation time,postoperative time and average hospitalization days.Efficacy indicators: preoperative and postoperative functional scores: dysfunction index(ODI),visual analogue scale,VAS)for back pain and leg pain.Imaging indexes:sacral slope(SS),lumbar lordosis(LL),disc angle(DA),pelvic index(PI)and sagittal vertical axis(SVA)were measured on X-ray films before and after operation: the central vertical line of C7 vertebral body and the back of sacrum.CT reconstruction was reviewed half a year after operation,and the fusion standard was continuous trabecular passage.All the data were statistically analyzed by SPSS22.0 software,and the measurement data were expressed by(S).The indicators that obey the normal distribution were compared by one-way analysis of variance,and the indicators that do not obey the normal distribution were compared by Kruskal-Wallis test.Classification variables were expressed by frequency and percentage,and chi-square test was used for comparison between groups.The analysis of variance of repeated measurement was used to compare the repeated measurement data between groups.P < 0.05 is statistically significant.Results: Perioperative indicators There was no significant difference in perioperative indexes between spo,pso and ACR groups(P>0.05).Compared with pso group,ACR and spo group had less intraoperative bleeding,shorter hospitalization time and shorter postoperative time(P<0.01).However,the operation time of ACR and pso group was longer than that of spo group(P<0.01).Efficacy indicators After operation,the pain score and dysfunction score of the three groups decreased compared with those before operation,with statistical difference(P<0.01).In the short-term follow-up of postoperative ODI(within 3 months),the reduction of ODI in ACR and pso patients was greater than that in spo patients,with statistical significance(P<0.05).In the long-term follow-up of ODI after operation(more than 6 months),the score of ACR group was significantly lower than that of pso and spo group(P<0.05).Although spo group was lower than that of pso group,there was no significant difference between the two groups(P>0.05).There was no statistical difference in VAS(leg pain)scores among the three groups during postoperative follow-up(P>0.05).In the short-term and long-term follow-up of postoperative VAS(back pain),compared with pso and spo patients,ACR patients have a greater relief(P<0.05).Imaging indicators There was no significant difference in preoperative LL,SS,PT and PI among the three groups(P>0.05),and PI was constant.For LL,SS and PT,there were significant differences between acr,pso and spo after operation(P<0.05).(Table 3)In terms of fusion,the fusion rates of ACR group,pso group and spo group were 95.7%,97.1% and 94.7%,respectively.The fusion rates of the three groups were similar,with no statistical difference(P>0.05).Conclusion: Anterior column reconstruction ACR(anterior longitudinal ligament release,discectomy and intervertebral fusion cage implantation)through lateral approach of psoas major muscle is becoming more and more mature.There are many advantages in the treatment of lumbar sagittal imbalance by this operation,which are mainly reflected in the following aspects:(1)Using the working channel to reach the intervertebral disc directly through the peritoneum,which reduces the complications such as adhesion injury and vascular injury in the abdominal cavity;(2)The operation area is in front of the spinal canal,which can reduce the interference to the nerves in the spinal canal,avoid the injury to the venous plexus in the spinal canal,and obviously reduce the intraoperative bleeding;(3)It does not damage the posterior ligament complex and the back muscles during the operation,which plays an important role in maintaining the stability of the lumbar spine and alleviating postoperative back pain;(4)The intervertebral cage with larger area can obviously increase the height of intervertebral space and the balance of coronal and sagittal position;(5)Minimal trauma,less bleeding,quick recovery,shortened hospitalization time and patients’ recovery time.