Effect Of PLIF On Spinal-Pelvic Sagittal Position Parameters And Correlation Of Clinical Efficacy In The Treatment Of Lumbar Spondylolisthesis

Objective: By comparing the spinal-pelvic sagittal position parameters of patients with lumbar spondylolisthesis treated by PILF(posterior decompression interbody bone fusion)before and after surgery,to explore the variation rule and characteristics of each parameter,to clarify the influence of each parameter change on postoperative clinical efficacy,and to draw relevant conclusions,so as to provide certain reference for clinicians to treat lumbar spondylolisthesis by PLIF surgery.Methods: Patients who underwent PLIF surgery for lumbar spondylolisthesis in the Second Affiliated Hospital of Inner Mongolia Medical University from September 2020 to October2022 were retrospectively included.Anteroposterior and lateral lumbar radiographs withclear bilateral femoral heads were taken before and at the last follow-up,and spinal-pelvic sagittal position parameters were measured.The measurement parameters include:pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),matching degree of pelvic incidence angle and lumbar lordosis angle(PI-LL),lumbosacral angle(LSA),L5 incidence(L5I),Degree of silp(SD),disc height(DH),etc.Health-related quality of life(HRQo L)was evaluated before and at the last follow-up of the included patients,including:Oswestry disability index(ODI),Visual Analgue Scale/Scre(VAS)and Scoliosis Research Society patient Intelligent-22(SRS-22),all scales were explained to patients by the same physician and the scores were calculated,and patients or their families helped to fill in the questionnaire truthfully.Paired sample t test was used to conduct statistical analysis of the spine-pelvis parameters and HRQo L during the preoperative and last follow-up.Pearson test was used to conduct statistical analysis of the correlation between the changes of each parameter and the changes of HRQo L during the preoperative and last follow-up,and the spine-pelvis parameters affecting HRQo L were screened out.Make a scatter plot to analyze its influence trend.Results: A total of 32 patients(15 males and 17 females)with lumbar spondylolisthesis were included in this study.The patients were 64.0±5.8 years old,163.8±6.3cm in height,66.4±5.6kg in weight,and 18.6±2.0 months in postoperative follow-up.At the last follow-up,PT,PI-LL,LSA,L5 I,SD and DH values were significantly decreased compared with those before surgery(P<0.01),SS and LL values were significantly increased compared with those before surgery(P<0.01),and PI values had no significant difference before and after surgery(P>0.05).The ODI index,VAS score and SRS-22 score at the last follow-up were significantly different from those before surgery(P<0.01).Among the parameters of sagittal plane between spine and pelvis,PT was closely correlated with PI and SS(P<0.01),Pi-LL was correlated with LL(P<0.05),L5 I was correlated with PT,LL and PI-LL(P<0.05),SD was correlated with PT and L5I(P<0.05).VAS score and SRS-22 score were correlated with PT and DH(P<0.05),ODI index was correlated with SS and SD,PT and SRS-22 score,SS and ODI index,DH and VAS score were negatively correlated,PT and VAS score,SD and ODI index,DH and SRS-22 score were positively correlated.Conclusion:1.PLIF can effectively reconstruct sagittal lumbar balance in patients with lumbar spondylolisthesis,and can also correct spinal-pelvic sagittal parameters.2.Spinal-pelvic sagittal position parameters are closely related to HRQo L in patients with lumbar spondylolisthesis,and correction of PT,SD and DH during surgery can effectively improve patients’ postoperative quality of life.