Relevant Research Between Morphological Changes Of Concave Intervertebral Foramina And Therapeutic Evaluation In Degenerative Lumbar Scoliosis Associated With Spinal Stenosis Patients Underwent OLIF Treatment

Objective(s):The symptoms of patients with degenerative lumbar scoliosis(DLS)are mostly caused by the narrowing of the spinal canal and nerve root canal caused by the narrowing of the intervertebral foramen.For the treatment of DLS with anterior oblique lateral approach lumbar interbody fusion(Oblique Lateral Interbody Fusion-OLIF),the evaluation of the decompression effect in the past is mostly based on changes in the diameter of the spinal canal or intervertebral foramen.In terms of effect,the Oswestry Disability Index(ODI)and Visual Analogue Scale-VAS were used for evaluation.However,the intervertebral foramen is a three-dimensional structure,and the diameter change of a single plane does not fully reflect the postoperative changes,and there has been little research on the correlation between each morphological change of the foramen and the treatment effect.This article studies the changes of the height,area and volume of the concave intervertebral foramina in these patients before and after surgery,combined with the changes in ODI and VAS scores of patients before and after surgery to discuss the symptoms of intervertebral foramina height,area and volume for patients Improved relevance.Methods:A systematic review of the X-rays,CT images,and clinical efficacy of patients diagnosed with degenerative scoliosis and undergoing OLIF surgery in the spine professional group of the Second Affiliated Hospital of Kunming Medical University from January 2017 to December 2018 analysis.Using the image processing software,the sagittal plane of the intervertebral foramen was used as the research plane on the CT image.The height and area of the intervertebral foramina of the surgical segment were measured and recorded.The original image was then reconstructed in three dimensions to measure and record the volume data.The ODI score,VAS score,and Cobb’s angle of the coronal plane were measured and recorded in all patients before and at the last follow-up.SPSS 22.0 software was used for statistical analysis.The analysis objects included:①Three indexes of intervertebral foramen:height(Foramen Height-FH),area(Foramen Area-FA),volume(Foramen Volume-FV),②preoperative and final Follow-up ODI score,VAS score,and Cobb’s angle of coronal plane.The measurement data is expressed as mean±standard deviation.continuous variables are tested by paired t test,and the test level a value is taken as 0.05 on both sides.Concave intervertebral foramen morphology improvement index height improvement(FH improvement-△FH),area improvement(FA improvement-△FA),volume improvement(FV improvement-△FV)and patient symptom improvement rate △ODI(ODI improvement),△VAS(VAS improvement)For multiple linear regression analysis,P<0.05 is considered statistically significant.Results:A total of 27 patients were included in the study,including 11 males and 16 females,aged 47-75 years,with an average age of(62.9±7.5)years.The follow-up time ranged from 12 to 30 months,with an average of(20.7±5.4)months.From preoperative to last follow-up,Cobb’s angle decreased from(23.9±5.9)° to(5.4±3.6)°,ODI score decreased from(68.2±11.6)%to(16.0±11.0)%,and VAS score was from(7.2±0.9)Points to(1.4±1.0)points.There were 36 segments in 27 patients,including 3 in L2-3 segment,15 in L3-4 segment,18 in L4-5 segment,18 in single segment surgery,and 9 in dual segment surgery.The average operation time of 18 patients with single-segment surgery was(134.5±23.9)min,and the average operation time of 9 patients with double-segment surgery was(197±23.6)min.After operation,1 case(3.7%)had shallow sensory loss on the left thigh,2 cases(7.4%)had skin temperature asymmetry on both legs,1 case had delirium mental symptoms(no previous history of mental illness),1 case had no abdominal viscera Device,vascular injury.and permanent nerve injury,the total complication rate of 27 patients was 14.8%.The concave side FH increased from(15.08±1.89)mm to(20.65±2.22)mm,FA increased from(109.68±12.12)mm2 to(156.85±15.57)mm2,and FV increased from(1.12±0.12)cm3 to(1.49±0.15)cm3,P<0.05,the differences were statistically significant.The concave side △FH,△FA,△FV were linearly positively correlated with △ODI(R2 linearity was 0.778,0.865,0.710)and △VAS(R2 linearity were 0.724,0.810,0.722),respectively,and △FA had the strongest correlation with patients symptom improvement,followed by △FH,and finally △FV(P<0.05).Conclusion(s):1.OLIF can significantly improve the symptoms of low back pain and lower limb pain in patients with degenerative scoliosis.Intervertebral foramen volume,area,height,etc.have been effectively improved,and the decompression effect is good.2.The concave side △FH,△FA,△FV were linearly positively correlated with△ODI,△VAS,respectively,and △FA had the strongest correlation with the patient’s symptom improvement rate,followed by △FH,and finally △FV.3.OLIF can solve some of the symptoms of intervertebral foramen stenosis,and when the intervertebral foramen area is more improved,the patient’s symptoms will be relieved to the greatest extent.