Surgery is a common way to treat degenerative lumbar spondylolisthesis, but some patients have poor postoperative health and quality of life. The relationship between preoperative spine pelvic parameters and postoperative healthy quality of life is not clear.
To investigate the preoperative predictors of postoperative poor improvement in healthy life quality for patients with degenerative lumbar spondylolisthesis based on spinopelvic parameters.
METHODS: A retrospective analysis was performed on 186 patients with degenerative lumbar spondylolisthesis who met the criteria and underwent posterior lumbar interbody fusion surgery from June 2014 to September 2017, including 87 males and 99 females. (1) All patients were examined by the whole spine X-ray films in a standing position and sagittal spinopelvic parameters were measured, including pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, L4 slope, L5 slope, and sagittal vertical axis. (2) At the last postoperative follow-up, SF-36 was used to evaluate the healthy life quality of the patients, and the patients were divided into good group and poor group according to this score. The basic data and spinopelvic parameters of the two groups were compared and the preoperative predictors of poor quality of life were analyzed by Logistic regression and receiver operating characteristic curve analysis.
RESULTS AND CONCLUSION: (1) All cases were followed up for 20 to 26 months, with an average of 24 months. (2) There were 127 cases in the good group and 59 cases in the poor group, with poor improvement in quality of life accounting for 32%. Group comparison revealed that sacral slope, lumbar lordosis, pelvic tilt, and sagittal vertical axis were larger in the poor group than in the good group (P < 0.05). There was no significant difference in sacral slope, L4 slope, L5 slope, and thoracic kyphosis between the two groups (P > 0.05). (3) Logistic regression analysis identified three preoperative predictors: pelvic incidence (P < 0.001), pelvic tilt (P < 0.001) and sagittal vertical axis (P=0.026). (4) Receiver operating characteristic curve analysis showed that pelvic incidence > 52.18°, pelvic tilt > 25.23°, and sagittal vertical axis > 3.84 cm were risk factors for poor improvement in quality of life in postoperative patients, and the AUC value of pelvic tilt (0.944) was the largest. Sufficient attention should be paid to patients with preoperative risk factors.