A retrospective cohort study on the significance of preoperative radiological evaluation of lumbar degenerative diseases for surgical reference

Abstract

Background Radiography has low radiation exposure and the ability to acquire information. Due to its cost-effectiveness and availability, preoperative radiographic imaging examination is considered to be a valuable method to evaluate the condition of patients with spinal disease. The aim of this cohort study is to analyze the impact of evaluating preoperative X-rays on the surgical management of lumbar degenerative diseases (LDD). Methods We reviewed 49 patients with LDD underwent single-level posterior instrumented lumbar fusion (PILF) between November 2017 and October 2022 in this cohort study. The median iliac angle (MIA), iliac crest height, intervertebral facet joint degeneration, lumbosacral angle (LSA), L5/S1 intervertebral space angle (ISA), intervertebral foramen height (IFH) and intervertebral space height (ISH) were measured on preoperative radiographs. In addition, operative time, intraoperative blood loss and postoperative complications were used to evaluate the surgical management. Correlation analysis was used to determine the correlation between preoperative radiographic presentation and surgical managements. Multivariate linear regression analysis was used for determination of risk factors for surgical management. Results Correlation analysis showed that the median iliac angle, height of iliac crest, lumbosacral angle and intervertebral facet joint degeneration were significantly correlated with surgical managements (P<0.05). Height of iliac crest, intervertebral facet joint degeneration and lumbosacral angle were positively correlated with surgical management. Meanwhile, MIA was negatively correlated with surgical management. No significant difference was found between the IFH, ISA, ISH and surgical managements in posterior lumbar surgery (P>0.05). After multiple linear regression analysis, height of iliac crest, median iliac angle and intervertebral facet joint degeneration were independent influence factors for the single-level lumbar surgical managements. Conclusions Some variables measured in radiograph shows that height of iliac crest, median iliac angle and intervertebral facet joint degeneration have a potential influence on surgical managements. The lumbosacral angle was positively associated with surgical management, but it was not statistically significant in multiple linear regression analysis (P>0.05). The above measurements in plain film can reflect the surgical procedure and have some guiding implications for the operation.

Evaluation and analysis of surgical treatment for single-level or multi-level lumbar degenerative disease based on radiography

“…(I) Height of the iliac crest: on the anteroposterior radiograph of the lumbar spine, the height of the iliac crest was measured as the distance between the intercrestal line and the midpoint of the top of the sacral vertebral body ( 14 ) ( Figure 1 ). (II) MIA: this angle was determined by measuring the angle between the line connecting the highest point of the iliac crest and the posterior superior iliac spine, and the central sacral vertical line (CSVL) ( 15 ). The CSVL was defined as a straight line passing through the midpoint of the upper edge of S1 and perpendicular to the horizontal ground.…”

“…(IV) Intervertebral facet joint degeneration: this was defined as moderate to severe hyperplasia of the intervertebral joint, resulting in difficult in distinguishing between intervertebral facet joint gaps. A normal intervertebral facet joint was defined as a joint with no degeneration and in which the intervertebral facet joint gap could be distinguished ( 15 ) ( Figure 4 ). (V) LSA: this was defined as the angle formed along the superior endplate of S1 relative to the horizontal plane ( 20 ) ( Figure 3 ).…”