Impact of sagittal spinopelvic alignment on clinical outcomes and health-related quality of life after decompression surgery without fusion for lumbar spinal stenosis

Restricted access


Patients with lumbar spinal stenosis (LSS) tend to bend forward to relieve neurological symptoms. They therefore have a positive sagittal vertical axis (SVA). The importance of the SVA value is well known in the field of adult spinal deformity; however, little is known about its impact on LSS. The authors sought to investigate the impact of sagittal spinopelvic alignment on clinical outcome and health-related quality of life (HRQOL) after decompression surgery for LSS.


The authors retrospectively reviewed 83 patients who underwent lumbar decompression without fusion between January 2014 and September 2015 with a minimum follow-up of 2 years. Standing whole-spine radiographs were examined preoperatively and at final follow-up. Based on the SVA, patients were allocated to a sagittal balance group (group B; SVA < 50 mm) or a sagittal imbalance group (group I; SVA ≥ 50 mm). The authors compared the groups using Japanese Orthopaedic Association (JOA), Zurich Claudication Questionnaire (ZCQ), Roland-Morris Disability Questionnaire (RMDQ), and the 8-item Short Form Health Survey (SF-8) scores.


Preoperative groups B (group pre-B) and I (group pre-I) included 58 and 25 patients, respectively. Preoperative sagittal malalignment had negative effects on the JOA score recovery rate, postoperative ZCQ physical function domain score, and numeric rating scale (NRS) score of postoperative low-back pain (LBP), but no significant effects were observed for RMDQ and SF-8 domain scores. Postoperatively, groups B (group post-B) and I (group post-I) included 60 and 23 patients, respectively. Group post-I had a significantly worse JOA score recovery rate, postoperative symptom severity domain score in the ZCQ, and NRS score for postoperative LBP. Similarly, the postoperative RMDQ score and the Physical Component Summary score of the SF-8 were significantly worse in group post-I.


Positive SVA had significantly negative effects on clinical outcome and HRQOL in LSS patients after lumbar decompression surgery.

ABBREVIATIONS ASA = American Society of Anesthesiologists; ASD = adult spinal deformity; EBL = estimated blood loss; HRQOL = health-related quality of life; JOA = Japanese Orthopaedic Association; LBP = low-back pain; LL = lumbar lordosis; LSS = lumbar spinal stenosis; MCS = Mental Component Summary; NRS = numeric rating scale; PCS = Physical Component Summary; PI = pelvic incidence; PI-LL = PI − LL mismatch; post-B = postoperative sagittal balance; post-I = postoperative sagittal imbalance; pre-B = preoperative sagittal balance; pre-I = preoperative sagittal imbalance; PT = pelvic tilt; RMDQ = Roland-Morris Disability Questionnaire; SF-8 = 8-item Short Form Health Survey; SVA = sagittal vertical axis; ZCQ = Zurich Claudication Questionnaire.

Article Information

Correspondence Yoji Ogura: Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.

INCLUDE WHEN CITING Published online January 25, 2019; DOI: 10.3171/2018.10.SPINE181094.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Flowchart of the study representing groups and numbers of patients. Eighty-three patients with lumbar spinal stenosis were allocated into 2 groups based on preoperative or postoperative SVA.


  • 1

    Ames CPSmith JSScheer JKBess SBederman SSDeviren V: Impact of spinopelvic alignment on decision making in deformity surgery in adults: a review. J Neurosurg Spine 16:5475642012

  • 2

    Chiba KToyama YMatsumoto MMaruiwa HWatanabe MNishizawa T: Intraspinal cyst communicating with the intervertebral disc in the lumbar spine: discal cyst. Spine (Phila Pa 1976) 26:211221182001

  • 3

    Dohzono SToyoda HMatsumoto TSuzuki ATerai HNakamura H: The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis. J Neurosurg Spine 23:49542015

  • 4

    Dohzono SToyoda HTakahashi SMatsumoto TSuzuki ATerai H: Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis. J Neurosurg Spine 25:39452016

  • 5

    Endo KSuzuki HTanaka HKang YYamamoto K: Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J 19:4354382010

  • 6

    Fujii KKawamura NIkegami MNiitsuma GKunogi J: Radiological improvements in global sagittal alignment after lumbar decompression without fusion. Spine (Phila Pa 1976) 40:7037092015

  • 7

    Glassman SDBridwell KDimar JRHorton WBerven SSchwab F: The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:202420292005

  • 8

    Hikata TWatanabe KFujita NIwanami AHosogane NIshii K: Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance. J Neurosurg Spine 23:4514582015

  • 9

    Lafage VSchwab FPatel AHawkinson NFarcy JP: Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599E6062009

  • 10

    Roland MMorris R: A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 8:1451501983

  • 11

    Schwab FUngar BBlondel BBuchowski JCoe JDeinlein D: Scoliosis Research Society—Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37:107710822012

  • 12

    Schwab FJBlondel BBess SHostin RShaffrey CISmith JS: Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803E8122013

  • 13

    Stucki GDaltroy LLiang MHLipson SJFossel AHKatz JN: Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976) 21:7968031996

  • 14

    Suzuki HEndo KKobayashi HTanaka HYamamoto K: Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication. Spine (Phila Pa 1976) 35:E344E3462010

  • 15

    Turner-Bowker DMBayliss MSWare JE JrKosinski M: Usefulness of the SF-8 Health Survey for comparing the impact of migraine and other conditions. Qual Life Res 12:100310122003

  • 16

    Watanabe KMatsumoto MIkegami TNishiwaki YTsuji TIshii K: Reduced postoperative wound pain after lumbar spinous process-splitting laminectomy for lumbar canal stenosis: a randomized controlled study. J Neurosurg Spine 14:51582011




All Time Past Year Past 30 Days
Abstract Views 106 106 106
Full Text Views 34 34 34
PDF Downloads 51 51 51
EPUB Downloads 0 0 0


Google Scholar