The effect of minimally invasive lumbar decompression surgery on sagittal spinopelvic alignment in patients with lumbar spinal stenosis: a 5-year follow-up study

View More View Less
  • 1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka; and
  • | 2 Department of Orthopaedic Surgery, Fuchu Hospital, Osaka, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Several studies have examined the relationship between sagittal spinopelvic alignment and clinical outcomes after spinal surgery. However, the long-term reciprocal changes in sagittal spinopelvic alignment in patients with lumbar spinal stenosis after decompression surgery remain unclear. The aim of this study was to investigate radiographic changes in sagittal spinopelvic alignment and clinical outcomes at the 2-year and 5-year follow-ups after minimally invasive lumbar decompression surgery.

METHODS

The authors retrospectively studied the medical records of 110 patients who underwent bilateral decompression via a unilateral approach for lumbar spinal stenosis. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain (LBP), leg pain, leg numbness, and spinopelvic parameters were evaluated before surgery and at the 2-year and 5-year follow-ups. Sagittal malalignment was defined as a sagittal vertical axis (SVA) ≥ 50 mm.

RESULTS

Compared with baseline, lumbar lordosis significantly increased after decompression surgery at the 2-year (30.2° vs 38.5°, respectively; p < 0.001) and 5-year (30.2° vs 35.7°, respectively; p < 0.001) follow-ups. SVA significantly decreased at the 2-year follow-up compared with baseline (36.1 mm vs 51.5 mm, respectively; p < 0.001). However, there was no difference in SVA at the 5-year follow-up compared with baseline (50.6 mm vs 51.5 mm, respectively; p = 0.812). At the 5-year follow-up, 82.5% of patients with preoperative normal alignment maintained normal alignment, whereas 42.6% of patients with preoperative malalignment developed normal alignment. Preoperative sagittal malalignment was associated with the VAS score for LBP at baseline and 2-year and 5-year follow-ups and the JOA score at the 5-year follow-up. Postoperative sagittal malalignment was associated with the VAS score for LBP at the 2-year and 5-year follow-ups and the VAS score for leg pain at the 5-year follow-up. There was a trend toward deterioration in clinical outcomes in patients with persistent postural malalignment compared with other patients.

CONCLUSIONS

After minimally invasive surgery, spinal sagittal malalignment can convert to normal alignment at both short-term and long-term follow-ups. Sagittal malalignment has a negative impact on the VAS score for LBP and a weakly negative impact on the JOA score after decompression surgery.

ABBREVIATIONS

CTK = cervicothoracic kyphosis; JOA = Japanese Orthopaedic Association; LBP = low-back pain; LL = lumbar lordosis; LSS = lumbar spinal stenosis; PI = pelvic incidence; PT = pelvic tilt; SS = sacral slope; SVA = sagittal vertical axis; TK = thoracic kyphosis; VAS = visual analog scale.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Hiromitsu Toyoda: Osaka City University Graduate School of Medicine, Osaka, Japan. h-toyoda@msic.med.osaka-cu.ac.jp.

INCLUDE WHEN CITING Published online June 11, 2021; DOI: 10.3171/2020.11.SPINE201552.

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

  • 1

    Glassman SD, Hamill CL, Bridwell KH, et al. The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine (Phila Pa 1976). 2007;32(24):27642770.

    • Search Google Scholar
    • Export Citation
  • 2

    Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine (Phila Pa 1976). 1994;19(14):16111618.

    • Search Google Scholar
    • Export Citation
  • 3

    Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009;34(17):E599E606.

    • Search Google Scholar
    • Export Citation
  • 4

    Schwab F, Patel A, Ungar B, et al. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35(25):22242231.

    • Search Google Scholar
    • Export Citation
  • 5

    Di Martino A, Quattrocchi CC, Scarciolla L, et al. Estimating the risk for symptomatic adjacent segment degeneration after lumbar fusion: analysis from a cohort of patients undergoing revision surgery. Eur Spine J. 2014;23(6)(suppl 6):693698.

    • Search Google Scholar
    • Export Citation
  • 6

    Le Huec JC, Faundez A, Dominguez D, et al. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop. 2015;39(1):8795.

    • Search Google Scholar
    • Export Citation
  • 7

    Matsumoto T, Okuda S, Maeno T, et al. Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion. J Neurosurg Spine. 2017;26(4):435440.

    • Search Google Scholar
    • Export Citation
  • 8

    Dohzono S, Toyoda H, Matsumoto T, et al. The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis. J Neurosurg Spine. 2015;23(1):4954.

    • Search Google Scholar
    • Export Citation
  • 9

    Dohzono S, Toyoda H, Takahashi S, et al. Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis. J Neurosurg Spine. 2016;25(1):3945.

    • Search Google Scholar
    • Export Citation
  • 10

    Chang HS. Influence of lumbar lordosis on the outcome of decompression surgery for lumbar canal stenosis. World Neurosurg. 2018;109(1):e684e690.

    • Search Google Scholar
    • Export Citation
  • 11

    Fujii K, Kawamura N, Ikegami M, et al. Radiological improvements in global sagittal alignment after lumbar decompression without fusion. Spine (Phila Pa 1976). 2015;40(10):703709.

    • Search Google Scholar
    • Export Citation
  • 12

    Hikata T, Watanabe K, Fujita N, et al. Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance. J Neurosurg Spine. 2015;23(4):451458.

    • Search Google Scholar
    • Export Citation
  • 13

    Ogura Y, Shinozaki Y, Kobayashi Y, et al. Impact of sagittal spinopelvic alignment on clinical outcomes and health-related quality of life after decompression surgery without fusion for lumbar spinal stenosis. J Neurosurg Spine. 2019;30(6):743749.

    • Search Google Scholar
    • Export Citation
  • 14

    Toyoda H, Nakamura H, Konishi S, et al. Clinical outcome of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis: minimum five-year follow-up. Spine (Phila Pa 1976). 2011;36(5):410415.

    • Search Google Scholar
    • Export Citation
  • 15

    Janusz P, Tyrakowski M, Yu H, Siemionow K. Reliability of cervical lordosis measurement techniques on long-cassette radiographs. Eur Spine J. 2016;25(11):35963601.

    • Search Google Scholar
    • Export Citation
  • 16

    Schwab FJ, Blondel B, Bess S, et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976). 2013;38(13):E803E812.

    • Search Google Scholar
    • Export Citation
  • 17

    Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society—Schwab Adult Spinal Deformity Classification: a validation study. Spine (Phila Pa 1976). 2012;37(12):10771082.

    • Search Google Scholar
    • Export Citation
  • 18

    Rose PS, Bridwell KH, Lenke LG, et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976). 2009;34(8):785791.

    • Search Google Scholar
    • Export Citation
  • 19

    Oe S, Yamato Y, Hasegawa T, et al. Correction to: Deterioration of sagittal spinal alignment with age originates from the pelvis not the lumbar spine: a 4-year longitudinal cohort study. Eur Spine J. 2020;29(8):21072108.

    • Search Google Scholar
    • Export Citation
  • 20

    Kobayashi T, Atsuta Y, Matsuno T, Takeda N. A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine (Phila Pa 1976). 2004;29(6):671676.

    • Search Google Scholar
    • Export Citation
  • 21

    Hori Y, Hoshino M, Inage K, et al. ISSLS Prize in Clinical Science 2019: Clinical importance of trunk muscle mass for low back pain, spinal balance, and quality of life-a multicenter cross-sectional study. Eur Spine J. 2019;28(5):914921.

    • Search Google Scholar
    • Export Citation
  • 22

    Hiyama A, Katoh H, Sakai D, et al. The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis. BMC Musculoskelet Disord. 2019;20(1):352.

    • Search Google Scholar
    • Export Citation
  • 23

    Xia W, Fu H, Zhu Z, et al. Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis. BMC Musculoskelet Disord. 2019;20(1):454.

    • Search Google Scholar
    • Export Citation
  • 24

    Ohyama S, Hoshino M, Terai H, et al. Sarcopenia is related to spinal sagittal imbalance in patients with spinopelvic mismatch. Eur Spine J. 2019;28(9):19291936.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 79 79 79
Full Text Views 14 14 14
PDF Downloads 24 24 24
EPUB Downloads 0 0 0