Effects of the difference between lumbar lordosis in the supine and standing positions on the clinical outcomes of decompression surgery for lumbar spinal stenosis

Shiho Nakano MD1, Masahiro Inoue MD, PhD1, Hiroshi Takahashi MD, PhD2, Go Kubota MD, PhD3, Junya Saito MD, PhD4, Masaki Norimoto MD, PhD4, Keita Koyama MD4, Atsuya Watanabe MD, PhD1, Takayuki Nakajima MD, PhD1, Yusuke Sato MD, PhD1, Shuhei Ohyama MD1, Sumihisa Orita MD, PhD5, Yawara Eguchi MD, PhD5, Kazuhide Inage MD, PhD5, Yasuhiro Shiga MD, PhD5, Masato Sonobe MD, PhD4, Arata Nakajima MD, PhD4, Seiji Ohtori MD, PhD5, Koichi Nakagawa MD, PhD4, and Yasuchika Aoki MD, PhD1
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  • 1 Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane;
  • | 2 Department of Orthopaedic Surgery, University of Tsukuba;
  • | 3 Department of Orthopaedic Surgery, Chiba Prefectural Sawara Hospital, Katori;
  • | 4 Department of Orthopaedic Surgery, Toho University Medical Center Sakura Hospital, Sakura; and
  • | 5 Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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OBJECTIVE

The authors sought to evaluate the relationship between the difference in lumbar lordosis (DiLL) in the preoperative supine and standing positions and spinal sagittal alignment in patients with lumbar spinal stenosis (LSS) and to determine whether this difference affects the clinical outcome of laminectomy.

METHODS

Sixty patients who underwent single-level unilateral laminectomy for bilateral decompression of LSS were evaluated. Spinopelvic parameters in the supine and standing positions were measured preoperatively and at 3 months and 2 years postoperatively. DiLL between the supine and standing positions was determined as follows: DiLL = supine LL − standing LL. On the basis of this determination patients were then categorized into DiLL(+) and DiLL(−) groups. The relationship between DiLL and preoperative spinopelvic parameters was evaluated using Pearson’s correlation coefficient. In addition, clinical outcomes such as visual analog scale (VAS) and Oswestry Disability Index (ODI) scores between the two groups were measured, and their relationship to DiLL was evaluated using two-group comparison and multivariate analysis.

RESULTS

There were 31 patients in the DiLL(+) group and 29 in the DiLL(−) group. DiLL was not associated with supine LL but was strongly correlated with standing LL and pelvic incidence (PI) − LL (PI − LL). In the preoperative spinopelvic alignment, LL and SS in the standing position were significantly smaller in the DiLL(+) group than in the DiLL(−) group, and PI − LL was significantly higher in the DiLL(+) group than in the DiLL(−) group. There was no difference in the clinical outcomes 3 months postoperatively, but low-back pain, especially in the sitting position, was significantly higher in the DiLL(+) group 2 years postoperatively. DiLL was associated with low-back pain in the sitting position, which was likely to persist in the DiLL(+) group postoperatively.

CONCLUSIONS

We evaluated the relationship between DiLL and spinal sagittal alignment and the influence of DiLL on postoperative outcomes in patients with LSS. DiLL was strongly correlated with PI − LL, and in the DiLL(+) group, postoperative low-back pain relapsed. DiLL can be useful as a new spinal alignment evaluation method that supports the conventional spinal sagittal alignment evaluation.

ABBREVIATIONS

DiLL = difference in LL; JOABPEQ = Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; LL = lumbar lordosis; LSS = lumbar spinal stenosis; ODI = Oswestry Disability Index; PI = pelvic incidence; SS = sacral slope; VAS = visual analog scale.

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