Does sagittal imbalance impact the surgical outcomes of short-segment fusion for lumbar spinal stenosis associated with degenerative lumbar scoliosis?

Hori, Yusuke; Matsumura, Akira; Namikawa, Takashi; Kato, Minori; Takahashi, Shinji; Ohyama, Shoichiro; Ozaki, Tomonori; Yabu, Akito; Nakamura, Hiroaki

doi:10.1016/j.jos.2018.10.005

Cited by 22 publications

(21 citation statements)

References 28 publications

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“…Kümmell's disease is characterized by delayed vertebral collapse and kyphotic deformity of the spine on the basis of osteoporosis [6,8] after patients suffered a mild trauma.The most obvious clinical symptoms are chronic refractory pain,kyphosis,and later neurologic symptoms [13][14][15].Previous theories of Kümmell's disease suggest that there are two different types of pain,acute pain secondary to a fresh fracture at an early stage,and a chronic low back pain that develops gradually after a plateau of weeks or months [1][2][3][6][7][8].As for the causes of chronic pain in the later stage,most of the literature indicates that it is due to bone necrosis,fracture nonunion,and instability caused by local micro-motion of the injured vertebra.With the collapse of the injured vertebra in the later stage,wedge formation of the vertebra gradually appears [6,7,9,11,14].As the understanding of the spine sagittal balance has deepened,it has gradually been realized that a good spine sagittal balance could help the lower back muscles do a minimal work to maintain a balanced posture [22,23].In conversely,the advancement of the gravity line caused by long-term kyphotic deformity of the spine will not only change the stress of the corresponding segment on the intervertebral disc,facet joints,and other tissue structures,but also will further accelerate the degeneration of the intervertebral discs and the facet joints leading to the appearance of discogenic low back pain.Thus secondary changes such as low back pain and the endplate in ammation become inevitable.At the same time,long-term kyphosis will cause strain and degeneration of the back extensors,which will further aggravate the sagittal imbalance [24,25].It has been reported that patients with chronic kyphotic deformities or sagittal imbalance have a higher proportion of long-term refractory pain in the back [26,27].Meanwhile,Mitsuhiro Enomoto used surface electromyography (SEMG) to appraise the psoas in cases of thoracolumbar kyphosis and the results also showed a signi cant correlation between muscle work and low back pain [28].…”

Section: Discussionmentioning

confidence: 99%

Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

Cheng

Wang

et al. 2021

Preprint

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Background: To evaluate the short to mid-term radiographic and clinical outcomes of the restoration of normal spinal alignment and sagittal balance in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods: Between February 2016 and May 2018,30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into two groups (A and B) according to whether the kyphosis was combined with neurological deficits.All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance.And the radiographic outcomes and clinical results of these 30 patients were retrospectively evaluated.The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS)of the whole spine before operation,immediately after operation,and the last follow-up of each group were measured and evaluated.The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups .Results: The average follow-up period of group A and B were 34.2 and 38.7 months respectively.The parameters of both groups such as SVA,TLK,and thoracolumbar Cobb angle after surgery and at the last follow-up were significantly improved compared with those before surgery.The ODI and the NRS of the two groups at the last follow-up were also significantly improved. Conclusion: In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

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Section: Discussionmentioning

confidence: 99%

Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

Cheng

Wang

et al. 2021

Preprint

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“…Although the long-segment fusion can accomplish satisfactory coronal and sagittal balance, the patients with ALDS are complicated by advanced age and medical comorbidities, increasing the incidence of complications and morbidity. [ 13 – 15 ] A previous study reported that long-segment fusion surgery was found to be associated with a major complication incidence as high as 28% to 86%. [ 16 ] To lower the incidence of the complications, several scholars [ 17 , 18 ] advocated the short-segment fusion for the treatment of ALDS, and aimed to alleviate the symptoms rather than restore the alignment.…”

Section: Discussionmentioning

confidence: 99%

A hybrid therapeutic approach for decreasing postoperative complications in patients with adult lumbar degenerative scoliosis

et al. 2020

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To decrease postoperative complications in patients with adult lumbar degenerative scoliosis (ALDS), short-segment fusion surgery was used in this study. However, the incidence of adjacent segment disease was found to be remarkable. Therefore, we applied the hybrid treatment (short-segment fusion for responsibility levels plus nonfusion stabilization of lumbar segments, which was called the Wallis system, for the proximal level) to patients enrolled into this study. The purpose of this study was to investigate the feasibility of a novel hybrid therapeutic approach for treating patients with ALDS. From January 2011 to January 2017, a retrospective study was conducted consisting of 16 patients with ALDS who were treated with hybrid treatment. All patients were treated with short-segment decompression and fusion for responsibility levels and nonfusion stabilization of lumbar segments for the proximal levels. The imaging outcomes were evaluated preoperatively and at the time of follow-up. The mean visual analog score for back pain decreased from 6.1 ± 2.0 preoperatively to 2.1 ± 0.7 at 2-year follow-up ( P < .05), and the mean visual analog score for leg pain reduced from 8.1 ± 0.6 preoperatively to 1.3 ± 0.8 at 2-year follow-up ( P < .05). The Oswestry disability index scores improved from 65.4 ± 16.3% preoperatively to 18.3 ± 5.6% at 2-year follow-up ( P < .05). The mean Cobb angle was 22.1 ± 6.2° preoperatively, and 13.8 ± 6.8° at 2-year follow-up ( P < .05). The lumbar lordosis changed from −40.4 ± 14.8° to −43.5 ± 11.2° at 2-year follow-up ( P < .05). Solid fusion was achieved in all the patients, and no incidence of adjacent segment disease was noted as well. The proposed hybrid treatment for patients with ALDS can achieve favorable clinical outcomes and a lower incidence of ALDS. However, the correction of deformity is still limited that highlights the necessity of further study.

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“…Previous studies have reported sagittal spinal misalignment has been shown to be a risk factor for LBP after fusion. [16][17][18] However, to our knowledge, there is no study regarding on the impact factors of LBP after OLIF. It was our hypothesis that the restored the sagittal spinopelvic alignment is beneficial to relieve the LBP.…”

Section: Introductionmentioning

confidence: 99%

Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

Zhang

Shen

et al. 2020

Preprint

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Background: The objective of the retrospective study was to investigated the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion(OLIF).Methods: In this retrospective study, 120 patients who undergoing single-level OLIF to treat lumbar degenerative disease were recruited. Preoperative and postoperative radiographic parameters, including segmental lordosis(SL), lumbar lordosis(LL), disk height(DH), pelvic incidence(PI), pelvic tilt (PT), sacral slope(SS), thoracic kyphosis(TK), C7-sagittal vertical axis (SVA). Visual analog scale(VAS) for back and leg pain, and Oswestry Disability Index(ODI), were used to evaluate symptoms and quantify disability. All patients achieved at least two-year follow-up.Results: A total of 120 Patients who complained low back pain were apportioned to LBP group (n=38; VAS scores for back pain≥3) or Non-LBP group (n=82;VAS scores for back pain＜3). There was no difference in age(P=0.082), gender(P=0.425), body mass index(P=0.138), degenerative spondylolisthesis or lumbar spinal stenosis(P=0.529) surgical level(P=0.651), blood Loss (P=0.889) and operative time(P=0.731) between the groups. In both groups, the ODI and VAS scores for back pain and leg pain were significantly improved at the final follow-up compared to the preoperative scores (P=0.003). Furthermore, except for the LBP (P=0.000), there were no significant differences in these scores between the two groups at the final follow-up (P > 0.05). According to the radiographic parameters, in Non-LBP group, the LL, SL, DH, TK and SS had all significantly improved; PT and C7-SVA significantly decreased at the final follow-up compared to the preoperative values. The DH in both groups had significantly improved, no significant difference was found(P=0.325). In the final follow-up, LL, PI-LL, PT and C7-SVA in Non-LBP group had more improvements compared to the LBP group (P＜0.05) . Multivariate analysis showed that PT, PI-LL and C7-SVA were identified as significant risk factors for LBP after OLIF.Conclusion: The clinical outcomes of OLIF for single-level lumbar degenerative disease were satisfactory. Our findings showed that PT, PI-LL mismatch and C7-SVA had the greatest impact on the incidence of LBP. Therefore, patients with appropriate decreased PT, improved C7-SVA and PI-LL match experienced less low back pain.

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Does sagittal imbalance impact the surgical outcomes of short-segment fusion for lumbar spinal stenosis associated with degenerative lumbar scoliosis?

Cited by 22 publications

References 28 publications

Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

A hybrid therapeutic approach for decreasing postoperative complications in patients with adult lumbar degenerative scoliosis

Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

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