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

Abstract

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.

Postoperative loss of correction after combined posterior and anterior spinal fusion surgeries in a lumbar burst fracture patient with Class II obesity

“…[ 5 , 18 ] More recently, preoperative difference in lumbar lordosis between standing and supine positions (DiLL) was proposed as a predictive factor for postoperative lumbar alignment changes after lumbar surgery for lumbar degenerative disease. [ 3 , 13 , 15 ] From our experience, it is suggested that postural differences in LKA are useful for evaluating the stability of thoracolumbar fractures after fusion surgery and predicting postoperative loss of correction.…”

Changes in lumbar lordosis and predicted minimum 5-year surgical outcomes after short-segment transforaminal lumbar interbody fusion

“…Multiple regression analysis was performed to exclude the influence of age, sex, BMI, scoliosis, and number of fused segments and a significant correlation was found between DiLL and each clinical score. As DiLL and PI-LL were found to be significantly correlated 34 , the two values could not be used in the multiple regression analysis to avoid multicollinearity. However, this study revealed that the difference in outcomes between patients with DiLL (+) and those with DiLL (−) was more evident in patients with PI-LL mismatches.…”