Spontaneous correction of sagittal spinopelvic malalignment after decompression surgery without corrective fusion procedure for lumbar spinal stenosis and its impact on clinical outcomes: A systematic review

Ogura, Yoji; Kobayashi, Yoshiomi; Shinozaki, Yoshio; Ogawa, Jun

doi:10.1016/j.jos.2019.05.021

Cited by 9 publications

(19 citation statements)

References 14 publications

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“…Our hypothesis confi rmed that patients with LSS don't decrease LL after non-instrumented decompression surgery, and we observed an increase of LL of 3.8º comparable to the mean increased reported in the literature, with a values between (1.7 and 6º) [13,17,[20][21][22][23]. The range of lumbar lordosis in the current series did not differ much from that of the general elderly population.…”

Section: Discussionsupporting

confidence: 86%

“…Patients with LSS tend to lean forward to relieve their symptoms, and preoperative LL could be improved when their symptoms reduce after decompression surgery without additional corrective procedures [5][6][7][8][9][10][11][12]. In a review by Ogura, et al [13], in 2019, it is remarked that LL was increased after decompression, with signifi cant improvement observed in 5 of the 6 studies. Roussouly, et al [14], reported the standard sagittal parameters in a normal population is in average value for LL was 61.4º with a range from 41.2º to 81.9º.…”

Section: Introductionmentioning

confidence: 99%

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Lumbar lordosis in patients undergoing non-instrumented spinal stenosis

Isart¹,

Vilà-Canet²,

Cáncer³

et al. 2021

Int J Spine Res

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Objective: To study the behaviour of Lumbar Lordosis (LL) after non-instrumented decompression surgery in patients diagnosed with Lumbar Spinal Stenosis (LSS). Methods and materials: Retrospective analysis of patients undergoing non-lumbar instrumented decompression surgery for lumbar spine stenosis, operated on between January 2011 and December 2017. The variables collected were age, sex, affected segment, and presence or not of degenerative spondylolisthesis (ELS). The Lumbar Lordosis (LL) parameter was analysed using conventional radiology in standing position pre and postoperatively. Results: 64 patients were selected, 17 women and 47 men, with an average age of 68 (35-83). 65% stenosis was located in a single level, and 39.1% had degenerative ELS grade I. The average follow-up was 26 months (6m-104m). A preoperative LL angle of 43.2º (9.8º-70.8º) and 47º (8º-76º) were found at the postoperative follow-up, with an average difference of 3.8º (-15.7º-20.2º). 9.4% (6 patients) of degenerative ELS evolved to grade II, and 8 patients needed reoperation for different reasons. In patients with ELS, we found a greater increase in postoperative LL (5.59º) than in patients without ELS (2.61º) (p = 0.08). No statistically significant relationship was found between the behaviour of the LL with the number of decompressed levels (p = 0.43) and the need for reoperation (p = 0.26). Conclusions: According to our study, the technique of posterior decompression without instrumentation of the lumbar spine stenosis is not associated with a decrease of lumbar lordosis parameter. Conversely, there is a slight tendency for LL to increase in cases where a degenerative ELS is present.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Lumbar lordosis in patients undergoing non-instrumented spinal stenosis

Isart¹,

Vilà-Canet²,

Cáncer³

et al. 2021

Int J Spine Res

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“…A single previous systematic review of the topic, which included 10 studies (eight of which were included in our review) [57], while lacking a quantitative meta-analysis, estimated that decompression surgery led to SVA correction in 25% to 73% of patients. It has also been suggested that greater PI-LL preoperatively correlates with residual sagittal malalignment postoperatively, which could be explained by structural degenerative changes rather than by reversible changes due to LSS itself [33,34,40].…”

Section: Discussionmentioning

confidence: 99%

Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

et al. 2021

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Purpose Positive spinal sagittal alignment is known to correlate with pain and disability. The association between lumbar spinal stenosis and spinal sagittal alignment is less known, as is the effect of lumbar decompressive surgery on the change in that alignment. The objective was to study the evidence on the effect of lumbar decompressive surgery on sagittal spinopelvic alignment. Methods The Cochrane Controlled Trials Register (CENTRAL), Medline, Embase, Scopus and Web of Science databases were searched in October 2019, unrestricted by date of publication. The study selection was performed by two independent reviewers. The risk of systematic bias was assessed according to the NIH Quality Assessment Tool. The data were extracted using a pre-defined standardized form. Results The search resulted in 807 records. Of these, 18 were considered relevant for the qualitative analysis and 15 for the meta-synthesis. The sample size varied from 21 to 89 and the average age was around 70 years. Decompression was mostly performed on one or two levels and the surgical techniques varied widely. The pooled effect sizes were most statistically significant but small. For lumbar lordosis, the effect size was 3.0 (95% CI 2.2 to 3.7) degrees. Respectively, for pelvic tilt and sagittal vertical axis, the effect sizes were − 1.6 (95% CI .2.6 to − 0.5) degrees and − 9.6 (95% CI − 16.0 to − 3.3) mm. Conclusions It appears that decompression may have a small, statistically significant but probably clinically insignificant effect on lumbar lordosis, sagittal vertical axis and pelvic tilt.

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“…Glassman et al reported that SVA is associated with clinical symptoms [ 29 ]. Ogura et al reported that SVA was improved by decompression alone for LSS without instrumentation because the patient leans forward to relieve symptoms [ 30 ]. However, there have been no reports about TSS and spinal alignment.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Spinal Alignment and Clinical Findings for the Efficacy of One-Stage Surgery in Tandem Spinal Stenosis

Kobayashi¹,

Eguchi²,

Suzuki³

et al. 2022

Cureus

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Introduction We compared preoperative skeletal muscle, pre-and post-operative spinal alignment or clinical symptoms between tandem spinal stenosis (TSS) patients who underwent simultaneous cervical and lumbar decompression and lumbar spinal stenosis (LSS) patients who underwent only lumbar decompression and the efficacy of one-stage surgery was examined. Methods This study included 82 patients, identifying 13 patients for the TSS group (mean age 77.2 years) and 69 patients for the LSS group (mean age 72.2 years). One-stage decompression surgery was performed on both groups. The spinal alignments were evaluated using Lumbar scoliosis (LS), Sagittal vertical axis (SVA), Lumbar lordosis (LL), Pelvic tilt (PT), Pelvic incidence (PI), and Sacral slope (SS). The clinical symptoms were evaluated using the visual analogue scale (VAS) score for low back pain (LBP), the Japanese Orthopedic Association scoring system (JOA score), the Roland-Morris Disability Questionnaire (RDQ), the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Oswestry Disability Index (ODI). Results The amount of bleeding was not significantly different between the two groups (p > .05). SVA, LL, PT, and SS were significantly improved in the LSS group (p < 0.05). In the TSS group, SVA, LL, PT, and SS tended to improve, but without significant differences. The proportion of JOABPEQ gait dysfunction that was difficult to climb stairs was 83% in the TSS group, and social life disturbance that was difficult to engage in ordinary activities was 67% in the TSS group, which was significantly higher than that in the LSS group (p < .05). Although clinical symptoms improved by surgery in both groups (p < .05), there was no significant difference in the degree of clinical symptom improvement before and after surgery (p > .05). Conclusions One-stage surgery for TSS is effective because it has the same intraoperative bleeding volume as LSS alone and is minimally invasive. It also improves forward-leaning posture and clinical symptoms equivalent to LSS alone.

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Spontaneous correction of sagittal spinopelvic malalignment after decompression surgery without corrective fusion procedure for lumbar spinal stenosis and its impact on clinical outcomes: A systematic review

Cited by 9 publications

References 14 publications

Lumbar lordosis in patients undergoing non-instrumented spinal stenosis

Lumbar lordosis in patients undergoing non-instrumented spinal stenosis

Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

Evaluation of Spinal Alignment and Clinical Findings for the Efficacy of One-Stage Surgery in Tandem Spinal Stenosis

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