Impact of sagittal spinopelvic alignment on clinical outcomes and health-related quality of life after decompression surgery without fusion for lumbar spinal stenosis

Ogura, Yoji; Shinozaki, Yoshio; Kobayashi, Yoshiomi; Kitagawa, Takahiro; Yonezawa, Yoshiro; Takahashi, Yohei; Yoshida, Kodai; Yasuda, Akimasa; Ogawa, Jun

doi:10.3171/2018.10.spine181094

Cited by 36 publications

(42 citation statements)

References 13 publications

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“…Previous studies regarding sagittal balance have demonstrated that lumbar malalignment after spine surgery may cause poor clinical outcomes [15,16]. patients should be provided proper correction of the spinal alignment in order to prevent complications to occur.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Sagittal Alignment May Be a Good Predictor for the Lumbar Spine Degeneration

Xu¹,

Guo²,

Chen³

et al. 2020

Preprint

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BackgroundIncreasing attention has been focused on (modic changes and end plate defect) MC&ED as a potential role in the etiopathogenesis of lumbar degeneration. The precise mechanism leading to progression of MC&ED is lacking. Some scholars thought lumbar sagittal alignment might be a key influence factor, but without enough clinical evidence. Hence, we investigated how lumbar sagittal alignment influences MC&ED.MethodsNinety-six asymptomatic or symptomatic patients with Modic changes or end plate defect were retrospectively recruited in this study from August 2016 to December 2018. MC&ED were observed in 76 patients and not observed in 20 patients, representing two groups for comparison. The lumbar sagittal parameters were measured, including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). The lumbar lordosis index(LLI) and idea LL were then calculated. Clinical outcomes were assessed using a visual analog scale(VAS) and an Oswestry Disability Index (ODI) before and after an operation.ResultsThere were no significant difference in the distribution of demographic and baseline clinical variables between both groups. Mean age and BMI showed significant difference between both groups (P < 0.05). There were significant correlations between LL, LLI, Loss of LL, and Level 1 (r = 0.281, 0.230, and 0.284, P < 0.05) Also, PI, PT were significantly correlated with Level 4 (r = 0.249, 0.202, P < 0.05). Compared with presurgery scores, an improvement was seen in postoperative VAS and ODI scores (P < 0.05). Further, the postoperative scores at 24 months in the without Modic or end plate defect group showed greater improvements compared with the with Modic or endplate defect group (P < 0.05).ConclusionThis analysis indicated that maintaining lumbar sagittal alignment was related to a lower risk of Modic changes in patients with the spinal degenerative disease. The lumbar sagittal alignment might be a factor that influenced the posterior inclination of the pelvis in symptomatic lumbar disease.

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Section: Discussionmentioning

confidence: 99%

Lumbar Sagittal Alignment May Be a Good Predictor for the Lumbar Spine Degeneration

Xu¹,

Guo²,

Chen³

et al. 2020

Preprint

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“…The importance of the spinal sagittal stability after vertebral surgery has been shown in many studies. 7,27,31,32 The spinal sagittal parameters include SVA, LL, and TL.…”

Section: Discussionmentioning

confidence: 99%

Use of the Sagittal Cobb* Angle to Guide the Rod Bending in the Treatment of Thoracolumbar Fractures：A Retrospective Clinical Study

Shi

Wang

Jin

et al. 2020

Preprint

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Background: Pedicle screw fixation is a well-established technique for thoracolumbar fracture. A large number of studies have shown that the bending angle of the connecting rod has a significant correlation with the postoperative spinal stability. However, no studies have confirmed an objective indicator to guide the bending angle of the connecting rod during the operation. Our study aims to define a sagittal Cobb* angle to guide the bending angle of the connecting rod during surgery.Methods: The frontal and lateral X-ray films in 150 cases of normal thoracolumbar spine were included to measure the normal spinal sagittal Cobb* angle in each segment. The patients who underwent single segment thoracolumbar fractures and pedicle screw internal fixation surgery were included. The radiological parameters included lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS) were measured. The incidence of adjacent segment degeneration（ASD）two years after surgery were measured.Results: The average values of normal sagittal Cobb* angle in each segment were -5.196±3.318 degrees (T12), 2.279±3.324 degrees (L1), 7.222±2.798 degrees (L2) and 12.417±11.962 degrees (L3) respectively. The LL in the three groups was 35.20±9.12 degrees，46.26±9.68 degrees and 54.24±15.3 degrees, respectively. Comparing with the normal group, there were significant differences in group A and group C respectively (P< 0.05). The results were similar in the parameters of TL, PT and SS. The incidences of SVA>50mm in group A, group B and group C were 23.33%,12.50% and 19.23%, respectively. The parameter of PI in three groups were 41.36±12.69, 44.53±15.27 and 43.38±9.85 degrees，respectively. The incidences of ASD in group A, group B and group C 2 years after surgery were 21.67%，13.75% and 17.95%, respectively.Conclusions: The study confirmed that the sagittal Cobb* angle can be used as a reference angle for bending rods. When the bending angle of the connecting rod is 4 to 8 degrees greater than the corresponding segment sagittal Cobb* angle, the patient's spinal sagittal stability is the best two years after the operation.

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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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Impact of sagittal spinopelvic alignment on clinical outcomes and health-related quality of life after decompression surgery without fusion for lumbar spinal stenosis

Cited by 36 publications

References 13 publications

Lumbar Sagittal Alignment May Be a Good Predictor for the Lumbar Spine Degeneration

Lumbar Sagittal Alignment May Be a Good Predictor for the Lumbar Spine Degeneration

Use of the Sagittal Cobb* Angle to Guide the Rod Bending in the Treatment of Thoracolumbar Fractures：A Retrospective Clinical Study

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

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