Improvement in Sagittal Balance After Decompression Surgery without Fusion in Patients with Degenerative Lumbar Stenosis: Clinical and Radiographic Results at 1 Year

Madkouri, Rachid; Brauge, David; Vidon-Buthion, Anthony; Fahed, Elie; Mourier, K.-L.; Beaurain, Jacques; Grelat, Michaël

doi:10.1016/j.wneu.2018.03.002

Cited by 20 publications

(19 citation statements)

References 45 publications

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“…Of 18 studies, three failed to produce the data needed for the meta-synthesis [27][28][29]. Thus, the quantitative meta-analysis was performed on 15 studies [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. LSS had been used as an inclusion criterion in 15 studies.…”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…In recent years, restoration of spinal balance, especially spino-pelvic sagittal balance in patients undergoing lumbar fixation, is of crucial importance [1,2]. However, only a few studies have reported the effects of pedicle screw insertion for spino-pelvic sagittal balance in lumbar fracture cases.…”

Section: Introductionmentioning

confidence: 99%

Effects of pedicle screw number and insertion depth on radiographic and functional outcomes in lumbar vertebral fracture

et al. 2020

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Background The influence of pedicle screw number and insertion depth on outcomes of lumbar fixation remains uncertain. The purpose of this study was to compare the imaging balance stability and clinical functional improvement of lumbar fracture patients with different pedicle screw numbers and insertion depths. Methods Sixty-five patients undergoing lumbar pedicle screw fixation from January 2016 to January 2018 were enrolled. They were included in long screw (LS) group and short screw (SS) group or 6 screw (6S) group and 4 screw (4S) group. The radiographic outcomes were assessed with lumbar lordosis (LL), segmental lordosis (SL), fractured vertebral lordosis (FL), sacral slope (SS), pelvic incidence (PL), and pelvic tilt (PT). The visual analog scale (VAS) and the Oswestry Disability Index (ODI) score were used for functional assessment. Multiple linear regression was performed to identify the risk factors of FL, SL, and LL correction at the final follow-up. Results FL, SL, and LL were significantly different in all matching subgroups to compare long and short screws and in most matching subgroups to compare 6 and 4 screws. The SS, PT, and PI seem to be similar in all subgroups in different periods. Significant differences of VAS and ODI were found between LS and SS in the 4S group and between 4S and 6S in the SS group. Insertion depth, screw number, BMD, age, and preoperative imaging data were significant factors for imaging balance stability correction at the final follow-up. Conclusions Long screws and 6 screws showed better fracture vertebral restoration and lumbar spinal sagittal stabilities. The surgery type, age, and BMD are important focus points for the treatment of lumbar vertebral fractures.

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“…Studies have demonstrated that PI plays a critical role in the overall alignment of the spine, and influences other sagittal spinal parameters, specifically, lumbar lordosis (LL) and thoracic kyphosis (TK) [1][2][3]. Indeed, sagittal spinopelvic alignment has become increasingly important for investigating preoperative planning and surgical outcomes in patients with lumbar degenerative diseases [4][5][6]. Failure to account for sagittal spinopelvic alignment might increase the risk of spinal misalignment and lead to poor clinical outcomes.…”

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

J Orthop Surg Res

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Background: We determined 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: We retrospectively reviewed 120 lumbar degenerative disease patients who underwent single-level OLIF. We compared 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), and C7-sagittal vertical axis (SVA). Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back and leg pain. All patients were followed up for at least 2 years. Results: Thirty-eight patients had postoperative LBP (VAS score for back pain ≥3; LBP group); the remaining 82 patients were in the non-LBP group. Age (P = 0.082), gender (P = 0.425), body mass index (P = 0.138), diagnosis (degenerative spondylolisthesis vs. lumbar spinal stenosis; P = 0.529), surgical level (P = 0.651), blood loss (P = 0.889), and operative time (P = 0.731) did not differ between the groups. In both groups, the ODI and VAS scores for back pain and leg pain significantly improved at the final follow-up compared with the preoperative scores (P = 0.003). Except for the VAS score for back pain (P = 0.000), none of the scores significantly differed between the two groups at the final follow-up (P > 0.05). In the non-LBP group, LL, SL, DH, TK, and SS significantly improved, while PT and C7-SVA significantly decreased at the final follow-up as compared with the preoperative values. In both groups, DH significantly improved postoperatively, with no significant between-group difference (P = 0.325). At the final follow-up, LL, PILL mismatch, PT, and C7-SVA showed significantly greater improvement in the non-LBP group than in the LBP group (P < 0.05). Multivariate analysis identified PT, PILL mismatch, and C7-SVA as significant risk factors for LBP after OLIF.

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Improvement in Sagittal Balance After Decompression Surgery without Fusion in Patients with Degenerative Lumbar Stenosis: Clinical and Radiographic Results at 1 Year

Cited by 20 publications

References 45 publications

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

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

Effects of pedicle screw number and insertion depth on radiographic and functional outcomes in lumbar vertebral fracture

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

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