Sagittal imbalance in patients with lumbar spinal stenosis and outcomes after simple decompression surgery

Shin, Eunhye; Kim, Chi Heon; Chung, Chun Kee; Choi, Yunhee; Yim, Dahae; Jung, Whei; Park, Sung Bae; Moon, Jung Hyeon; Heo, Won; Kim, Sung Mi

doi:10.1016/j.spinee.2016.08.023

Cited by 44 publications

(37 citation statements)

References 48 publications

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“…Nevertheless, increased L 4-5 T but decreased L 4-5 S is found to compensate and prevent the center of gravity displacement (19). Interestingly, L 4-5 I was normal in patients with disk herniation (L 4-5 I = 49.8°) and degenerative disk disease (L 4-5 I = 51.6°), but it was much higher (L 4-5 I = 60.0°) in patients with DLS (24,38), indicating a predisposition to DLS in patients with a higher L 4-5 I (4). In this study, the surgical correction was aimed to realign the lumbar spine by PLF or TLIF.…”

Section: Statisticsmentioning

confidence: 92%

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Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

Chumnanvej

Segkhaphant²

2018

Turkish Neurosurgery

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be elucidated (1,7,33). Thus, the objective parameters such as spinopelvic parameters are required (9,11,29). Since spinopelvic parameters are intricately associated with the deformity, changes in spinopelvic parameters can be objectively determined after correction of the deformity (10,17,23,25,28,38). Several studies have proposed methods for determination of spinopelvic parameters after surgical correction for DLS (2-5,

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Section: Statisticsmentioning

confidence: 92%

“…In the standing position, pelvic morphology is indicated by L 4-5 I (24). It is associated with the anatomic morphology of the pelvis and modulates the sagittal spinal alignment (21,22,32,36,38). The normative values of L 4-5 I have a range of 50 o -55 o (2,5,24,39,40).…”

Section: The Lessons Learntmentioning

confidence: 99%

Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

Chumnanvej

Segkhaphant²

2018

Turkish Neurosurgery

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“…Vermutlich ist dies ein funktionelles Phänomen durch die Erleichterung bringende Inklinationsstellung der Lendenwirbelsäule. So wiesen in einer aktuellen Publikation 54 % der Stenosepatienten eine sagittale Dysbalance auf, in 73 % dieser Patienten führte jedoch die alleinige Dekompressionsoperation innerhalb von 6 Monaten zu einer Normalisierung [13]. In Einklang mit diesen Ergebnissen konnte Bayerl et al [14] zeigen, dass die alleinige Dekompressionsoperation auch bei Patienten mit dekompensierter sagittaler Dysbalance bei lumbaler Spinalkanalstenose zu einem gleich guten Ergebnis führt, wie bei Patienten mit präoperativer normaler sagittaler Balance.…”

Section: Notwendigkeit Von Korrekturoperationen Bei Sagittaler Dysbalunclassified

Sagittales Profil der Wirbelsäule: Was ist sinnvoll, was gefährdet den Patienten, was ist Hype? Evidenz für Korrekturoperationen bei sagittaler Dysbalance

Thomé

2019

Die Wirbelsäule

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ZusammenfassungIn den letzten Jahren hat das sagittale Profil der Wirbelsäule zunehmend Beachtung gefunden und es konnten je nach Beckenkonfiguration unterschiedliche Wirbelsäulentypen identifiziert werden. Kommt es durch die fortschreitende Bandscheibendegeneration zu einer Entlordosierung der Lendenwirbelsäule, resultiert eine sagittale Dysbalance, oft im Sinne einer degenerativen Lumbalskoliose. Nicht selten forcieren Versteifungsoperationen diese Entwicklung iatrogen durch Fixierungen in entlordosierter Position. Fällt das C7-Lot vor die Hüftköpfe, spricht man von dekompensierter sagittaler Dysbalance, die von vielen Wirbelsäulenchirurgen als entscheidend für die Patientendisabilität angesehen wird und aufwändige Korrekturoperationen indiziert werden. Derartige Eingriffe, die häufig Osteotomien erfordern, gehen jedoch mit einem 50 %igen perioperativen Komplikationsrisiko und mit einer Versagens- bzw. Reoperationsrate von ebenfalls 50 % einher, so dass dieser Hype zunehmend kritisch gesehen wird, zumal beispielsweise in Fällen von lumbalen Spinalstenosen ungeachtet des sagittalen Profils reine Dekompressionsoperationen gute Ergebnisse erzielen. Bei insgesamt spärlicher Evidenzlage können daher aktuell umfangreiche Deformitätenkorrekturen nur bei ausgeprägter sagittaler Dysbalance und stärksten, therapierefraktären Beschwerden empfohlen werden. Eine detaillierte präoperative Evaluation und Risikoabschätzung ist in diesem Zusammenhang ebenso unerlässlich wie die Versorgung an spezialisierten Zentren. In diesem selektionierten Patientengut sind Outcome und Patientenzufriedenheit allerdings erstaunlich gut. Es ist davon auszugehen, dass sich die Datenlage in den nächsten Jahren verdichtet und auch altersspezifische Empfehlungen möglich sind. Auch wenn aktuell die routinemäßige Korrektur des sagittalen Profils bei allen Patienten nicht empfohlen werden kann, so macht das Konzept der sagittalen Balance grundsätzlich Sinn. Dementsprechend sollte bei Instrumentationen vor allem der unteren Lendenwirbelsäule eine Wiederherstellung der physiologischen lumbalen Lordose angestrebt werden.

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“…(32)(33)Sagittal imbalance can result from a number of causes,such as Ankylosing spondylitis, Parkinson's disease ,some neuromuscular diseases(Myasthenia gravis,limb girdle dystrophy,etc),and some spine disorders . [34]Among spine disorders,the causes of sagittal imbalance is mainly Spinal Deformity,lumbar spinal stenosis , lumar spondylolisthesis,thoracolumbar fractures,et al [28][29][30][31]Paravertebral muscle is also considered to be an important factor in the stabilization of spinal sequence.Among them, ES and MF, as active muscles of lumbar spine, play an important role in the extension of the spine in reaction to gravity and body weight to maintaining spinal balance. [4] [20] Clinically, we found that some patients showed spinal sagittal balance when standing, but hunched or leaning forward after a period of walking or working.Standing full-spine lateral digital radiographs shows increased SVA dynamically.These patients often complain of feeling weakness in the lower back, marked hunchback and leaning forward after a period of walking or working without severe lower back pain or neurogenic claudication.Other notable clinical features is as following:1)Inability to hold things in front of themselves.2)Support with elbows in order to wash dishes or faces.3)Di cult in climbing slopes.4) Prefered to carry things on their back rather than hold them in front of themselves.…”

Section: Introductionmentioning

confidence: 99%

Moderate Degeneration of the Lumbar Paravertebral Muscle in Patients With Dynamic Sagittal Imbalance,A retrospective cohort study

Wang

et al. 2020

Preprint

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Study Design: A retrospective cohort study.Background: Sagittal imbalance of the spine is a comprehensive concept and can be caused by many causes. Paravertebral muscle is an important factor in the stabilization of spine.The active subsystem formed by the muscles around the lumbar spine plays an important role in maintaining lumbar spine stability and extendding the spine . Clinically, we found that some patients showed spinal sagittal balance when they were energetic, but hunched or leaning forward after a period of walking or working.Standing full-spine lateral digital radiographs shows increased sagittal vertical axis (SVA)dynamically.We call this symptoms a dynamic sagittal imbalance（DSI. However, the sagittal sequence, paravertebral muscle changes, and the correlation between them in DSI patients have not been clearly explored. The purpose of this study was to investigate the changes of spinal-pelvic parameters; paravertebral muscle; and the relationship between the two in DSI patients .Method: The study group comprised 31 patients with DSI and 42 control patients.All subjects underwent radiologic whole spine X-ray examination and lumbar MRI( Magnetic Resonance Imaging) scanning. Spinal-pelvic parameters such as sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) was measured. The cross-sectional areas （CSA）of the erector spinae (ES),multiﬁdus (MF), and vertebral body were measured at L2/L3 and L4/L5. The fat infiltration (FI) and relative cross-sectional area (RCSA)of muscle of these muscles were quantitatively measured though Image J. All subjects were examined for bone mineral density and pulmonary function to test the overall skeletal muscle capacity.Result: Compared with the control group,the DSI group had a smaller lumbar lordosis，more severe fat infiltration and lower Relative functional cross-sectional area(RFCSA) of paravertebral muscle ES(erector spinae)&MF(multifidus). There was no correlation between muscle degeneration and spinal-pelvic parameters in DSI patients.In addition,There were no statistically significant differences in bone mineral density test and pulmonary function test which reflected systemic skeletal muscle capacity of whole body.Conclusion: DSI，along with moderate degeneration of the paravertebral muscles of the lumbar spine.Usually accompanied by a reduction in lumbar lordosis. DSI is regards as the pre-state of PDSI.

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Sagittal imbalance in patients with lumbar spinal stenosis and outcomes after simple decompression surgery

Cited by 44 publications

References 48 publications

Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

Sagittales Profil der Wirbelsäule: Was ist sinnvoll, was gefährdet den Patienten, was ist Hype? Evidenz für Korrekturoperationen bei sagittaler Dysbalance

Moderate Degeneration of the Lumbar Paravertebral Muscle in Patients With Dynamic Sagittal Imbalance,A retrospective cohort study

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