Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis

Lee, Byung Ho; Park, Jin Oh; Kim, Hak-Sun; Suk, Kyung Soo; Lee, Sang Yoon; Lee, Hwan Mo; Yang, Jae‐Ho; Moon, Seong Hwan

doi:10.1016/j.clineuro.2016.06.016

Cited by 16 publications

(21 citation statements)

References 27 publications

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“…Indeed, poor postoperative spinal sagittal alignment is related to body imbalance, which may account for the association between poor spinal sagittal alignment and falls. 28 29 In this study, we included patients who underwent posterolateral fusion surgery along with decompressive surgery for LSS. These patients were set as the control group against the LLIF group, as PLF alone does not change the SB-related parameters postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery

et al. 2017

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PurposeTo demonstrate the impact of correcting sagittal balance (SB) on functional outcomes of surgical treatment for degenerative spinal disease and actual falls via utilization of new minimally invasive lumbar fusion techniques via a lateral approach.Materials and MethodsFrom November 2011 to March 2015, we enrolled 56 patients who underwent minimally invasive lateral lumbar interbody fusion (LLIF) and matched 112 patients receiving decompression/postero-lateral fusion (PLF) surgery for lumbar spinal stenosis. According to SB status using C7-plumb line-distance (C7PL) and surgery type, patients were divided into three groups: SB PLF, sagittal imbalance (SI) PLF, and LLIF groups. We then compared their outcomes.ResultsThe mean C7PL was 6.2±13.6 mm in the SB PLF group, 72.9±33.8 mm in the SI PLF group, and 74.8±38.2 mm in the LLIF group preoperatively. Postoperatively, C7PL in only the LLIF group improved significantly (p=0.000). Patients in the LLIF group showed greater improvement in fall-related functional test scores than the SI PLF group (p=0.007 for Alternate-Step test, p=0.032 for Sit-to-Stand test). The average number of postoperative falls was 0.4±0.7 in the SB PLF group, 1.1±1.4 in the SI PLF group, and 0.8±1.0 in the LLIF group (p=0.041). Oswestry Disability Index and the Euro-QoL 5 dimension visual analogue scale scores also showed greater improvements in the LLIF group than in the SI PLF group at postoperative 1 year (p=0.003, 0.016).ConclusionSurgical correction of SI in patients with lumbar spinal stenosis using a combination of minimal invasive LLIF and posterior surgery achieved better surgical outcomes and a lower incidence of actual falls than PLF surgery.

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Section: Discussionmentioning

confidence: 99%

“…These patients were set as the control group against the LLIF group, as PLF alone does not change the SB-related parameters postoperatively. 29 …”

Section: Discussionmentioning

confidence: 99%

Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery

et al. 2017

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“…When fusion is performed, it is important to consider sagittal balance as achieving sagittal balance after surgery can result in good surgical outcomes and also help reduce the risk of fall after surgery [ 38 , 39 ]. Studies have reported that the recent emergence of surgical techniques using minimally invasive spine surgery, including endoscopic decompression, has led to better results in terms of length of hospital stay, blood loss, cost, and postoperative outcome than the existing surgical methods [ 36 , 40 - 43 ].…”

Section: Nonoperative Treatmentmentioning

confidence: 99%

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

et al. 2020

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Patients with lumbar spinal stenosis may exhibit symptoms such as back pain, radiating pain, and neurogenic claudication. Although long-term outcome of treatments manifests similar results for both nonsurgical and surgical treatments, positive effects such as short-term improvement in symptoms and decreased fall risk may be expected with surgery. Surgical treatment is basically decompression, and a combination of treatments can be added depending on the degree of decompression and the accompanying instability. Recently, minimally invasive surgery has been found to result in excellent outcomes in the treatment of lumbar spinal stenosis. Therefore, better treatment effects can be anticipated with an approach aimed at understanding the overall pathophysiology and treatment methods of lumbar spinal stenosis.

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“…The reasons for the same improvement in quality of life in both groups are still unclear, and the mild-to-moderate sagittal imbalance may be one of the reasons [ 18 ]. Compared with coronal imbalance, sagittal imbalance had a greater impact on the quality of life of patients; and when SVA was >6 cm, the ODI was significantly higher [ 19 , 20 ]. However, the average preoperative SVA was 54.18 mm in patients with Cobb angle 20°~40°, and then decreased to 27.27 mm at the final follow-up.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Short-Segment Fixation versus Long-Segment Fixation for Degenerative Scoliosis with Cobb Angle 20°~40°: A Retrospective Observational Study

Zhu

et al. 2020

Med Sci Monit

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Background There remains a great deal of controversy regarding the selection of long-segment fixation and short-segment fixation, especially for degenerative scoliosis (DS) patients with Cobb angle 20°~40°. The purpose of this study was to investigate the effects of different fixation levels in DS patients with Cobb angle 20°~40°. Material/Methods We enrolled 96 DS patients, divided into a long-segment fixation group (>3 segments) and a short-segment fixation group (≤3 segments). The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes. The spinal-pelvic parameters and complications were also collected and analyzed. Results The short-segment fixation group had the advantages of less blood loss, shorter operation time and shorter fluoroscopy time (P<0.05). The 2 groups achieved similar effects in leg pain (VAS) and ODI after operation (P>0.05); however, there was a better relief of low back pain in the long-segment fixation group (P<0.05 ) . The changes of Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS) in the long-segment fixation group were more obvious than that in the short-segment fixation group at the final follow-up (P<0.05). The prevalence of complications in the long-segment fixation group was significantly higher than in the short-segment fixation group (P<0.01). Conclusions Short-segment fixation has less surgical trauma and fewer complications, whereas long-segment fixation has more advantages in improving spine-pelvis parameters and relieving low back pain.

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Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis

Cited by 16 publications

References 27 publications

Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery

Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

Effectiveness of Short-Segment Fixation versus Long-Segment Fixation for Degenerative Scoliosis with Cobb Angle 20°~40°: A Retrospective Observational Study

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