Alteration of Lumbar Sagittal Alignment after Surgical Decompression with Fusion for Lumbar Spinal Stenosis
Journal
Formosan Journal of Musculoskeletal Disorders
Journal Volume
14
Journal Issue
4
Start Page
124
End Page
128
Date Issued
2023-10
Author(s)
Abstract
Background:
Lumbar spinal stenosis (LSS) is a disorder inducing pain in buttocks and lower extremities, with or without back pain. The resulting symptoms are often exacerbated by standing, walking, or torso extension. Leaning forward could alleviate spinal stenosis and its related symptoms, but the sagittal alignment of the lumbar spine is therefore compromised.
Objectives:
The purpose of this study was to evaluate the lumbar sagittal alignment before and after surgical decompression for LSS.
Materials and Methods:
From June 2014 to March 2018, 73 patients who underwent surgery for LSS and were followed more than 24 months were included in this study. All patients were treated with decompression and mini-open transforaminal lumbar interbody fusion (TLIF). Spinal fusion surgery was applied to cases with segmental instability and significant back pain. Radiographic outcome measures included focal segmental lordotic angle (the segment where decompression was performed), lumbar regional lordotic angle from L1 to S1, and sacral slope (SS) at preoperative, postoperative before discharge, 3 months, 6 months, 12 months, and 24 months with standing lumbar spine radiography. Functional outcome by Oswestry Disability Index (ODI: 0–100) was recorded.
Results:
At postoperative D1, regional alignment decreased significantly, but then has significant improvement from 3 months to 24 months. Focal alignment decreased gradually since D1. There was no significant change of SS at all-time points. Visual analog scale (VAS) scores for back pain and ODI scores were significantly improved (P < 0.05) in all patients at 12-month and 24-month follow-up.
Conclusions:
Patients with LSS tend to lean forward to reduce pain and neurologic symptoms. The resulting attenuation of lumbar lordosis could be improved after surgical decompression with fusion. The limitations of this study include small patient numbers, lack of final fusion assessment, and lack of whole sagittal alignment profile assessment.
Subjects
Decompression
lumbar spine
sagittal alignment
spinal stenosis
transforaminal lumbar interbody fusion
Publisher
Wolters Kluwer
Type
journal article