Impact of Decompression Surgery without Fusion for Lumbar Spinal Stenosis on Sagittal Spinopelvic Alignment

2019 ◽  
Vol 09 (02) ◽  
pp. 110-115
Author(s):  
克 聂
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Decompression Surgery ◽  
Spinopelvic Alignment ◽  
Lumbar Spinal

The effect of minimally invasive lumbar decompression surgery on sagittal spinopelvic alignment in patients with lumbar spinal stenosis: a 5-year follow-up study

2021 ◽  
pp. 1-8
Author(s):  
Hamidullah Salimi ◽  
Hiromitsu Toyoda ◽  
Kentaro Yamada ◽  
Hidetomi Terai ◽  
Masatoshi Hoshino ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Decompression Surgery ◽  
Vas Score ◽  
Spinopelvic Alignment ◽  
Sagittal Malalignment ◽  
Lumbar Spinal

OBJECTIVE Several studies have examined the relationship between sagittal spinopelvic alignment and clinical outcomes after spinal surgery. However, the long-term reciprocal changes in sagittal spinopelvic alignment in patients with lumbar spinal stenosis after decompression surgery remain unclear. The aim of this study was to investigate radiographic changes in sagittal spinopelvic alignment and clinical outcomes at the 2-year and 5-year follow-ups after minimally invasive lumbar decompression surgery. METHODS The authors retrospectively studied the medical records of 110 patients who underwent bilateral decompression via a unilateral approach for lumbar spinal stenosis. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain (LBP), leg pain, leg numbness, and spinopelvic parameters were evaluated before surgery and at the 2-year and 5-year follow-ups. Sagittal malalignment was defined as a sagittal vertical axis (SVA) ≥ 50 mm. RESULTS Compared with baseline, lumbar lordosis significantly increased after decompression surgery at the 2-year (30.2° vs 38.5°, respectively; p < 0.001) and 5-year (30.2° vs 35.7°, respectively; p < 0.001) follow-ups. SVA significantly decreased at the 2-year follow-up compared with baseline (36.1 mm vs 51.5 mm, respectively; p < 0.001). However, there was no difference in SVA at the 5-year follow-up compared with baseline (50.6 mm vs 51.5 mm, respectively; p = 0.812). At the 5-year follow-up, 82.5% of patients with preoperative normal alignment maintained normal alignment, whereas 42.6% of patients with preoperative malalignment developed normal alignment. Preoperative sagittal malalignment was associated with the VAS score for LBP at baseline and 2-year and 5-year follow-ups and the JOA score at the 5-year follow-up. Postoperative sagittal malalignment was associated with the VAS score for LBP at the 2-year and 5-year follow-ups and the VAS score for leg pain at the 5-year follow-up. There was a trend toward deterioration in clinical outcomes in patients with persistent postural malalignment compared with other patients. CONCLUSIONS After minimally invasive surgery, spinal sagittal malalignment can convert to normal alignment at both short-term and long-term follow-ups. Sagittal malalignment has a negative impact on the VAS score for LBP and a weakly negative impact on the JOA score after decompression surgery.

Impact of decompression surgery without fusion for lumbar spinal stenosis on sagittal spinopelvic alignment: minimum 2-year follow-up

2019 ◽  
Vol 30 (6) ◽  
pp. 743-749
Author(s):  
Yoji Ogura ◽  
Yoshio Shinozaki ◽  
Yoshiomi Kobayashi ◽  
Takahiro Kitagawa ◽  
Yoshiro Yonezawa ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Sagittal Alignment ◽  
Decompression Surgery ◽  
Lumbar Decompression ◽  
Spinopelvic Alignment ◽  
Global Sagittal Alignment ◽  
Sagittal Malalignment ◽  
Lumbar Spinal

OBJECTIVEThe importance of global sagittal alignment is well known. Patients with lumbar spinal stenosis (LSS) generally tend to bend forward to relieve their neurological symptoms, i.e., they have a positive sagittal vertical axis (SVA). We hypothesized that the positive SVA associated with LSS is symptom related and should improve after surgery. However, little is known about the changes in sagittal alignment in LSS patients after decompression surgery. In this study the authors aimed to evaluate midterm radiographical changes in sagittal spinopelvic alignment after decompression surgery for LSS and to determine the factors influencing the improvement in sagittal spinopelvic alignment.METHODSThe authors retrospectively reviewed 89 patients who underwent lumbar decompression without fusion between January 2014 and September 2015 with a minimum follow-up of 2 years. Standing whole-spine radiographs at the preoperative stage and at the final follow-up were examined. We analyzed SVA, lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), thoracolumbar kyphosis (TLK), and thoracic kyphosis (TK).RESULTSLL and TK were significantly increased postoperatively. SVA and PI minus LL (PI-LL) were significantly decreased. There were no significant differences between the preoperative and postoperative PT, PI, SS, or TLK. Twenty-nine patients had preoperative sagittal malalignment with SVA > 50 mm. Thirteen of the 29 patients improved to SVA < 50 mm after decompression surgery. Lower ASA grade, preoperative higher LL, and lower PI-LL were related to patient improvement. A receiver operating characteristic curve for the preoperative PI-LL had an area under the curve value of 0.821, indicating moderate accuracy (p = 0.003). A cutoff value for preoperative PI-LL of 19.2° showed a sensitivity of 93.5% and a specificity of 71.4%.CONCLUSIONSLumbar decompression can lead to a reactive improvement in the lumbar and global sagittal alignment. However, some of the sagittal malalignment in LSS was irreversible. Preoperative PI-LL was a useful predictor to distinguish reversible from irreversible sagittal malalignment.

scholarly journals Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hua Li ◽  
Yufu Ou ◽  
Furong Xie ◽  
Weiguo Liang ◽  
Gang Tian ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Discectomy ◽  
Lumbar Spine Surgery ◽  
Decompression Surgery ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Pain Scores ◽  
Endoscopic Lumbar Discectomy ◽  
Lumbar Spinal

Abstract Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

Impact of leg numbness on patient satisfaction following decompression surgery for lumbar spinal stenosis

2021 ◽  
Vol 93 ◽  
pp. 112-115
Author(s):  
Yoji Ogura ◽  
Yoshiyuki Takahashi ◽  
Takahiro Kitagawa ◽  
Yoshiro Yonezawa ◽  
Kodai Yoshida ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Decompression Surgery ◽  
Lumbar Spinal

Reversibility of nerve root sedimentation sign in lumbar spinal stenosis patients after decompression surgery

2017 ◽  
Vol 26 (10) ◽  
pp. 2573-2580 ◽  
Author(s):  
Christian Barz ◽  
Markus Melloh ◽  
Lukas P. Staub ◽  
Sarah J. Lord ◽  
Harry R. Merk ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Nerve Root ◽  
Decompression Surgery ◽  
Lumbar Spinal

Association Between Paravertebral Muscle Mass and Improvement in Sagittal Imbalance After Decompression Surgery of Lumbar Spinal Stenosis

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yuichi Yoshida ◽  
Junichi Ohya ◽  
Taiki Yasukawa ◽  
Yuki Onishi ◽  
Junichi Kunogi ◽  
...  
Keyword(s):  
Muscle Mass ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Sagittal Imbalance ◽  
Decompression Surgery ◽  
Paravertebral Muscle ◽  
Lumbar Spinal

scholarly journals An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach

Pain Medicine ◽  
2019 ◽  
Vol 20 (Supplement_2) ◽  
pp. S23-S31
Author(s):  
Sudhir Diwan ◽  
Dawood Sayed ◽  
Timothy R Deer ◽  
Amber Salomons ◽  
Kevin Liang
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Conservative Management ◽  
Treatment Algorithm ◽  
Decompression Surgery ◽  
Optimal Care ◽  
Epidural Steroid Injections ◽  
Vascular Elements ◽  
Evidenced Based ◽  
Lumbar Spinal

Abstract Objective Lumbar spinal stenosis (LSS) can lead to compression of the neural and vascular elements and is becoming more common due to degenerative changes that occur because of aging processes. Symptoms may manifest as pain and discomfort that radiates to the lower leg, thigh, and/or buttocks. The traditional treatment algorithm for LSS consists of conservative management (physical therapy, medication, education, exercise), often followed by epidural steroid injections (ESIs), and when nonsurgical treatment has failed, open decompression surgery with or without fusion is considered. In this review, the variables that should be considered during the management of patients with LSS are discussed, and the role of each treatment option to provide optimal care is evaluated. Results This review leads to the creation of an evidence-based practical algorithm to aid clinicians in the management of patients with LSS. Special emphasis is directed at minimally invasive surgery, which should be taken into consideration when conservative management and ESI have failed.

Sign in / Sign up

Export Citation Format

Share Document