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

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• 作者：E. Kyung Shin ; BS^a ; Chi Heon Kim ; MD ; PhD^b ; ^c ; ^d ; ^{chiheon1@snu.ac.kr} ; Chun Kee Chung ; MD ; PhD^b ; ^c ; ^d ; ^e ; Yunhee Choi ; PhD^f ; Dahae Yim ; MS^f ; Whei Jung ; BS^a ; Sung Bae Park ; MD^b ; ^c ; ^d ; ^g ; Jung Hyeon Moon ; MD^b ; ^c ; Won Heo ; MD^b ; ^c ; Sung-Mi Kim ; RN^b
• 关键词：Balance ; Laminectomy ; Ligamentum flavum ; Sagittal ; Spinal stenosis ; Spine ; Surgery
• 刊名：The Spine Journal
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：17
• 期：2
• 页码：175-182
• 全文大小：651 K
• 卷排序：17

文摘

Lumbar spinal stenosis (LSS) is the most common lumbar degenerative disease, and sagittal imbalance is uncommon. Forward-bending posture, which is primarily caused by buckling of the ligamentum flavum, may be improved via simple decompression surgery.PurposeThe objectives of this study were to identify the risk factors for sagittal imbalance and to describe the outcomes of simple decompression surgery.Study DesignThis is a retrospective nested case-control studyPatient SampleThis was a retrospective study that included 83 consecutive patients (M:F=46:37; mean age, 68.5±7.7 years) who underwent decompression surgery and a minimum of 12 months of follow-up.Outcome MeasuresThe primary end point was normalization of sagittal imbalance after decompression surgery.MethodsSagittal imbalance was defined as a C7 sagittal vertical axis (SVA) ≥40 mm on a 36-inch-long lateral whole spine radiograph. Logistic regression analysis was used to identify the risk factors for sagittal imbalance. Bilateral decompression was performed via a unilateral approach with a tubular retractor. The SVA was measured on serial radiographs performed 1, 3, 6, and 12 months postoperatively. The prognostic factors for sagittal balance recovery were determined based on various clinical and radiological parameters.ResultsSagittal imbalance was observed in 54% (45/83) of patients, and its risk factors were old age and a large mismatch between pelvic incidence and lumbar lordosis. The 1-year normalization rate was 73% after decompression surgery, and the median time to normalization was 1 to 3 months. Patients who did not experience SVA normalization exhibited low thoracic kyphosis (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02–1.10) (p<.01) and spondylolisthesis (HR, 0.33; 95% CI, 0.17–0.61) before surgery.ConclusionsSagittal imbalance was observed in more than 50% of LSS patients, but this imbalance was correctable via simple decompression surgery in 70% of patients.