Impact of sagittal spinopelvic alignment on clinical outcomes and health-related quality of life after decompression surgery without fusion for lumbar spinal stenosis

OBJECTIVE

Patients with lumbar spinal stenosis (LSS) tend to bend forward to relieve neurological symptoms. They therefore have a positive sagittal vertical axis (SVA). The importance of the SVA value is well known in the field of adult spinal deformity; however, little is known about its impact on LSS. The authors sought to investigate the impact of sagittal spinopelvic alignment on clinical outcome and health-related quality of life (HRQOL) after decompression surgery for LSS.

METHODS

The authors retrospectively reviewed 83 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 were examined preoperatively and at final follow-up. Based on the SVA, patients were allocated to a sagittal balance group (group B; SVA < 50 mm) or a sagittal imbalance group (group I; SVA ≥ 50 mm). The authors compared the groups using Japanese Orthopaedic Association (JOA), Zurich Claudication Questionnaire (ZCQ), Roland-Morris Disability Questionnaire (RMDQ), and the 8-item Short Form Health Survey (SF-8) scores.

RESULTS

Preoperative groups B (group pre-B) and I (group pre-I) included 58 and 25 patients, respectively. Preoperative sagittal malalignment had negative effects on the JOA score recovery rate, postoperative ZCQ physical function domain score, and numeric rating scale (NRS) score of postoperative low-back pain (LBP), but no significant effects were observed for RMDQ and SF-8 domain scores. Postoperatively, groups B (group post-B) and I (group post-I) included 60 and 23 patients, respectively. Group post-I had a significantly worse JOA score recovery rate, postoperative symptom severity domain score in the ZCQ, and NRS score for postoperative LBP. Similarly, the postoperative RMDQ score and the Physical Component Summary score of the SF-8 were significantly worse in group post-I.

CONCLUSIONS

Positive SVA had significantly negative effects on clinical outcome and HRQOL in LSS patients after lumbar decompression surgery.

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

OBJECTIVE

The 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.

METHODS

The 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).

RESULTS

LL 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%.

CONCLUSIONS

Lumbar 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.

Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

OBJECTIVE Previous studies have reported spinal straightening and pelvic retroversion when changing from erect to sitting posture in patients with adolescent idiopathic scoliosis (AIS), which were thought to be related to low-back pain after sitting for long periods. However, the sitting sagittal alignment after posterior spinal fusion has not been evaluated. This study aims to assess the influence of posterior fusion surgery upon sitting sagittal spinopelvic alignment in adolescents with idiopathic thoracic curves (thoracic AIS [T-AIS]). METHODS A total of 44 T-AIS patients (30 Lenke I and 14 Lenke II) from the authors' center were included in this study. Preoperative and postoperative long-cassette lateral radiographs of the spine and pelvis were obtained with the patients in standing and sitting positions. Thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured on standing and sitting lateral radiographs. Patients were divided into selective thoracic fusion (STF) and nonselective thoracic fusion (NSTF) groups. RESULTS At baseline, TK, LL, and SS decreased by 27.5%, 42.1%, and 31.1%, respectively, from the standing to the sitting position, while PT increased by 193.6%. After posterior spinal fusion, increased TK, LL, and SS and corresponding decreased PT were observed compared to baseline parameters in the sitting position. Comparison of postoperative sitting and standing values for the whole cohort showed that the mean LS and SS values were significantly lower in the sitting position (decreased by 14.0% and 13.9%, respectively, compared to standing), whereas the mean PT value was significantly greater (increased by 39.0%, compared to standing). Similar changes were also observed in the STF group: postoperatively the mean LL value was 15.6% lower in sitting than in standing, while the mean SS value was 11.5% lower. However, no obvious changes of the postoperative values in sitting were found in the NSTF group. CONCLUSIONS Nonselective thoracic fusion surgery in T-AIS patients diminished spinal straightening and pelvic retroversion during sitting. Reducing distal fusion levels was of special value in not only saving more lumbar mobility, but also preserving the function of pelvic posterior rotation.

Sagittal-spinopelvic alignment improves in patients with bilateral highly dislocated hip (Crowe type IV) after subtrochanteric shortening total hip arthroplasty: A retrospective radiographic study

In patients with bilateral highly dislocated hips (HDHs), total hip arthroplasty with subtrochanteric shortening osteotomy (S-THA) is a viable option for achieving adequate reconstruction with restoration of the anatomical hip center. This procedure has the potential to improve sagittal spinopelvic alignment (SSPA). However, reports are scarce owing to the rarity of this disease. The objective of this study is to investigate pre- and post-operative SSPA in patients with HDHs who had undergone S-THA. This retrospective radiographic study included 55 patients (54 females and 1 male; average age, 63.1 ± 6.9 years) who underwent S-THA. Lateral spine radiographs in the standing position were obtained pre- and post-operatively. The SSPA included lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), and intervertebral disc (ID) angle of L1/2-L5/S. The SSPA pre- and post-S-THA was compared using a paired t test. Pearson correlation coefficient was used to assess the relationships between parameters. The mean pre- and post-operative LL and SS values were 62° and 49° (LL) and 50° and 39° (SS), respectively (P < .001). The ID angle was significantly reduced post-operatively at all levels (P < .001). The correlation coefficients between preoperative LL and SS and postoperative LL and PI were 0.81 and 0.38, respectively (P < .01). The preoperative SSPA of Crowe type IV HDHs revealed excessive pelvic anteversion and lumbar hyperlordosis, with a high correlation between LL and SS, suggesting that these alterations were compensatory changes to maintain body balance. Furthermore, in patients with HDHs and residual spinal flexibility, restoring the original pelvic morphology with S-THA may contribute to improved SSPA.

Influence of Spinopelvic Alignment on the Clinical Outcomes Following Decompression Surgery for Lumbar Stenosis

Introduction The role of sagittal spinopelvic alignment in lumbar spinal stenosis (LSS) patients and its potential influence on post-decompression surgery outcomes is a topic of growing interest. Lumbar spinal stenosis is a prevalent degenerative condition, and with an aging population, the frequency of surgical interventions for LSS has risen. While decompression surgery aims to relieve symptoms, the potential impact of preoperative spinopelvic alignment on postoperative results remains controversial. This study examined the correlation between sagittal spinopelvic parameters and clinical outcomes in LSS patients undergoing decompression surgery. Methods This study included 100 patients with LSS who underwent decompression surgery between 2021 and 2023 and 100 healthy individuals as a control group. The LSS group comprised 50 men and 50 women, with a mean age of 55.8±12.41 years, while the control group consisted of 50 men and 50 women, with a mean age of 55.17±13.39 years. Sagittal spinopelvic alignment parameters, including pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis, were assessed preoperatively. Postoperative clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results In the cohort of 200 participants, 100 were diagnosed with lumbar spinal stenosis (LSS), and 100 were healthy controls. Both groups had an equal gender distribution (50 males and 50 females). The mean age was 55.8 (±12.4) years for the LSS group and 55.2 (±13.4) years for the control group. Among the analyzed radiographic parameters, only lumbar lordosis (LL) levels showed a significant difference between groups, notably lower in the LSS group (p=0.020). Preoperative VAS scores in LSS patients averaged 7.58±1.32, which postoperatively dropped to 2.22±1.95 (p<0.001). Similarly, ODI (%) declined from a preoperative average of 55.76±11.65 to 18.62±18.17 postoperatively (p<0.001). Patients with postoperative ODI levels exceeding 20% had higher preoperative scores and significantly altered radiographic measurements. The receiver operating characteristic (ROC) analysis indicated PT as the most predictive radiographic parameter, with an area under the curve (AUC) of 0.945. Multivariate logistic regression pinpointed PT and LL as key predictors associated with increased risks for postoperative Oswestry disability levels exceeding 20%. Conclusion Our study suggests that sagittal spinopelvic alignment plays an important role in the development and progression of LSS. Addressing sagittal alignment may be crucial for achieving optimal clinical outcomes after decompression surgery. Further research is needed to elucidate the mechanisms underlying the relationship between sagittal alignment and LSS.

Characteristics of sagittal spinopelvic alignment in patients with Parkinson's disease

Introduction

The aim of this study was to characterize the associations between sagittal spinopelvic alignment and motor symptoms in patients with Parkinson's disease (PD).

Methods

The study included patients with idiopathic PD (aged <80 years and with abnormal posture). All patients underwent whole‐spine lateral and coronal radiography. Sagittal spinopelvic alignment was evaluated using nine parameters. Motor symptoms were evaluated using the Movement Disorder Society‐sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) part III score—with bradykinesia and axial motor sub‐scores. Multivariate analysis was used to analyze associations between motor symptoms and sagittal spinopelvic alignment in PD patients according to sex.

Results

The study subjects were 79 PD patients (39 men, 40 women; median age, 70 years). Clear sex‐related differences were noted. In male patients, the MDS‐UPDRS part III score correlated significantly with cervical sagittal vertical axis (SVA), and bradykinesia and axial motor scores correlated significantly with SVA, cervical SVA, and T1 slope. In female patients, the MDS‐UPDRS part III score correlated significantly with thoracic kyphosis, bradykinesia score correlated significantly with cervical SVA and thoracic kyphosis, and the axial motor score correlated significantly with SVA, cervical SVA, T1 slope, sacral slope, and pelvic tilt.

Conclusion

Our results showed clear correlations among various motor symptoms and sagittal global alignment in PD patients and that these correlations are different in female PD patients and their male counterparts.