Improvement in sagittal balance after decompression surgery without fusion in patients with degenerative lumbar stenosis: Clinical and radiographic results at 1 year.

Improvement in sagittal balance after decompression surgery without fusion in patients with degenerative lumbar stenosis: Clinical and radiographic results at 1 year.

World Neurosurg. 2018 Mar 09;:

Authors: Madkouri R, Brauge D, Vidon-Buthion A, Fahed E, Mourier KL, Beaurain J, Grelat M

Abstract
OBJECTIVE: The aim of this study was to evaluate modifications in static spinal status after posterior decompression surgery without fusion in patients with symptomatic central canal stenosis.
MATERIAL & METHODS: From November 2014 to May 2016, 72 patients who underwent isolated decompression for lumbar spinal stenosis were prospectively enrolled in this monocentric study. All of the patients had lateral full-body x-rays using the EOS system (EOS Imaging, Paris, France) before surgery and after 12 months of follow-up. Patients were classified into 3 groups according to their preoperative Sagittal Vertical Axis (<50mm, ≥ 50 mm and < 100mm, ≥ 100 mm).
RESULTS: SVA decreased significantly (SVA preop: 72.3 ± 43.1; SVA postop: 48.3 ± 46.8. p < 0.001). Lumbar lordosis increased significantly from 41.9 ± 13.4 in the preoperative period to 46.5 ± 14.8 at the last follow-up (p < 0.001). In the imbalance groups, the mean postoperative SVA decreased significantly compared with preoperative SVA (p = 0.004). Surgery led to a significant increase in lumbar lordosis in the three groups (p<0.05). Nonetheless, a certain degree of residual imbalance persisted in the major imbalance group. In all of the groups, decompression surgery led to a significant improvement in clinical scores (p<0.05).
CONCLUSION: Our study showed an improvement in sagittal balance and lumbar lordosis following decompression surgery without fusion, even in patients with a preoperative SVA > 100 mm. However, a certain degree of sagittal imbalance may persist following the surgery in patients with major initial imbalance (SVA> 100 mm). Nonetheless, after surgery, these patients experienced a clinical benefit comparable to that in the other groups.

PMID: 29530708 [PubMed - as supplied by publisher]

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