Long-Term Changes in Sagittal Balance After Microsurgical Decompression of Lumbar Spinal Canal Stenosis in Elderly Patients: A Follow-Up Study for 5-Years After Surgery.
World Neurosurg
; 176: e384-e390, 2023 Aug.
Article
em En
| MEDLINE
| ID: mdl-37236312
ABSTRACT
OBJECTIVE:
The purpose of this study is to investigate long-term changes in spinal sagittal balance after microsurgical decompression in lumbar canal stenosis (LCS).METHODS:
Fifty-two patients who underwent microsurgical decompression for symptomatic single level L4/5 spinal canal stenosis at our hospital were included in the study. All patients had standing full spine radiographs taken preoperatively, 1 year postoperatively, and 5 years postoperatively. Spinal parameters including sagittal balance were measured from the obtained images. First, preoperative parameters were compared with 50 age-matched asymptomatic volunteers. Next, the parameters before and after surgery were compared to examine long-term changes.RESULTS:
Sagittal vertical axis (SVA) was significantly increased in the LCS cases compared to the volunteers (P = 0.03). Postoperative lumbar lordosis (LL) was significantly increased (P = 0.03). Postoperative mean SVA decreased but the difference was not significant (P = 0.12). Although there was no correlation between preoperative parameters and the Japanese Orthopedic Association score, postoperative pelvic incidence (PI)-LL and pelvic tilt changes correlated with changes in Japanese Orthopedic Association score (PI-LL; P = 0.0001, pelvic tilt; P = 0.04). However, after 5 years of surgery, LL decreased and PI-LL increased (LL; P = 0.08, PI-LL; P = 0.03). Sagittal balance began to deteriorate but was not significant (P = 0.31). At 5 years postoperatively, 18 of 52 patients (34.6%) were found to have L3/4 adjacent segment disease. Cases with adjacent segment disease showed significantly worse SVA and PI-LL (SVA; P = 0.01, PI-LL; P < 0.01).CONCLUSIONS:
In LCS, lumbar kyphosis improves and sagittal balance tends to improve after microsurgical decompression. However, after 5 years, adjacent intervertebral degeneration occurs more frequently and sagittal balance begins to deteriorate in about one third of cases.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Estenose Espinal
/
Lordose
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Humans
Idioma:
En
Revista:
World Neurosurg
Ano de publicação:
2023
Tipo de documento:
Article