Spontaneous correction of sagittal spinopelvic malalignment after decompression surgery without corrective fusion procedure for lumbar spinal stenosis and its impact on clinical outcomes: A systematic review |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan;2. Department of Orthopaedic Surgery, Ota Memorial Hospital, Gunma, Japan;3. Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan;4. Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan;5. Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan;6. Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan;1. Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan;2. Department of Anesthesia, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan;1. Dept. of Orthopaedic Sports Medicine, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-0064, Japan;2. Dept. of Orthopaedic Surgery, Yukioka Hospital, 2-2-3, Ukita, Kitaku, Osaka, Osaka, 530-0021, Japan;3. Dept. of Physical Therapy, Faculty of Biomedical Engineering, Osaka Electro-Communication University, 1130-70, Kiyotaki, Shijonawate, Osaka, 575-0063, Japan;4. Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan;5. Dept. of Orthopaedic Surgery, Osaka Police Hospital, 10-31, Kitayamacho, Tennojiku, Osaka, Osaka, 543-0035, Japan;6. Medical Science Committee, The Japan High School Baseball Federation, 1-22-25 Edobori Nishiku, Osaka, Osaka, 550-0002, Japan;1. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan;2. Dept. of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan;3. Dept. of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan;4. Dept. of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan;5. Dept. of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan;6. Dept. of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan;7. Dept. of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan;8. Dept. of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan;9. Dept. of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan;10. Dept. of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan;11. Dept. of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan;12. Dept. of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan;13. Dept. of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan;14. Dept. of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan;15. Dept. of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan;p. Dept. of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan;q. Dept. of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan;r. Dept. of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan;s. Dept. of Orthopaedic Surgery, Fujita Health University, Aichi, Japan;t. Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan;1. Case Western Reserve University School of Medicine, Cleveland, Ohio, USA;2. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA;3. Department of Neurological Surgery, University Hospitals Cleveland Medical Center;4. Department of Neurology, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;5. Department of Psychiatry, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;1. Department of Neurosurgery, Aydın Adnan Menderes University Faculty of Medicine, Efeler, Aydın, Turkey;2. Department of Radiology, Yüksek İhtisas University Faculty of Medicine, Balgat, Ankara, Turkey;3. Department of Imaging Sciences, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, New York, USA |
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| Abstract: | ![]()
BackgroundThe impact of a positive sagittal vertical axis (SVA) on the surgical outcome for lumbar spinal stenosis (LSS) remains unclear, because sagittal imbalance in LSS may partly result from the tendency of patients to lean forward to reduce symptoms. Such an abnormality could be normalized by decompression surgery alone without corrective fusion. As this spontaneous correction is not well known, some surgeons perform only neural decompression in patients with positive SVA and decreased lumbar lordosis (LL), unless flatback-related symptoms are present, whereas other surgeons add corrective fusion to restore spinopelvic alignment. We systematically reviewed previous studies on this issue.MethodsPubMed, Cochrane Library, and Embase were searched for English articles on the relationship between SVA and decompression surgery for LSS. The rates of spontaneous correction in spinopelvic parameters and the impact of SVA on clinical outcomes were analyzed.ResultsThe rate of spontaneous SVA correction from >40–50 mm to normal values following decompression surgery alone varied from 25% to 73%. Overall, the spinopelvic parameters tended to improve postoperatively, with statistically significant changes in some series. Postoperative residual sagittal imbalance, rather than preoperative imbalance, more consistently showed a negative impact on clinical outcomes, but not on leg symptoms. For predicting postoperative sagittal imbalance, 2 studies identified the cutoff of >20° for preoperative PI-LL mismatch. Another study suggested SVA >80 mm as a useful value for this purpose.ConclusionIn LSS treated with decompression surgery alone, postoperative rather than preoperative sagittal imbalance more consistently affects clinical outcomes, particularly low back pain. This is probably because decompression usually partly improves preoperative spinopelvic sagittal malalignment. Thus, LSS, if associated with preoperative PI-LL mismatch <20° and SVA <80 mm, may not require additional corrective fusion procedures. |
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