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Preoperative sagittal balance may not correlate with quality of life after decompressive surgery
Researchers from Tokyo found no significant correlations between preoperative sagittal balance and quality of life or clinical results following lumbar decompression surgery in patients with lumbar spinal canal stenosis without coronal imbalance.
In this study, researchers retrospectively reviewed data of consecutive patients with lumbar canal stenosis (LCS) who were treated from 2009 to 2011. A total of 109 patients were included and analyzed according to preoperative sagittal vertical axis (SVA) parameters.
The patients were categorized as having a preoperative SVA less than 50 mm (group A) or having a preoperative SVA greater than or equal to 50 mm (group B). Researchers noted those in group B had a significantly smaller lumbar lordosis and thoracic kyphosis angles, and a larger pelvic tilt.
After surgery, patients in group B experienced a significant decrease in SVA (76.3 ± 29.7 mm vs. 54.3 ± 39.8 mm). Researchers also found patients with a preoperative SVA greater than 80 mm experienced a residual postoperative sagittal imbalance of 82.8 ± 41.6 mm.
There were no significant differences preoperatively and postoperatively in VAS scores, Roland-Morris Disability Questionnaire (RMDQ) scores or Health Related Quality of Life (HRQoL) scores between groups A and B, the researchers wrote.
However, patients with a severe preoperative SVA of more than 80 mm compared to patients with a normal postoperative SVA of less than 50 mm had significantly less postoperative JOA Back Pain Evaluation Questionnaire scores for walking ability and higher RMDQ and VAS scores for low-back pain.
The researchers concluded decompressive surgery for LCS improved SVA values in patients with preoperative sagittal imbalance, but patients with severe preoperative sagittal imbalance had postoperative residual imbalance. Clinical and HRQoL outcomes were both negatively influenced by postoperative residual imbalance. – by Robert Linnehan
Disclosures: The researchers report no relevant financial disclosures.