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Abstract

Background: Postoperative sagittal alignment has been shown to be associated with patient-reported outcome measures (PROMs) following open lumbar decompression procedures, although it is unknown whether preoperative sagittal imbalance affects clinical outcomes of minimally invasive surgical (MIS) decompression only surgery. Purpose: We sought to evaluate the impact of preoperative pelvic incidence-lumbar lordosis (PI-LL) imbalance on PROMs after MIS laminectomy for the treatment of neurogenic claudication symptoms. Methods: We conducted a retrospective cohort study of adult patients undergoing MIS laminectomy for degenerative lumbar spinal stenosis between April 2017 and April 2021 at a single institution. Of the 52 patients included (mean follow-up, 17 months) radiographs were taken prior to surgery and assessed for sagittal alignment parameters. Patients were grouped based on the preoperative PI-LL (balanced vs unbalanced). Changes in PROMs were compared between unbalanced PI-LL and balanced PI-LL groups. Minimal clinically important difference (MCID) for Oswestry Disability Index (ODI) was also assessed. Results: Of the 52 patients, 17 (32.7%) had unbalanced age-adjusted preoperative PI-LL. There was no significant difference found in PROMs between unbalanced and balanced PI-LL groups preoperatively or at final follow-up. Compared with those with unbalanced PI-LL, patients with balanced PI-LL were shown to have no added benefit in achieving MCID for ODI at long-term follow-up and no added benefit in the time to achieving MCID. Conclusion: These retrospective findings suggest that patients with unbalanced preoperative PI-LL may experience significant benefit in long-term clinical outcomes following MIS laminectomy, similarly to those with balanced PI-LL at baseline. The findings also suggest that the presence of sagittal imbalance preoperatively may not appreciably influence the long-term clinical outcomes following MIS laminectomy. Prospective study involving a larger population is warranted.

Keywords

minimally invasive lumbar spine laminectomy decompression sagittal alignment PI-LL

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References

Barrey

Roussouly

Perrin

Le Huec

. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J. 2011;20(suppl 5):626–633. https://doi.org/10.1007/s00586-011-1930-3.

Bayerl

Pöhlmann

Finger

, et al. The sagittal balance does not influence the 1 year clinical outcome of patients with lumbar spinal stenosis without obvious instability after microsurgical decompression. Spine. 2015;40:1014–1021. https://doi.org/10.1097/brs.0000000000000928.

Beyer

Khalifé

Lafage

, et al. Pelvic compensation in sagittal malalignment: how much retroversion can the pelvis accommodate? Spine. 2020;45:e203–e209. https://doi.org/10.1097/brs.0000000000003228.

Bouras

Stranjalis

Loufardaki

, et al. Predictors of long-term outcome in an elderly group after laminectomy for lumbar stenosis. J Neurosurg Spine. 2010;13:329–334. https://doi.org/10.3171/2010.3.Spine09487.

Chan

Bisson

Bydon

, et al. Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine. 2018;30:234–241. https://doi.org/10.3171/2018.8.Spine17913.

Chang

. Effect of sagittal spinal balance on the outcome of decompression surgery for lumbar canal stenosis. World Neurosurg. 2018;119:e200–e208. https://doi.org/10.1016/j.wneu.2018.07.104.

Copay

Glassman

Subach

Berven

Schuler

Carreon

. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8:968–974. https://doi.org/10.1016/j.spinee.2007.11.006.

Dohzono

Toyoda

Hori

, et al. Spinopelvic sagittal alignment after microendoscopic laminotomy in patients with lumbar degenerative spondylolisthesis. J Neurol Surg A Cent Eur Neurosurg. 2018;79:479–485. https://doi.org/10.1055/s-0038-1666847.

Duchesne

Kyle

Simmons

, et al. Impact of telemedicine upon rural trauma care. J Trauma. 2008;64(1):92–97. https://doi.org/10.1097/TA.0b013e31815dd4c4.

10.

Farrokhi

Haghnegahdar

Rezaee

Sharifi Rad

. Spinal sagittal balance and spinopelvic parameters in patients with degenerative lumbar spinal stenosis; a comparative study. Clin Neurol Neurosurg. 2016;151:136–141. https://doi.org/10.1016/j.clineuro.2016.10.020.

11.

Glassman

Bridwell

Dimar

Horton

Berven

Schwab

. The impact of positive sagittal balance in adult spinal deformity. Spine. 2005;30:2024–2029. https://doi.org/10.1097/01.brs.0000179086.30449.96.

12.

Hikata

Watanabe

Fujita

, et al. Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance. J Neurosurg Spine. 2015;23:451–458. https://doi.org/10.3171/2015.1.Spine14642.

13.

Kennamer

Arginteanu

Moore

Steinberger

Yao

Gologorsky

. Complications of poor cervical alignment in patients undergoing posterior cervicothoracic laminectomy and fusion. World Neurosurg. 2019;122:e408–e414. https://doi.org/10.1016/j.wneu.2018.10.062.

14.

Lafage

Schwab

Challier

, et al. Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine. 2016;41:62–68. https://doi.org/10.1097/brs.0000000000001171.

15.

Le Huec

Thompson

Mohsinaly

Barrey

Faundez

. Sagittal balance of the spine. Eur Spine J. 2019;28:1889–1905. https://doi.org/10.1007/s00586-019-06083-1.

16.

Lee

Jahng

Hyun

Kim

. Expansive laminoplasty versus laminectomy alone versus laminectomy and fusion for cervical ossification of the posterior longitudinal ligament: is there a difference in the clinical outcome and sagittal alignment? Clin Spine Surg. 2016;29:E9–E15. https://doi.org/10.1097/bsd.0000000000000058.

17.

Liu

Zheng

Wang

. Pelvic retroversion is the key protective mechanism of L4-5 degenerative spondylolisthesis. Eur Spine J. 2015;24:1204–1211. https://doi.org/10.1007/s00586-014-3395-7.

18.

Löfgren

Osman

Blomqvist

Vavruch

. Sagittal alignment after laminectomy without fusion as treatment for cervical spondylotic myelopathy: follow-up of minimum 4 years postoperatively. Global Spine J. 2020;10:425–432. https://doi.org/10.1177/2192568219858302.

19.

Louie

Vaishnav

Gang

, et al. Development and initial internal validation of a novel classification system for perioperative expectations following minimally invasive degenerative lumbar spine surgery. Clin Spine Surg. 2021;34:E537–E544. https://doi.org/10.1097/bsd.0000000000001246.

20.

Lovecchio

Vaishnav

Steinhaus

, et al. Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion? Neurosurg Focus. 2020;49:E17. https://doi.org/10.3171/2020.6.Focus20393.

21.

Lovecchio

Qureshi

. The current state of minimally invasive approaches to adult spinal deformity. Curr Rev Musculoskelet Med. 2019;12:318–327. https://doi.org/10.1007/s12178-019-09570-6.

22.

Lugue

MKT

Watanabe

Yamazaki

, et al. Impact of L4/5 posterior interbody fusion with or without decompression on spinopelvic alignment and health-related quality-of-life outcomes. Clin Spine Surg. 2020;33:E504–E511. https://doi.org/10.1097/bsd.0000000000001013.

23.

Madkouri

Brauge

Vidon-Buthion

, et al. 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;114:e417–e424. https://doi.org/10.1016/j.wneu.2018.03.002.

24.

Mok

Gang

Qureshi

McAnany

. Using minimally invasive techniques adds to the value equation for select patients. J Spine Surg. 2019;5:S101–S107. https://doi.org/10.21037/jss.2019.05.03.

25.

Ogura

Shinozaki

Kobayashi

, et al. Impact of decompression surgery without fusion for lumbar spinal stenosis on sagittal spinopelvic alignment: minimum 2-year follow-up [published online ahead of print February 15, 2019]. J Neurosurg Spine. https://doi.org/10.3171/2018.11.Spine181092.

26.

Phan

Mobbs

. Minimally invasive versus open laminectomy for lumbar stenosis: a systematic review and meta-analysis. Spine. 2016;41:E91–E100. https://doi.org/10.1097/brs.0000000000001161.

27.

Pourtaheri

Sharma

Savage

, et al. Pelvic retroversion: a compensatory mechanism for lumbar stenosis. J Neurosurg Spine. 2017;27:137–144. https://doi.org/10.3171/2017.2.Spine16963.

28.

Shahi

Shinn

Singh

, et al. ODI <25 denotes patient acceptable symptom state after minimally invasive lumbar spine surgery. Spine. 2023;48(3):196–202. https://doi.org/10.1097/brs.0000000000004479.

29.

Shahi

Song

Dalal

, et al. Improvement following minimally invasive lumbar decompression in patients 80 years or older compared with younger age groups. J Neurosurg Spine. 2022;37:828–835. https://doi.org/10.3171/2022.5.Spine22361.

30.

Shahi

Vaishnav

Mai

, et al. Practical answers to frequently asked questions in minimally invasive lumbar spine surgery. Spine J. 2023;23:54–63. https://doi.org/10.1016/j.spinee.2022.07.087.

31.

Szewczyk

Riccio

Entezami

German

. The effect of minimally invasive dorsal cervical decompression for myelopathy on spinal alignment and range of motion. Clin Neurol Neurosurg. 2020;196:105967. https://doi.org/10.1016/j.clineuro.2020.105967.

32.

Vaishnav

Gang

Qureshi

. Time-demand, radiation exposure and outcomes of minimally invasive spine surgery with the use of skin-anchored intraoperative navigation: the effect of the learning curve. Clin Spine Surg. 2022;35:E111–E120. https://doi.org/10.1097/bsd.0000000000001167.

33.

Vaishnav

Othman

Virk

Gang

Qureshi

. Current state of minimally invasive spine surgery. J Spine Surg. 2019;5:S2–S10. https://doi.org/10.21037/jss.2019.05.02.

34.

Vaishnav

Saville

McAnany

, et al. Retrospective review of immediate restoration of lordosis in single-level minimally invasive transforaminal lumbar interbody fusion: a comparison of static and expandable interbody cages. Oper Neurosurg. 2020;18:518–523. https://doi.org/10.1093/ons/opz240.

35.

Virk

Qureshi

. Navigation in minimally invasive spine surgery. J Spine Surg. 2019;5:S25–S30. https://doi.org/10.21037/jss.2019.04.23.

36.

Zhao

Xie

Zhao

. Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion: a finite element analysis. World Neurosurg. 2018;114:e114–e120. https://doi.org/10.1016/j.wneu.2018.02.073.

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The Impact of Preoperative Sagittal Imbalance on Long-term Postoperative Outcomes Following Minimally Invasive Laminectomy

Abstract

Keywords

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