gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Sagittal profile influences the clinical outcome in patients with lumbar spinal stenosis after decompressive surgery

Meeting Abstract

  • Simon Bayerl - Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Florian Poehlmann - Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Tobias Finger - Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.01.06

doi: 10.3205/14dgnc267, urn:nbn:de:0183-14dgnc2674

Published: May 13, 2014

© 2014 Bayerl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Patients with symptomatic lumbar spinal stenosis should be treated by operative decompression. Nevertheless there is a significant amount of patients, who doesn’t benefit from surgery. The sagittal profile defined by Roussouly has been shown to effect the clinical outcome of patients with degenerative disc disease after total disc replacement. However no study exists, that investigates whether the different types of sagittal profile (SPT1-4) influence the postoperative outcome of patients with spinal stenosis, who received decompressive surgery without instrumentation.

Method: Our retrospective study contains 121 patients with lumbar spinal stenosis, who received lumbar spinal decompression without instrumentation between 2011 and 2013. In our preliminary data we show the short-term follow-up (10.4 ± 3.3 months) of 80 patients. Preoperatively all patients received whole spine upright standing x-rays. The patients were differentiated in 4 groups according to the different types of sagittal profile. The clinical outcome was determined by the Oswestry Disability Index (ODI), Roland Morris Questionnaire (RMQ), Odom’s criteria, Visual Analogue Scale (VAS) for leg pain and back pain as well as walking distance and time before and 6-18 months after surgery.

Results: 80 patients display all 4 sagittal profile types (type 1: n=15; type 2 n=23; type 3: n=24; type 4: n=18). Already after several months of follow-up we see a statistical significant difference concerning the clinical outcome in the 4 groups. Patients with SPT 1 are suffering from significantly stronger low back pain (VAStype 1= 5.8±2.4; VAStype 2= 3.7±2.9; VAStype 3= 3.7±2.9; VAStype 4= 1.0±1.6). Additionally the functional disability is increased in patients with SPT 1 (ODItype 1= 38.3±14,8%; ODItype 2= 26,3±11.1%; ODItype 3= 28.3±10.3%; ODItype 4= 15.9±16.8%). Thus only 40% of patients with SPT 1 rated an excellent or good outcome (Odom’s criteria good/excellent: Type 2: 70%; Type 3: 79%; Type 4: 88%).

Conclusions: Patients with SPT 1 and lumbar spinal stenosis show a worse clinical outcome compared with other profile types several months after surgery. Hyperlordosis in the lower lumbar spine with increased shear forces and facet load might lead to increased back pain and functional disability. This study indicates, that in patients with SPT 1 suffering from symptomatic spinal stenosis and back pain decompression with additional instrumentation should be considered.