Article
The sagittal spinal profile type influences the clinical outcome in patients with lumbar spinal stenosis after microsurgical decompression – a prospective five-year follow-up
Der sagittale Profiltyp beeinflusst das klinische Resultat von Patienten mit lumbaler Spinalkanalstenose, die eine mikrochirurgische Dekompression erhalten haben – ein Verlauf über 5 Jahre
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Authors
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Simon Heinrich Bayerl
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Malte Dinkelbach
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Florian Pöhlmann
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Tobias Finger
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Vincent Prinz
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: 30-40% of patients with symptomatic lumbar spinal stenosis do not benefit from microsurgical decompression. A possible cause might be the anatomical precondition and the spinal alignment of these patients. Recently we presented in a prospective five-year follow-up that the preoperative sagittal balance is not the critical factor concerning patients’ outcome. However, we already know that the Sagittal Profile Type defined by Roussouly influences the 1-year outcome scores after microsurgery. Now we were able to analyse the influence of the sagittal profile type (SPT) on surgical results in a long-term prospective manner.
Methods: Prospective collected five-year follow-up data of 72 patients with lumbar spinal stenosis, who received decompressive surgery, were analysed. Patients were divided into 4 groups according to their SPT. Outcome scores (Numeric Pain Rating Scales for leg and back pain, walking distance, Oswestry Disability Index, Roland and Morris Disability Questionnaire, Odom’s criteria and the SF-36 score) were collected and changes of radiographic parameters were analysed using full spine lateral radiographs.
Results: All patients showed a significant benefit of leg pain and claudication pain after microsurgical decompression. However, Patients with SPT1 did not significantly benefit from surgical decompression concerning back pain scores and back pain associated disability. Their results were significantly worse compared to the groups with other SPTs (DNRSback SPT1= -1,4; DNRSback SPT2= -3,0; DNRSback SPT3= -3,4; DNRSback SPT4= -4,3; DODI SPT1= -14; DODI SPT2= -24; DODI SPT3= -27; DODI SPT4= -29). The success rate (Odom’s criteria) of the SPT1 group was less then 50% compared to 70-80% in all other groups.
Conclusion: The SPT1 with a small pelvic incidence combined with a short lordosis and long kyphosis results in a high load on dorsal lumbar structures. After microsurgical decompression addressing these structures back pain release is not satisfying. Patients are increasingly restricted in their everyday lives over the long-term. After his results we should reconsider whether there might be alternative treatment options for patients with spinal stenosis and SPT1.
