Radiographic Changes in Sagittal Spinopelvic Parameters Following Lumbar Canal Decompression: A Prospective Cohort Study

Iman  Kiani; Abolfazl  Safari; Parham  Talebian

doi:10.18502/jost.v12i2.21510

Iman Kiani Center for Orthopedic Trans-Disciplinary Applied Research, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
Abolfazl Safari Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
Parham Talebian Orthopedic Surgeon and Spine Fellowship, Orthopedic Surgery Research Center (OSRC), Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v12i2.21510

Keywords: Lumbar Vertebrae; Decompression; Spinal Stenosis; Pelvis

Abstract

Background: Sagittal spinopelvic alignment, encompassing parameters such as lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and plumb line-sagittal vertical axis (PL-SVA), is a critical determinant of outcomes following lumbar decompression surgery. While decompression is effective in alleviating neurogenic claudication in degenerative lumbar spinal stenosis (DLSS), its impact on sagittal alignment remains unclear. This study evaluates the radiographic and clinical outcomes associated with decompression surgery.

Methods: In this prospective cohort study, 24 patients who underwent decompression via laminectomy or laminotomy between July 2017 and July 2018 were included. Sagittal alignment parameters were assessed preoperatively and at follow-up, using Electronic Optical Scan (EOS) imaging. Pain and functional outcomes were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Statistical comparisons were performed using paired t-tests.

Results: Postoperative evaluation showed significant improvement in LL (29.50 ± 15.02 to 51.58 ± 5.99, P < 0.001) and sacral slope (SS) (31.15 ± 2.05 to 26.99 ± 5.00, P < 0.001), and a significant decrease in PT (11.68 ± 2.91 to 6.06 ± 4.62, P < 0.001). No statistically significant changes were noted in PI (P = 0.264) or PL-SVA (P = 0.540). Improvements in LL and SS were negatively correlated with reductions in VAS scores (P = 0.034 and P = 0.028, respectively).

Conclusion: Lumbar decompression was associated with spinopelvic alignment and reduced pain in patients with DLSS. These findings suggest that realignment of sagittal parameters following decompression alone may contribute to improved clinical outcomes