The association between lumbar lordosis preoperatively and changes in PROMs for lumbar spinal stenosis patients 2 years after spinal surgery: radiological and clinical results from the NORDSTEN-spinal stenosis trial.
Lumbar lordosis
Lumbar spinal stenosis
Lumbar spine surgery
Patient-related outcome measures
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
22 Feb 2024
22 Feb 2024
Historique:
received:
24
10
2023
accepted:
09
01
2024
revised:
21
12
2023
medline:
22
2
2024
pubmed:
22
2
2024
entrez:
22
2
2024
Statut:
aheadofprint
Résumé
Patients with lumbar spinal stenosis (LSS) sometimes have lower lumbar lordosis (LL), and the incidence of LSS correlates closely with the loss of LL. The few studies that have evaluated the association between LL and clinical outcomes after non-instrumented surgery for LSS show conflicting results. This study investigates the association between preoperative LL and changes in PROMs 2 years after decompressive surgery. This prospective cohort study obtained preoperative and postoperative data for 401 patients from the multicenter randomized controlled spinal stenosis trial as part of the NORwegian degenerative spondylolisthesis and spinal STENosis (NORDSTEN) study. Before surgery, the radiological sagittal alignment parameter LL was measured using standing X-rays. The association between LL and 2-year postoperative changes was analyzed using the oswestry disability index (ODI), a numeric rating scale (NRS) for low back and leg pain, the Zurich claudication questionnaire (ZCQ), and the global perceived effect (GPE) score. The changes in PROMs 2 years after surgery for quintiles of lumbar lordosis were adjusted for the respective baseline PROMs: age, sex, smoking, and BMI. The Schizas index and the Pfirrmann index were used to analyze multiple regressions for changes in PROMs. There were no associations in the adjusted and unadjusted analyses between preoperative LL and changes in ODI, ZCQ, GPE, and NRS for back and leg pain 2 years after surgery. LL before surgery was not associated with changes in PROMs 2 years after surgery. Lumbar lordosis should not be a factor when considering decompressive surgery for LSS.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with lumbar spinal stenosis (LSS) sometimes have lower lumbar lordosis (LL), and the incidence of LSS correlates closely with the loss of LL. The few studies that have evaluated the association between LL and clinical outcomes after non-instrumented surgery for LSS show conflicting results. This study investigates the association between preoperative LL and changes in PROMs 2 years after decompressive surgery.
METHOD
METHODS
This prospective cohort study obtained preoperative and postoperative data for 401 patients from the multicenter randomized controlled spinal stenosis trial as part of the NORwegian degenerative spondylolisthesis and spinal STENosis (NORDSTEN) study. Before surgery, the radiological sagittal alignment parameter LL was measured using standing X-rays. The association between LL and 2-year postoperative changes was analyzed using the oswestry disability index (ODI), a numeric rating scale (NRS) for low back and leg pain, the Zurich claudication questionnaire (ZCQ), and the global perceived effect (GPE) score. The changes in PROMs 2 years after surgery for quintiles of lumbar lordosis were adjusted for the respective baseline PROMs: age, sex, smoking, and BMI. The Schizas index and the Pfirrmann index were used to analyze multiple regressions for changes in PROMs.
RESULTS
RESULTS
There were no associations in the adjusted and unadjusted analyses between preoperative LL and changes in ODI, ZCQ, GPE, and NRS for back and leg pain 2 years after surgery.
CONCLUSION
CONCLUSIONS
LL before surgery was not associated with changes in PROMs 2 years after surgery. Lumbar lordosis should not be a factor when considering decompressive surgery for LSS.
Identifiants
pubmed: 38386059
doi: 10.1007/s00586-024-08137-5
pii: 10.1007/s00586-024-08137-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Austevoll IM et al (2019) Decompression alone versus decompression with instrumental fusion the NORDSTEN degenerative spondylolisthesis trial (NORDSTEN-DS); study protocol for a randomized controlled trial. BMC Musculoskeletal Disorder 20(1):7. https://doi.org/10.1186/s12891-018-2384-0
doi: 10.1186/s12891-018-2384-0
Roussouly P et al (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30(3):346–353. https://doi.org/10.1097/01.brs.0000152379.54463.65
doi: 10.1097/01.brs.0000152379.54463.65
pubmed: 15682018
Aylott CEW et al (2012) Spinous process morphology: the effect of ageing through adulthood on spinous process size and relationship to sagittal alignment. Eur Spine J 21:1007–1012. https://doi.org/10.1007/s00586-011-2029-6
doi: 10.1007/s00586-011-2029-6
pubmed: 21959943
Bouknaitir JB et al (2022) Change in sagittal alignment after decompression alone in patients with lumbar spinal stenosis without significant deformity: a prospective cohort study. J Neurosurg Spine 37(1):57–63. https://doi.org/10.3171/2021.10.SPINE21445
doi: 10.3171/2021.10.SPINE21445
Abbas J et al (2010) Degenerative lumbar spinal stenosis and lumbar spine configuration. Eur Spine J 19(11):1865–1873. https://doi.org/10.1007/s00586-010-1516-5
doi: 10.1007/s00586-010-1516-5
pubmed: 20652366
pmcid: 2989266
Madkouri R et al (2018) Improvement in sagittal balance after decompression surgery without fusion in patients with degenerative lumbar stenosis: clinical and radiographic results at 1 Year. World Neurosurg 114:e417–e424. https://doi.org/10.1016/j.wneu.2018.03.002
doi: 10.1016/j.wneu.2018.03.002
pubmed: 29530708
Mirzashahi B et al (2022) Factors affecting the outcome of lumbar canal stenosis surgery: a two-year follow-up study. Caspian J Neurol Sci 8(3):143–148. https://doi.org/10.32598/CJNS.8.30.4
doi: 10.32598/CJNS.8.30.4
Hermansen E et al (2022) Comparison of 3 different minimally invasive surgical techniques for lumbar spinal stenosis: a randomized clinical trial. JAMA Netw Open 5(3):e224291. https://doi.org/10.1001/jamanetworkopen.2022.4291.PMID:35344046;PMCID:PMC8961320
doi: 10.1001/jamanetworkopen.2022.4291.PMID:35344046;PMCID:PMC8961320
pubmed: 35344046
pmcid: 8961320
Hermansen E, Austevoll IM, Romild UK et al (2017) Study-protocol for a randomized controlled trial comparing clinical and radiological results after three different posterior decompression techniques for lumbar spinal stenosis: the Spinal Stenosis Trial (SST) (part of the NORDSTEN Study). BMC Musculoskelet Disord 18:121
doi: 10.1186/s12891-017-1491-7
pubmed: 28327114
pmcid: 5361830
Indrekvam K, Bånerud IF, Hermansen E et al (2023) The Norwegian degenerative spondylolisthesis and spinal stenosis (NORDSTEN) study: study overview, organization structure and study population. Eur Spine J 32:4162–4173
doi: 10.1007/s00586-023-07827-w
pubmed: 37395780
Ogen I et al (2022) Factors associated with low back pain in patients with lumbar spinal stenosis: a cross-sectional study. BMC Musculoskelet Disord 23:552. https://doi.org/10.1186/s12891-022-05483-7
doi: 10.1186/s12891-022-05483-7
Hatakka J et al (2021) Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review. Eur Spine J 30:2413–2426. https://doi.org/10.1007/s00586-021-06827-y
doi: 10.1007/s00586-021-06827-y
pubmed: 33844059
Dohzono S et al (2016) Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis. J Neurosurg Spine 25:39–45. https://doi.org/10.3171/2015.12.SPINE15805
doi: 10.3171/2015.12.SPINE15805
pubmed: 26967988
Chun SW et al (2017) The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J 17:1180–1191
doi: 10.1016/j.spinee.2017.04.034
pubmed: 28476690
Chang HS et al (2018) Influence of lumbar lordosis on the outcome of decompression surgery for lumbar canal stenosis. World Neurosurg 109:e684–e690. https://doi.org/10.1016/j.wneu.2017.10.055
doi: 10.1016/j.wneu.2017.10.055
pubmed: 29061449
Costa MA et al (2021) Correlation between clinical outcomes and spinopelvic parameters in patients with lumbar stenosis undergoing decompression surgery. Eur Spine J 30(2):1–8
Schizas C et al (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 35(21):1919–1924. https://doi.org/10.1097/brs.0b013e3181d359bd
doi: 10.1097/brs.0b013e3181d359bd
pubmed: 20671589
Pfirrmann CW et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878
doi: 10.1097/00007632-200109010-00011
pubmed: 11568697