Spontaneous correction of the sagittal balance of the spine after decompressive surgery for degenerative lumbar stenosis

BACKGROUND: Correction of sagittal imbalance in patients with degenerative spine conditions is typically achieved through corrective decompressingstabilizing procedures that restore angular relationships in the spine. In some cases, however, surgeons have observed an improvement in both regional and overall balance after isolated decompressions. The question that remains is what mechanisms and factors contribute to the spontaneous correction of sagittal alignment after lumbar decompression surgery.

AIMS: to determine changes in the sagittal profile of the spine after decompression surgery in patients who have undergone decompression surgery for degenerative lumbar stenosis.

MATERIALS AND METHODS: prospective observational study of 96 patients who underwent microsurgical decompression for degenerative lumbar stenosis at all clinically significant levels. Clinical and radiological outcomes were assessed by measuring various parameters of the sagittal profile, such as Pi, Pt, SS, low LL, LL, SVA, and Barrey index, both before and 6 months after surgery.

RESULTS: In the postoperative period, a significant increase in lower lumbar lordosis LowLL (L4-S1) (p=0.03), an increase in segmental angles L2-L3, L3-L4, L4-L5, L5-S1 (p<0.05), a decrease in the Barrey index (p=0.048), indicating a spontaneous correction of regional and global balance of the spine without surgical correction of vertebral-pelvic parameters. Significant predictors of this correction after isolated lumbar decompression were the Pelvic Incidence value before surgery (p=0.07), the patient's age (p<0.001), and the SVA value before surgery (p=0.002).

CONCLUSIONS: In isolated decompressive surgeries performed on patients with degenerative spinal stenosis, there has been an improvement in both regional and global sagittal alignment parameters. This means that there has been a spontaneous correction of the balance without the need for any corrective measures. Predictors for this spontaneous balance correction include a Pi value, a patient age, and a preoperative SVA value. Isolated decompression of the intracranial neurovascular structures at the lumbar level can sometimes eliminate orthopedic issues that were not initially targeted by surgery.

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