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Does Laminectomy Affect Spino-Pelvic Balance in Lumbar Spinal Stenosis? A Study Based on the EOS X-Ray Imaging System

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The Funnel: From the Skull Base to the Sacrum

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 135))

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Abstract

Purpose: Lumbar spinal stenosis (LSS) is a degenerative disorder causing the forward bending of the trunk and pelvic retroversion with the consequent loss of lumbar lordosis; surgical treatment is intended to enlarge the canal and foramina and decompress the nerve roots. The purpose of our study is to determine whether and to what extent facet-sparing laminectomy affects the spino-pelvic balance.

Methods: The spino-pelvic balance of 26 patients was analysed before and after surgery through the EOS X-ray Imaging System. The following parameters were considered: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Clinical data were expressed in numeric values according to the Oswestry Disability Index (ODI), the visual analogue scale (VAS) and the modified Japanese Orthopaedic Association (mJOA) scoring system.

Results: Significant SS decreases and PT increases were noticed after surgery, without modification in LL, axial vertebral rotation (AVR) and the general alignment. Pain and disability had a significant improvement, as represented by a decrease in scores on the VAS and ODI scales and an increase in scores on the mJOA functional scale.

Conclusion: The most important parameter seems to be a congruence between pelvic and spinal parameters, which achieves an economic posture with the physiologic position of the axis of gravity. According to the literature, a standard sagittal balance (SB) has not been defined.

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References

  1. Overdevest G, Vleggeert-Lankamp C, Jacobs W, Thomé C, Gunzburg R, Peul W. Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Eur Spine J. 2015;24(10):2244–63.

    Article  PubMed  Google Scholar 

  2. Dubousset J, Charpak G, Dorion I, Skalli W, Lavaste F, Deguise J, Kalifa G, Ferey S. A new 2D and 3D imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the EOS system. Bull Acad Natl Med. 2005;189(2):287–97; discussion 297–300.

    PubMed  Google Scholar 

  3. Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop. 2016;10(1):1–14.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schizas C, Нeumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine. 2010;35:1919–24.

    Article  PubMed  Google Scholar 

  5. Fairbank JC, Pynsent PB. The oswestry disability index. Spine. 2000;25:2940–52.

    Article  CAS  PubMed  Google Scholar 

  6. Reips UD, Funke F. Interval-level measurement with visual analogue scales in internet-based research: VAS generator. Behav Res Methods. 2008;40:699–704.

    Article  PubMed  Google Scholar 

  7. Sato N, Sekiguchi M, Kikuchi S, Shishido H, Sato K, Konno S. Effects of long-term corset wearing on chronic low back pain. Fukushima J Med Sci. 2012;58:60–5.

    Article  PubMed  Google Scholar 

  8. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine. 2005;30:346–53.

    Article  PubMed  Google Scholar 

  9. Illés T, Somoskeöy S. Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results. Eur Spine J. 2013;22:1255–63.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, Smith S, Terry A. Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine. 1989;14(1):33–6.

    Article  CAS  PubMed  Google Scholar 

  11. Bresnahan L, Ogden AT, Natarajan RN, et al. A biomechanical evaluation of graded posterior element removal for treatment of lumbar stenosis: comparison of a minimally invasive approach with two standard laminectomy techniques. Spine. 2009;34(1):17–23.

    Article  PubMed  Google Scholar 

  12. Hindle RJ, Pearcy MJ, Cross A. Mechanical function of the human lumbar interspinous and supraspinous ligaments. J Biomed Eng. 1990;12(4):340–4.

    Article  CAS  PubMed  Google Scholar 

  13. Suzuki H, Endo K, Kobayashi H, Tanaka H, Yamamoto K. Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication. Spine. 2010;35:E344–6.

    Article  PubMed  Google Scholar 

  14. Fujii K, Kawamura N, Ikegami M, Niitsuma G, Kunogi J. Radiological improvements in global sagittal alignment after lumbar decompression without fusion. Spine. 2015;40(10):703–9.

    Article  PubMed  Google Scholar 

  15. Hikata T, Watanabe K, Fujita N, Iwanami A, Hosogane N, Ishii K, Nakamura M, Toyama Y, Matsumoto M. Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance. J Neurosurg Spine. 2015;23:451–8.

    Article  PubMed  Google Scholar 

  16. Jeon CH, Lee HD, Lee YS, Seo HS, Chung NS. Change in sagittal profiles after decompressive laminectomy in patients with lumbar spinal canal stenosis. A 2-years preliminary report. Spine. 2015;40(5):E279–85.

    Article  PubMed  Google Scholar 

  17. Bayerl SH, Pöhlmann F, Finger T, Onken J, Franke J, Czabanka M, Woitzik J, Vajkoczy P. The sagittal balance does not influence the 1-year clinical outcome of patients with lumbar spinal stenosis without obvious instability after microsurgical decompression. Spine. 2015;40(13):1014–21.

    Article  PubMed  Google Scholar 

  18. Mac-Thiong JM, Berthonnaud E, Dimar JR, Betz RR, Labelle H. Sagittal alignment of the spine and pelvis during growth. Spine. 2004;29:1642–7.

    Article  PubMed  Google Scholar 

  19. Aaro S, Dahlborn M. Estimation of vertebral rotation and spine rib cage deformity in scoliosis by computer tomography. Spine. 1981;6(5):460–7.

    Article  CAS  PubMed  Google Scholar 

  20. Yazici M, Acaroglu ER, Alanay A, Deviren V, Cila A, Surat A. Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis. J Pediatr Orthop. 2001;21(2):252–6.

    Article  CAS  PubMed  Google Scholar 

  21. Zander T, Rohlmann A, Klockner A, Bergmann G. Influence of graded facetectomy and laminectomy on spinal biomechanics. Eur Spine J. 2003;12(4):427–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Bisschop A, van Engelen SJPM, Kingma I, Holewijn RM, Stadhouder A, van der Veen AJ, van Dieën JH, van Royen BJ. Single level lumbar laminectomy alters segmental biomechanical behavior without affecting adjacent segments. Clin Biomech (Bristol, Avon). 2014;29(8):912–7.

    Article  PubMed  Google Scholar 

  23. Delank KS, Gercek E, Kuhn S, Hartmann F, Hely H, Röllinghoff M, Rothschild MA, Stützer H, Sobottke R, Eysel P. How does spinal canal decompression and dorsal stabilization affect segmental mobility? A biomechanical study. Arch Orthop Trauma Surg. 2010;130(2):285–92.

    Article  PubMed  Google Scholar 

  24. Cardoso MJ, Dmitriev AE, Helgeson M, Lehman RA, Kuklo TR, Rosner MK. Does superior-segment facet violation or laminectomy destabilize the adjacent level in lumbar transpedicular fixation? An in vitro human cadaveric assessment. Spine (Phila Pa 1976). 2008;33(26):2868–73.

    Article  PubMed  Google Scholar 

  25. Stagnara P, De Mauroy JC, Dran G, Gonon GP, Costanzo G, Dimnet J, Pasquet A. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine. 1982;7(4):335–42.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, IRCCS Fondazione Policlinico Universitario “Agostino Gemelli,” Università Cattolica del Sacro Cuore, Rome, Italy

    Manuela D’Ercole & Nicola Montano

  2. Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy

    Gualtiero Innocenzi & Francesco Ricciardi

  3. Medical Physics Department, Ospedale S Anna, San Fermo della Battaglia (Co), Italy

    Paola Lattuada

  4. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

  5. Department of Neurosurgery, Ospedale S Anna, San Fermo della Battaglia (Co), Italy

    Simona Bistazzoni

Authors
  1. Manuela D’Ercole
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  2. Gualtiero Innocenzi
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  3. Paola Lattuada
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  4. Francesco Ricciardi
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  5. Nicola Montano
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  6. Massimiliano Visocchi
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  7. Simona Bistazzoni
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Correspondence to Manuela D’Ercole .

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Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

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The authors have no conflicts of interests to declare that are relevant to the content of this article.

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Approval was obtained from the ethics committee of IRCCS Neuromed. The procedures used in this study adhered to the tenets of the 1964 Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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D’Ercole, M. et al. (2023). Does Laminectomy Affect Spino-Pelvic Balance in Lumbar Spinal Stenosis? A Study Based on the EOS X-Ray Imaging System. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_62

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  • DOI: https://doi.org/10.1007/978-3-031-36084-8_62

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-031-36084-8

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