Long-Term Changes in Sagittal Balance After Microsurgical Decompression of Lumbar Spinal Canal Stenosis in Elderly Patients: A Follow-Up Study for 5-Years After Surgery

World Neurosurg. 2023 Aug:176:e384-e390. doi: 10.1016/j.wneu.2023.05.069. Epub 2023 May 24.


Objective: The purpose of this study is to investigate long-term changes in spinal sagittal balance after microsurgical decompression in lumbar canal stenosis (LCS).

Methods: Fifty-two patients who underwent microsurgical decompression for symptomatic single level L4/5 spinal canal stenosis at our hospital were included in the study. All patients had standing full spine radiographs taken preoperatively, 1 year postoperatively, and 5 years postoperatively. Spinal parameters including sagittal balance were measured from the obtained images. First, preoperative parameters were compared with 50 age-matched asymptomatic volunteers. Next, the parameters before and after surgery were compared to examine long-term changes.

Results: Sagittal vertical axis (SVA) was significantly increased in the LCS cases compared to the volunteers (P = 0.03). Postoperative lumbar lordosis (LL) was significantly increased (P = 0.03). Postoperative mean SVA decreased but the difference was not significant (P = 0.12). Although there was no correlation between preoperative parameters and the Japanese Orthopedic Association score, postoperative pelvic incidence (PI)-LL and pelvic tilt changes correlated with changes in Japanese Orthopedic Association score (PI-LL; P = 0.0001, pelvic tilt; P = 0.04). However, after 5 years of surgery, LL decreased and PI-LL increased (LL; P = 0.08, PI-LL; P = 0.03). Sagittal balance began to deteriorate but was not significant (P = 0.31). At 5 years postoperatively, 18 of 52 patients (34.6%) were found to have L3/4 adjacent segment disease. Cases with adjacent segment disease showed significantly worse SVA and PI-LL (SVA; P = 0.01, PI-LL; P < 0.01).

Conclusions: In LCS, lumbar kyphosis improves and sagittal balance tends to improve after microsurgical decompression. However, after 5 years, adjacent intervertebral degeneration occurs more frequently and sagittal balance begins to deteriorate in about one third of cases.

Keywords: Lumbar spinal canal stenosis; Microsurgical decompression; Spinal sagittal balance.

MeSH terms

  • Aged
  • Constriction, Pathologic
  • Decompression
  • Follow-Up Studies
  • Humans
  • Lordosis* / diagnostic imaging
  • Lordosis* / surgery
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery
  • Retrospective Studies
  • Spinal Canal
  • Spinal Stenosis* / diagnostic imaging
  • Spinal Stenosis* / surgery