Research Articles

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

Abstract

Background: Sagittal spinopelvic alignment, encompassing parameters such as lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and 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 uncertain. This study evaluates the radiographic and clinical outcomes associated with decompression surgery.
Methods: In this prospective cohort study, 24 patients underwent decompression via laminectomy or laminotomy between July 2017 and July 2018. Sagittal alignment parameters were assessed preoperatively and at follow-up using 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), SS (31.15 ± 2.05 to 26.99 ± 5, 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).
Conclusion: Lumbar decompression can significantly influence spinopelvic alignment and reduce pain in patients with DLSS. These findings suggest that realignment of sagittal parameters following decompression alone may contribute to improved clinical outcomes.

1. Ames CP, Smith JS, Scheer JK, Bess S, Bederman SS, Deviren V, et al. Impact of spinopelvic alignment on decision making in deformity surgery in adults: A review. J Neurosurg Spine. 2012;16(6):547-64. doi: 10.3171/2012.2.Spine11320. [PubMed: 22443546].
2. Sai Krishna M, Sharma D, Menon J, Barathi D. Low Back PainHow Significant are the Spinopelvic Parameters? Global Spine J. 2016;6(1_suppl):s-0036-1582699-s-0036-. doi: 10.1055/s-00361582699.
3. Silvers HR, Lewis PJ, Asch HL. Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg. 1993;78(5):
695-701. doi: 10.3171/jns.1993.78.5.0695. [PubMed: 8468598].
4. Lenga P, Gülec G, Bajwa AA, Issa M, Oskouian RJ, Chapman JR, et al. Lumbar Decompression versus Decompression and Fusion in Octogenarians: Complications and Clinical Course With 3-Year Follow-Up. Global Spine J. 2024;14(2):687-96. doi: 10.1177/21925682221121099. [PubMed: 36148681]. [PubMed Central: PMC10802554].
5. Ball JR, Gallo MC, Kebaish K, Hang N, Ton A, Hernandez F, et al. National Trends in Lumbar Degenerative Spondylolisthesis With Stenosis Treated With Fusion Versus Decompression. Neurospine. 2024;21(4):1068-77. doi: 10.14245/ns.2448624.312. [PubMed: 39765242]. [PubMed Central: PMC11744538].
6. Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK. A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis. Pain Med. 2019;20(Suppl 2):S32-s44. doi: 10.1093/pm/pnz161. [PubMed: 31808530]. [PubMed Central: PMC7101166].
7. 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-year preliminary report. Spine (Phila Pa 1976). 2015;40(5):E279-85. doi: 10.1097/brs.0000000000000745. [PubMed: 25901983].
8. Fujii K, Kawamura N, Ikegami M, Niitsuma G, Kunogi J. Radiological improvements in global sagittal alignment after lumbar decompression without fusion. Spine (Phila Pa 1976). 2015;40(10):703-9. doi: 10.1097/brs.0000000000000708. [PubMed: 25394314].
9. Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop. 2015;39(1): 87-95. doi: 10.1007/s00264-014-2516-6. [PubMed: 25192690].
10. Lenz M, Oikonomidis S, Hartwig R, Gramse R, Meyer C, Scheyerer MJ, et al. Clinical outcome after lumbar spinal J Orthop Spine Trauma. 2026; 12(2): 68-71. fusion surgery in degenerative spondylolisthesis: a 3-year
follow-up. Arch Orthop Trauma Surg. 2022;142(5):721-7. doi: 10.1007/s00402-020-03697-9. [PubMed: 33372234]. [PubMed Central: PMC8994725].
11. Bayerl SH, Pöhlmann F, Finger T, Onken J, Franke J, Czabanka M, et al. The Sagittal Balance Does not Influence the 1 Year Clinical Outcome of Patients with Lumbar Spinal Stenosis without Obvious Instability after Microsurgical Decompression. Spine (Phila Pa 1976). 2015;40(13):1014-21. doi: 10.1097/brs.0000000000000928. [PubMed: 25893354].
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IssueVol 12 No 2 (2026) QRcode
SectionResearch Articles
DOI https://doi.org/10.18502/jost.v12i2.21510
Keywords
Lumbar Vertebrae Decompression Spinal Stenosis Pelvis
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How to Cite
1.
Kiani I, Safari A, Talebian P. Radiographic Changes in Sagittal Spinopelvic Parameters Following Lumbar Canal Decompression: A Prospective Cohort Study. J Orthop Spine Trauma. 2026;12(2):68-71.