Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 68 71 Iman Kiani Center for Orthopedic Trans-Disciplinary Applied Research, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Abolfazl Safari Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Parham Talebian Orthopedic Surgeon and Spine Fellowship, Orthopedic Surgery Research Center (OSRC), Tehran University of Medical Sciences, Tehran, Iran 2025 07 27 2026 04 11 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. https://jost.tums.ac.ir/index.php/jost/article/view/699 https://jost.tums.ac.ir/index.php/jost/article/download/699/465