Abstract
ABSTRACT Objective To compare the sagittal alignment (SA) parameters in individuals with LCS and surgical indication with a control group and to study the correlations between SA parameters and ODI, VAS and EQ-5D in individuals with LCS and surgical indication. Methods In this multicenter cross-sectional case-control study, the individuals were allocated as follows. A stenosis group (SG) composed by patients with LCS confirmed by magnetic resonance imaging with surgical indication, treated between July 2010 and August 2016 and a control group (CG), without LCS. All subjects underwent anamnesis, completed the Health-related Quality of Life (HRQoL) and total spine radiographs were taken. Clinical data, HRQoL and radiographic parameters were correlated. Results Sixty-four individuals formed the SG and 14 the CG. The SG had higher values of mean age, coronal imbalance, sagittal vertical axis (SVA), pelvic tilt (PT), sacrofemoral distance (SFD), overhang (OH), PI-LL mismatch, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain and smaller thoracic kyphosis (TK), total (TLPL) and regional lumbopelvic lordosis (RLPL) in all vertebrae, sagittal offset (SO) in all evaluated vertebrae and EuroQol-5D (EQ-5D) with p <0.05. In the SG, the only significant correlations (p <0.05) were between TK and ODI and EQ-5D; all the other sagittal parameters did not correlated with VAS, ODI or EQ-5D. Conclusion SG had SA parameters altered in relation to CG. There was a direct correlation between decrease in TK and worsening of ODI and EQ-5D in SG. Level of evidence: III; Case Control Study.
Highlights
Degenerative lumbar stenosis (DLS) is a narrowing of the lumbar spinal canal and/or the vertebral foramens, characterized by low back pain, radicular pain, and/or claudication
The Visual Analog Scale (VAS) presented a correlation with the LLR of L4 (r = - 0.662 and p = 0.014), L5 (r = - 0.624 and p = 0.023), T1 sagittal alignment (SA) (r = -0.6 and p = 0.039), T9 SA (r = - 0.607 and p = 0.036), and PI-lumbar lordosis (LL) mismatch (r = - 0.599 and p = 0.024)
The lack of a correlation observed between the SA parameters and quality of life in the above-mentioned study is compatible with the data obtained in our study. This raises questions about the reproducibility of the results reported in studies that claim that the SA parameters are predictors of quality of life in individuals with DSL
Summary
Degenerative lumbar stenosis (DLS) is a narrowing of the lumbar spinal canal and/or the vertebral foramens, characterized by low back pain, radicular pain, and/or claudication. It is a common clinical condition, affecting more than 200,000 people in the USA,[1] being the main reason for indications of spinal surgery in patients above 65 years of age and affecting 1 in every 1000 people per year in this age group.[2] The increasing prevalence of disease, considered an exacerbation of the degenerative physiological process of aging, is expected as the life expectancy of the population continues to rise.[3,4]. Flexion of the trunk increases the area of the lumbar foramens by 12% and in extension there is a reduction of 15% of their sectional area.[8]
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