Abstract
Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis.
Highlights
Global sagittal imbalance with lumbar hypo-lordosis has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations [1,2]. This condition can cause a variety of problems, including low back pain (LBP) while standing and/or walking
To correct the sagittal imbalance, highly invasive long-segment fusion surgery with posterior wedge osteotomy [6] is still the mainstream for these cases. The essence of these operations is the shortening of the posterior elements [7] and rationally correct, the procedures are highly invasive and frequently cause severe complications
This is a retrospective study of seven consecutive patients who underwent processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise for thoraco-lumbar kyphosis between 1 March and 30 September 2019 at one single spine center
Summary
Global sagittal imbalance with lumbar hypo-lordosis has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations [1,2] This condition can cause a variety of problems, including low back pain (LBP) while standing and/or walking. Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis
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