• Weiguo Zhu, Kang Sun, Xiangyu Li, Chao Kong, and Shibao Lu.
• Department of Orthopaedic Surgery, Xuanwu Hospital Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China.
• World Neurosurg. 2022 Aug 1; 164: e741-e748.

ObjectiveWe sought to investigate the risk factors of suboptimal postoperative outcomes after short-segment surgery for degenerative lumbar spinal stenosis and severe sagittal imbalance and to recommend the appropriate candidates for the short fusion.MethodsA total of 101 elderly subjects who underwent short-segment surgery were included. Preoperative sagittal vertical axis decreased to ≤50 mm was determined as sagittal compensation; otherwise, it was determined as sagittal decompensation. At the latest follow-up, 64 patients with sagittal decompensation and 14 patients with proximal junctional kyphosis (PJK) were detected. Sagittal imbalance with the related symptoms was named as symptomatic sagittal imbalance. Preoperative clinical data and spinopelvic parameters were collected and compared between different groups.ResultsSymptomatic sagittal imbalance and severe degeneration of paravertebral muscle were revealed to be the risk factors for sagittal decompensation and PJK. More sagittal decompensations (100%) and PJKs (60%) were observed in patients with both of these risk factors. On the contrary, postoperative outcomes were superior with less sagittal decompensation (46.9%) and PJK (0%) in those with neither of the 2 factors.ConclusionsSymptomatic sagittal imbalance and severe degeneration of paraspinal muscle are the risk factors predisposing suboptimal surgical outcomes after lumbar short-segment decompression and fusion for degenerative lumbar spinal stenosis. We believe essential spinal function and substantial quality of paraspinal muscle are the keys to long-lasting good outcomes.Copyright © 2022 Elsevier Inc. All rights reserved.

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