• Momotaro Kawai, Mitsuru Yagi, Toshiki Okubo, Masahiro Ozaki, Satoshi Suzuki, Yohei Takahashi, Osahiko Tsuji, Narihito Nagoshi, Morio Matsumoto, Masaya Nakamura, and Kota Watanabe.
• Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
• Spine. 2024 Jul 15; 49 (14): 100410111004-1011.

Study DesignRetrospective case series.ObjectiveThe aim of this study was to compare the outcomes of posterior decompression surgery for lumbar spinal canal stenosis (LSS) in patients with preoperative sagittal malalignment (MA) with those without, after adjusting for age and sex.Summary Of Background DataSagittal balance is an important factor in spine surgery and is thought to affect postoperative outcomes after LSS. However, the relationship between sagittal MA and postoperative outcomes has not been thoroughly examined.Patients And MethodsWe included 533 patients who underwent surgical treatment for LSS and also achieved 2-year follow-up. Patients were categorized into either an MA+ group (69 patients) or a matched-alignment (MA-) group (348 patients) based on age-adjusted preoperative sagittal alignment. We compared the baseline and 2-year postoperative health-related quality of life (HRQOL) using the Visual Analog Scale and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores. We also calculated clinical efficacy using the minimal clinically important difference based on JOABPEQ scores, and age and sex-adjusted JOABPEQ scores 2 years after surgery. Differences between groups were examined using the Mann-Whitney U test and χ 2 analysis, where applicable.ResultsBoth groups showed an improved HRQOL after decompression surgery. Similar proportions of patients showed substantial improvement, as estimated by the minimal clinically important difference, in 4 out of 5 subdomains of the JOABPEQ. A significantly smaller proportion of patients in the MA+ group showed substantial improvement in lumbar function. The age and sex-adjusted HRQOL scores 2 years after surgery were lower in the MA+ group, particularly in the lumbar function and social life function subdomains of the JOABPEQ.ConclusionThe effects of posterior decompression surgery alone can still be observed at least 2 years postoperatively for patients with LSS and concomitant sagittal MA. Patients with sagittal MA may experience lower HRQOL than those without this type of MA.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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