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European Spine Journal

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01-08-2017 | Original Article

Surgical versus nonsurgical treatment of lumbar degenerative kyphosis

Authors: Tae Sik Goh, Jong Ki Shin, Myung Soo Youn, Hong Seok Lee, Taek Hoon Kim, Jung Sub Lee

Published in: European Spine Journal | Issue 8/2017

Abstract

Purpose

Surgery is widely performed for lumbar degenerative kyphosis (LDK), but its effectiveness as compared with nonsurgical treatment has not been demonstrated.

Methods

In this prospective study, surgical candidates with LDK were enrolled at three spine centres. Two treatment options were performed either surgery using a pedicle subtraction osteotomy or nonsurgical care. Outcomes were measured using a Visual analogue scale (VAS) of back pain as a primary endpoint, the Oswestry disability index (ODI), the 36-item short-form health survey (SF-36), sagittal vertical axis (SVA) and treatment-related complications.

Results

Of the 126 LDK patients treated during the reference period, 97 patients were enrolled (47 in the surgical group and 50 in the nonsurgical group). Surgical group produced statistically reduced VAS of back pain and better functional outcomes than nonsurgical group since 12 months after treatment, but the rate of serious complications was higher after surgery. Interestingly, both surgical and nonsurgical groups had improved outcomes in terms of pain intensity and function at the 2-year follow-up period.

Conclusions

Surgery might be a preferred treatment option for LDK, but great caution is needed. And conservative treatment could be the considerable treatment option for LDK who is unwilling or has poor medical condition to operate.

Kim WJ, Kang JW, Kang SI, Sung HI, Park KY, Park JG, Kwon WC, Choy WS (2010) Factors affecting clinical results after corrective osteotomy for lumbar degenerative kyphosis. Asian Spine J 4:7–14. doi:10.4184/asj.2010.4.1.7 CrossRefPubMedPubMedCentral

Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, Eoh JH, Kim YJ (2010) Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976) 35:E1386–E1391. doi:10.1097/BRS.0b013e3181e88be6 CrossRef

Lee SH, Kim KT, Suk KS, Lee JH, Seo EM, Huh DS (2011) Sagittal decompensation after corrective osteotomy for lumbar degenerative kyphosis: classification and risk factors. Spine (Phila Pa 1976) 36:E538–E544. doi:10.1097/BRS.0b013e3181f45a17 CrossRef

Lee CS, Lee CK, Kim YT, Hong YM, Yoo JH (2001) Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine (Phila Pa 1976) 26:2029–2035CrossRef

Jang JS, Lee SH, Kim JM, Min JH, Han KM, Maeng DH (2009) Can patients with sagittally well-compensated lumbar degenerative kyphosis benefit from surgical treatment for intractable back pain? Neurosurgery 64:115–121. doi:10.1227/01.neu.0000335642.14527.26 (discussion 121) CrossRefPubMed

Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23:1177–1189. doi:10.1007/s00586-014-3227-9 CrossRefPubMed

Jeon CH, Kim DJ, Kim SK, Kim DJ, Lee HM, Park HJ (2006) Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index. J Korean Med Sci 21:1092–1097. doi:10.3346/jkms.2006.21.6.1092 CrossRefPubMedPubMedCentral

Han CW, Lee EJ, Iwaya T, Kataoka H, Kohzuki M (2004) Development of the Korean version of Short-Form 36-Item Health Survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med 203:189–194CrossRefPubMed

Alsaleh K, Ho D, Rosas-Arellano MP, Stewart TC, Gurr KR, Bailey CS (2016) Radiographic assessment of degenerative lumbar spinal stenosis: is MRI superior to CT? Eur Spine J. doi:10.1007/s00586-016-4724-9 PubMed

10.

Kuittinen P, Sipola P, Leinonen V, Saari T, Sinikallio S, Savolainen S, Kroger H, Turunen V, Airaksinen O, Aalto T (2014) Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis. PLoS One 9:e106404. doi:10.1371/journal.pone.0106404 CrossRefPubMedPubMedCentral

11.

Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine (Phila Pa 1976) 13:1317–1326CrossRef

12.

Berjano P, Aebi M (2015) Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities. Eur Spine J 24(Suppl 1):S49–S57. doi:10.1007/s00586-014-3670-7 CrossRefPubMed

13.

Le Huec JC, Aunoble S (2012) Pedicle subtraction osteotomy for sagittal imbalance. Eur Spine J 21:1896–1897. doi:10.1007/s00586-012-2474-x CrossRefPubMedPubMedCentral

14.

Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836. doi:10.1007/s00586-010-1476-9 CrossRefPubMedPubMedCentral

15.

Takahashi K, Miyazaki T, Takino T, Matsui T, Tomita K (1995) Epidural pressure measurements. Relationship between epidural pressure and posture in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 20:650–653CrossRef

16.

Suzuki H, Endo K, Kobayashi H, Tanaka H, Yamamoto K (2010) Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication. Spine (Phila Pa 1976) 35:E344–E346. doi:10.1097/BRS.0b013e3181c91121 CrossRef

17.

Crawford CH 3rd, Glassman SD, Mummaneni PV, Knightly JJ, Asher AL (2016) Back pain improvement after decompression without fusion or stabilization in patients with lumbar spinal stenosis and clinically significant preoperative back pain. J Neurosurg Spine 25:596–601. doi:10.3171/2016.3.spine151468 CrossRefPubMed

18.

Farrokhi MR, Haghnegahdar A, Rezaee H, Sharifi Rad MR (2016) Spinal sagittal balance and spinopelvic parameters in patients with degenerative lumbar spinal stenosis; a comparative study. Clin Neurol Neurosurg 151:136–141. doi:10.1016/j.clineuro.2016.10.020 CrossRefPubMed

19.

Kuwahara W, Deie M, Fujita N, Tanaka N, Nakanishi K, Sunagawa T, Asaeda M, Nakamura H, Kono Y, Ochi M (2016) Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery. Clin Biomech (Bristol, Avon) 40:45–51. doi:10.1016/j.clinbiomech.2016.10.016 CrossRef

20.

Shin EK, Kim CH, Chung CK, Choi Y, Yim D, Jung W, Park SB, Moon JH, Heo W, Kim SM (2017) Sagittal imbalance in patients with lumbar spinal stenosis and outcomes after simple decompression surgery. Spine J 17:175–182. doi:10.1016/j.spinee.2016.08.023 CrossRefPubMed

Title: Surgical versus nonsurgical treatment of lumbar degenerative kyphosis
Authors: Tae Sik Goh
Jong Ki Shin
Myung Soo Youn
Hong Seok Lee
Taek Hoon Kim
Jung Sub Lee
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 8/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5008-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Surgical versus nonsurgical treatment of lumbar degenerative kyphosis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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