Spinal Sagittal Alignment Among Patients with Degenerative Lumbar Canal Stenosis

Degenerative lumbar canal stenosis (DLS) is a common spinal pathology charac - terized by radicular pain and neurogenic claudication. Sagittal alignment and its indices have been affected in several spinal pathologies and may play a key role in surgical planning and outcome. In this case-control study, we aimed to assess sagittal alignment among patients with DLS compared to healthy individuals.

Sixty patients DLS and 60 healthy volunteers were selected. Pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), pelvic incidence (PI), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were obtained in lateral standing X-ray radiographs.

Mean LL was lower in DLS patients (35.3±10.2) compared to normal controls (44.78±12.95), which was statistically significant (P <0.05). In contrast, there were no significant differences in PI, SVA, and SS between the groups. In patients with DLS, TK was lower, and PT was higher when compared to healthy individuals (P<0.05).

Patients with DLS utilize decreased lordosis of the lumbar spine as a compensatory mechanism to decompress the thecal sac and spinal roots and improve their symptoms. Consequently, these patients recruit compensatory adjustments such as thoracic hyperkyphosis and increased PT to maintain sagittal alignment.