Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 4

Does laminectomy Affect Spino-Pelvic Balance in Lumbar Spinal Stenosis? A Study Based on Eos® X Ray Imaging System

Manuela D’Ercole1*, Gualtiero Innocenzi2, Paola Lattuada3, Francesco Ricciardi2 and Simona Bistazzoni4

1Department of Neurosurgery, IRCCS Fondazione Policlinico Universitario “Agostino Gemelli” Università Cattolica del Sacro Cuore largo Agostino Gemelli, Roma Italy
2Department of Neurosurgery, IRCCS Neuromed Via Atinense, Pozzilli (IS), Italy
3Medical Physics Department Ospedale S Anna, Via Ravona, San Fermo della Battaglia (Co), Italy
4Department of Neurosurgery Ospedale S Anna, Via Ravona, San Fermo della Battaglia (Co), Italy

*Corresponding Author: Manuela D’Ercole, Department of Neurosurgery, IRCCS Fondazione Policlinico Universitario “Agostino Gemelli” Università Cattolica del Sacro Cuore largo Agostino Gemelli, Roma Italy.

Received: February 19, 2022; Published: March 11, 2022


Purpose: Lumbar spinal stenosis (LSS) is a degenerative disorder, causing forward bending of trunk and pelvic retroversion with consequent loss of lumbar lordosis; surgical treatment is intended to enlarge the canal and foramina and decompress the nerve roots. The purpose of our study is to analyse if and to what extent facets-sparing laminectomy affects the spino-pelvic balance.

Methods: Spino-pelvic balance was analyzed before and after surgery through EOS® X-Ray Imaging System on 26 patients. Parameters considered were: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Clinical data were expressed in numeric values through Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), modified Japanese Orthopaedic Association scoring system (mJOA).

Results: Significant SS decrease and PT increase were noticed after surgery, without modification in LL, axial vertebral rotation (AVR) and the general alignment. Pain and disability had a significant improvement, as represented by decrease of scores in VAS and ODI scales and increase in mJOA functional scale.

Conclusion: The most important parameter seems to be a congruence between pelvic and spinal parameters in order to achieve an economic posture with physiologic position of the axis of gravity. According to literature, a standard SB is not defined.

Keywords: Lumbar Spinal Stenosis; Sagittal Balance; EOS System; Spino-Pelvic Parameters


  1. Overdevest G., et al. “Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis”. European Spine Journal 10 (2015): 2244-2263.
  2. Dubousset J., et al. “A new 2D and 3D imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the EOS system”. Bulletin de L'Académie Nationale de Médecine 2 (2005): 287-297.
  3. Melhem E., et al. “EOS® biplanar X-ray imaging: concept, developments, benefits, and limitations”. Journal of Children's Orthopaedics 1 (2016): 1-14.
  4. Schizas C., et al. “Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images”. Spine 35 (2010): 1919-1924.
  5. Fairbank JC and Pynsent PB. “The oswestry disability index”. Spine 25 (2000): 2940-2952.
  6. Reips UD and Funke F. “Interval-level measurement with visual analogue scales in Internet-based research: VAS Generator”. Behavior Research Methods 40 (2008): 699-704.
  7. Sato N., et al. “Effects of long-term corset wearing on chronic low back pain”. Fukushima Journal of Medical Science 58 (2012): 60-65.
  8. Roussouly P., et al. “Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position”. Spine 30 (2005): 346-353.
  9. Illés T and Somoskeöy S. “Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results”. European Spine Journal 22 (2013): 1255-1263.
  10. Mayer TG., et al. “Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients”. Spine 1 (1989): 33-36.
  11. Bresnahan L., et al. “A biomechanical evaluation of graded posterior element removal for treatment of lumbar stenosis: comparison of a minimally invasive approach with two standard laminectomy techniques”. Spine 1 (2009): 17-23.
  12. Hindle RJ., et al. “Mechanical function of the human lumbar interspinous and supraspinous ligaments”. Journal of Biomedical Engineering 4 (1990): 340-344.
  13. Suzuki H., et al. “Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication”. Spine 35 (2010): E344-346.
  14. Fujii K., et al. “Radiological Improvements in global sagittal alignment after lumbar decompression without fusion”. Spine10 (2014): 703-709.
  15. Hikata T., et al. “Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance”. Journal of Neurosurgery: Spine 23 (2015): 451-458.
  16. Jeon CH., et al. “Change in sagittal profiles after decompressive laminectomy in patients with lumbar spinal canal stenosis. A 2-years preliminary report”. Spine 5 (2015): 279-285.
  17. Bayerl SH., et al. “The sagittal balance does not influence the 1-year clinical outcome of patients with lumbar spinal stenosis without obvious instability after microsurgical decompression”. Spine13 (2015): 1014-1021.
  18. Mac-Thiong JM., et al. “Sagittal alignment of the spine and pelvis during growth”. Spine 29 (2004): 1642-1647.
  19. Aaro S and Dahlborn M. “Estimation of vertebral rotation and spine rib cage deformity in scoliosis by computer tomography”. Spine 6 (1981): 460-467.
  20. Yazici M., et al. “Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis”. Journal of Pediatric Orthopaedics 21 (2001): 252-256.
  21. Zander T., et al. “Influence of graded facectomy and laminectomy on spinal biomechanics”. European Spine Journal 12 (2003): 427-434.
  22. Bisschop A., et al. “Single level lumbar laminectomy alters segmental biomechanical behavior without affecting adjacent segments”. Clinical Biomechanics 8 (2014): 912-917.
  23. Delank KS., et al. “How does spinal canal decompression and dorsal stabilization affect segmental mobility? A biomechanical study”. Archives of Orthopaedic and Trauma Surgery 2 (2010):285-292.
  24. Cardoso MJ., et al. “Does superior-segment facet violation or laminectomy destabilize the adjacent level in lumbar transpedicular fixation? An in vitro human cadaveric assessment”. Spine26 (2008): 2868-2873.
  25. Stagnara P., et al. “Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphopsis and lordosis”. Spine 7 (1982): 335-342.


Citation: Manuela D’Ercole., et al. “Does laminectomy Affect Spino-Pelvic Balance in Lumbar Spinal Stenosis? A Study Based on Eos® X Ray Imaging System".Acta Scientific Orthopaedics 5.4 (2022): 71-76.


Copyright: © 2022 Manuela D’Ercole., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US