Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy
PurposeSpine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explore...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1494780/full |
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| author | José Poblete Carrizo José Poblete Carrizo Jesús Martínez Julio González Alejandra Mosteiro Ramon Torné Ramon Torné Alberto Di Somma Alberto Di Somma José Ríos Joaquim Enseñat Joaquim Enseñat Salvador Fuster Salvador Fuster |
| author_facet | José Poblete Carrizo José Poblete Carrizo Jesús Martínez Julio González Alejandra Mosteiro Ramon Torné Ramon Torné Alberto Di Somma Alberto Di Somma José Ríos Joaquim Enseñat Joaquim Enseñat Salvador Fuster Salvador Fuster |
| author_sort | José Poblete Carrizo |
| collection | DOAJ |
| description | PurposeSpine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explores them as prognostic factors in patients undergoing lumbar microdiscectomy, which could help identify those at higher risk of surgical failure.MethodsProspective analysis of patients treated with lumbar microdiscectomy (n = 52) and healthy control subjects (n = 45) in a single tertiary centre. Follow up of 12 and 24 months after surgery, with radicular and lumbar pain evaluation according to the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Comparison of several objective spinal biomechanic factors, measured by a single experienced radiologist. Assessment of spinal sagittal balance as a prognostic factor after lumbar discectomy.ResultsCompared to healthy individuals, patients with symptomatic lumbar disc herniation showed lower thoracic kyphosis (39.03 vs. 34.42° p = 0.034), lower thoraco-lumbar transition T10-L2 angulation (6.79 vs. 2.08° p = 0.005), lower lumbar lordosis (59.54 vs. 48.36° p < 0.001) and lumbo-sacral angulation L4-S1 (40.20 vs. 29.16° p < 0.001), lower pelvic incidence (54.71vs 49.86° p = 0.014) and lower sacral slope (42.07 vs. 33.34° p < 0.001). Sagittal balance (SVA) was negative in healthy subjects −3.09 mm and positive lumbar-disc patients 15.04 (p = 0.013). Noteworthy, the radicular and lumbar pain and disability outcomes 12 and 24 months after surgery were significantly better in the group with normal sagittal balance (ODI 14.52 vs. 40.06 p < 0.001; radicular VAS 2.74 vs. 5.58 p < 0.001; lumbar VAS 3.61 vs. 4.06 p < 0.001).ConclusionLumbar degenerative disc disease represents a major burden for healthcare systems; thus, its management is determinant. Lumbar discectomy shows overall positive results, with a significant reduction of pain and disability in the majority of cases. However, a subgroup of patients, still not well defined, may experience persistent pain after the intervention. The use of objective measurements of sagittal balance may help identify these patients for which simple discectomy may not suffice and contribute to treatment planification. |
| format | Article |
| id | doaj-art-7f01db49bc8d495b91482cb1bfc2bf8e |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj-art-7f01db49bc8d495b91482cb1bfc2bf8e2025-02-12T07:25:54ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-02-011210.3389/fsurg.2025.14947801494780Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomyJosé Poblete Carrizo0José Poblete Carrizo1Jesús Martínez2Julio González3Alejandra Mosteiro4Ramon Torné5Ramon Torné6Alberto Di Somma7Alberto Di Somma8José Ríos9Joaquim Enseñat10Joaquim Enseñat11Salvador Fuster12Salvador Fuster13Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFaculty of Medicine, University of Barcelona, Barcelona, SpainDepartment of Neurosurgery, Centro Médico ABC Santa Fe, Ciudad de Mexico, MexicoDepartment of Neurosurgery, Clínica RedSalud Providencia, Universidad de Santiago de Chile, Santiago de Chile, ChileDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFaculty of Medicine, University of Barcelona, Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFaculty of Medicine, University of Barcelona, Barcelona, SpainDepartment of Clinical Pharmacology, Hospital Clínic de Barcelona, Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFaculty of Medicine, University of Barcelona, Barcelona, SpainFaculty of Medicine, University of Barcelona, Barcelona, SpainDepartment of Orthopaedics and Traumatology, Hospital Clínic de Barcelona, Barcelona, SpainPurposeSpine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explores them as prognostic factors in patients undergoing lumbar microdiscectomy, which could help identify those at higher risk of surgical failure.MethodsProspective analysis of patients treated with lumbar microdiscectomy (n = 52) and healthy control subjects (n = 45) in a single tertiary centre. Follow up of 12 and 24 months after surgery, with radicular and lumbar pain evaluation according to the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Comparison of several objective spinal biomechanic factors, measured by a single experienced radiologist. Assessment of spinal sagittal balance as a prognostic factor after lumbar discectomy.ResultsCompared to healthy individuals, patients with symptomatic lumbar disc herniation showed lower thoracic kyphosis (39.03 vs. 34.42° p = 0.034), lower thoraco-lumbar transition T10-L2 angulation (6.79 vs. 2.08° p = 0.005), lower lumbar lordosis (59.54 vs. 48.36° p < 0.001) and lumbo-sacral angulation L4-S1 (40.20 vs. 29.16° p < 0.001), lower pelvic incidence (54.71vs 49.86° p = 0.014) and lower sacral slope (42.07 vs. 33.34° p < 0.001). Sagittal balance (SVA) was negative in healthy subjects −3.09 mm and positive lumbar-disc patients 15.04 (p = 0.013). Noteworthy, the radicular and lumbar pain and disability outcomes 12 and 24 months after surgery were significantly better in the group with normal sagittal balance (ODI 14.52 vs. 40.06 p < 0.001; radicular VAS 2.74 vs. 5.58 p < 0.001; lumbar VAS 3.61 vs. 4.06 p < 0.001).ConclusionLumbar degenerative disc disease represents a major burden for healthcare systems; thus, its management is determinant. Lumbar discectomy shows overall positive results, with a significant reduction of pain and disability in the majority of cases. However, a subgroup of patients, still not well defined, may experience persistent pain after the intervention. The use of objective measurements of sagittal balance may help identify these patients for which simple discectomy may not suffice and contribute to treatment planification.https://www.frontiersin.org/articles/10.3389/fsurg.2025.1494780/fulllumbar disc herniationsagittal balancebiomechanicmicrodiscectomyprognosisrecurrence |
| spellingShingle | José Poblete Carrizo José Poblete Carrizo Jesús Martínez Julio González Alejandra Mosteiro Ramon Torné Ramon Torné Alberto Di Somma Alberto Di Somma José Ríos Joaquim Enseñat Joaquim Enseñat Salvador Fuster Salvador Fuster Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy Frontiers in Surgery lumbar disc herniation sagittal balance biomechanic microdiscectomy prognosis recurrence |
| title | Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy |
| title_full | Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy |
| title_fullStr | Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy |
| title_full_unstemmed | Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy |
| title_short | Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy |
| title_sort | influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy |
| topic | lumbar disc herniation sagittal balance biomechanic microdiscectomy prognosis recurrence |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1494780/full |
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