Can we predict post-surgical improvement in functional stooping in lumbar spinal stenosis? Insights from oblique lumbar interbody fusion outcomes and radiologic predictors

Background Functional stooping, characterized by a forward-flexed lumbar posture in patients with lumbar spinal stenosis (LSS), serves as a compensatory mechanism aimed at alleviating pain by expanding the constricted spinal canal. Surgeons widely use the oblique lateral interbody fusion (OLIF) to t...

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Published in:BMC musculoskeletal disorders Vol. 26; no. 1; pp. 670 - 11
Main Authors: Kang, Dong-Ho, Baek, Jonghyuk, Chang, Bong-Soon, Chang, Sam Yeol, Kim, Dongook, Park, Sanghyun, Kim, Hyoungmin
Format: Journal Article
Language:English
Published: London BioMed Central 09.07.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Aged
Aged, 80 and over
Clinical outcomes
Congenital diseases
Epidemiology
Female
Functional stooping
Humans
Internal Medicine
Kyphosis
Lordosis - diagnostic imaging
Lordosis - surgery
Lumbar spinal stenosis
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - physiopathology
Lumbar Vertebrae - surgery
Magnetic resonance imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Oblique lumbar interbody fusion
Orthopedics
Patient outcomes
Patients
Perioperative care
Postural Balance - physiology
Radiology
Regression analysis
Rehabilitation
Retrospective Studies
Rheumatology
Sagittal imbalance
Short-level fusion
Spinal canal
Spinal fusion
Spinal Fusion - methods
Spinal stenosis
Spinal Stenosis - diagnostic imaging
Spinal Stenosis - physiopathology
Spinal Stenosis - surgery
Sports Medicine
Standing Position
Stenosis
Surgery
Thorax
Treatment Outcome
Vertebrae
X-rays
South Korea
United States > US
Sagittal imbalance
Lumbar spinal stenosis
Short-level fusion
Oblique lumbar interbody fusion
Functional stooping
ISSN:1471-2474, 1471-2474
Online Access:Get full text
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Summary:Background Functional stooping, characterized by a forward-flexed lumbar posture in patients with lumbar spinal stenosis (LSS), serves as a compensatory mechanism aimed at alleviating pain by expanding the constricted spinal canal. Surgeons widely use the oblique lateral interbody fusion (OLIF) to treat patients with LSS, restoring segmental lordosis in index surgical level. In some patients with LSS, improvement of global sagittal imbalance occurs after short-level OLIF. it remains unclear whether this is predominantly due to segmental correction or the resolution of functional stooping. Therefore, this study aimed to evaluate the effect of functional stooping resolution and segmental correction on sagittal imbalance after short-level OLIF, and identifying predictors of presence or absence of preoperative functional stooping in LSS. Methods A retrospective review was conducted on LSS patients who underwent single or two-level OLIF with preoperative C7 sagittal vertical axis (SVA) > 50 mm. The clinical and radiological factors were analyzed. Logistic regression and receiver operating characteristic curve analysis were conducted to identify factors associated with presence or abscence of preoperative functional stooping, and to establish predictive threshold values, respectively. Results A total of 103 patients with a mean age of 71.6 ± 8.6 years were included. In patients with preoperative functional stooping, segmental correction at the index surgical level contributed to only 47.7% of the total change of lumbar lordosis (LL), whereas the change of lordosis in remnant mobile lumbar segments constituted 52.3% of the total change of LL. Preoperative thoracic kyphosis (TK) (OR [95% CI]: 1.037 [1.002–1.073]), and preoperative SVA (OR [95% CI]: 0.986 [0.972–0.999]) were significant associated factors for predicting LSS patients without functional stooping. Conclusions Functional stooping resolution markedly impacts global sagittal balance correction in LSS patients following short-level OLIF. Preoperative functional stooping correlates with greater TK and reduced SVA. For patients likely to achieve functional stooping resolution, single-level surgery may suffice initially, with deformity correction reserved if needed.
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ISSN:1471-2474
1471-2474
DOI:10.1186/s12891-025-08821-7