Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study

Abstract

Recent studies suggested a predominant role of spinopelvic parameters to explain lumbosacral spondylolisthesis pathogeny. We compare the pelvic incidence and other parameters of sagittal spinopelvic balance in adolescents and young adults with developmental spondylolisthesis to those parameters in a control group of healthy volunteers. We compared the angular parameters of the sagittal balance of the spine in a cohort of 244 patients with a developmental L5-S1 spondylolisthesis with those of a control cohort of 300 healthy volunteers. A descriptive and correlation study was performed. The L5 anterior slipping and lumbosacral kyphosis in spondylolisthesis patients was described using multiple regression analysis study. Our study demonstrates that the related measures of sagittal spinopelvic alignment are disturbed in adolescents and young adults with developmental spondylolisthesis. These subjects stand with an increased sacral slope, pelvic tilt and lumbar lordosis but with a decreased thoracic kyphosis. Pelvic incidence was significantly higher in spondylolisthesis patients as compared with controls but was not clearly correlated with the grade of slipping. We showed the same ''sagittal balance strategy'' in spondylolisthesis patients as in the control group regarding correlations between pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis. We believe that the lumbosacral kyphosis is a stronger factor than pelvic incidence which need to be taken into account as a predominant factor in theories of pathogenesis of lumbosacral spondylolithesis. We thus believe that increased lumbar lordosis associated with L5-S1 spondylolisthesis is secondary to the high pelvic incidence and is an important factor causing high shear stresses at the L5-S1 pars interarticularis. However, the ''local'' sagittal imbalance of the lumbosacral junction is compensated by adjacent mobile segments in the upper lumbar spine, the pelvis orientation and the thoracic spine. The result is not optimal but a satisfactory global sagittal balance of the trunk, even in the most severe grade of slipping.

Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods

“…The computer measurement values of the spino-pelvic axis established in this study were used for comparison to the manually measured spino-pelvic parameters in the current study [1]. Recent studies have further validated the superior accuracy, reproducibility and versatility of this computer methodology in the measurement of the sagittal spino-pelvic axis in various pathological conditions including spondylolisthesis and degenerative conditions [11,13,14,21,23,24].…”

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

“…Because of its close relationship with the spine, many studies have investigated the influence of sacropelvic balance and morphology in the evaluation and treatment of spinal disorders, such as developmental spondylolisthesis [1][2][3][4][5][6][7][8][9][10][11][12], degenerative spondylolisthesis [13,14], adolescent idiopathic scoliosis [15][16][17], and adult spinal deformity [18][19][20]. Some authors have also raised the role of sacropelvic morphology and balance in the pathogenesis and surgical treatment of hip osteoarthritis [21][22][23][24].…”

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

“…Likewise, the impact of a physiological spino-pelvic alignment on clinical outcomes has been demonstrated repeatedly, and sagittal imbalance has been shown to cause worse outcomes following spinal surgery [3,5,15,16,20,25,26,28,30,33,38,42].…”