SPINO-PELVIC SAGITTAL ALIGNMENT IN PATIENTS WITH HIGH-GRADE L<sub>5</sub> ISTHMIC SPONDYLOLISTHESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGXi , KONGQingquan ,  SONGYueming , LIULimin , LITao , GONGQuan , ZENGJiancheng , LIUHao

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

SONGYueming, Email: hx_sym@163.com

Keywords：

High-grade isthmic spondylolisthesis; Spino-pelvic; Sagittal alignment

DOI：

10.7507/1002-1892.20160014

Video：

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Objective To observe the character of spino-pelvic sagittal alignment in patients with high-grade L₅ isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation. Method Between January 2009 and June 2014, 25 patients with high-grade L₅ isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method:the balanced pelvis subgroup (n=14) and unbalanced pelvis subgroup (n=11) . The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively. Results All patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P<0.05) , while the TK was significantly smaller than that of control group (P<0.05) . In the balanced pelvis subgroup, LSA, LL, and SVA at last follow-up significantly decreased while TK significantly increased when compared with preoperative ones (P<0.05) . In the unbalanced pelvis subgroup, LSA, PT, and SVA at last follow-up significantly decreased while SS, LL, and TK significantly increased when compared with preoperative ones (P<0.05) . The preoperative LSA and PT in the unbalanced pelvis subgroup were significantly greater, while SS, LL, and TK were significantly smaller than those of balanced pelvis subgroup (P<0.05) ; while at last follow-up, significant differentce was found only in LSA between 2 subgroups (P<0.05) . Conclusions The LSA should be paid more attention in surgery to assure recovery of the sagittal balance because patients with high-grade L₅ isthmic spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.

Citation： YANGXi, KONGQingquan, SONGYueming, LIULimin, LITao, GONGQuan, ZENGJiancheng, LIUHao. SPINO-PELVIC SAGITTAL ALIGNMENT IN PATIENTS WITH HIGH-GRADE L₅ ISTHMIC SPONDYLOLISTHESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 65-71. doi: 10.7507/1002-1892.20160014 Copy

1.	Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1) :40-47.
2.	Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J, 2007, 16(9) :1459-1467.
3.	Yang X, Kong Q, Song Y, et al. The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases. Eur Spine J, 2014, 23(3) :569-575.
4.	Barrey C, Jund J, Perrin G, et al. Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery, 2007, 61(5) :981-986.
5.	杨曦,宋跃明.脊柱-骨盆矢状位曲度对腰椎退变性疾病的影响.中国脊柱脊髓杂志, 2013, 23(10) :935-939.
6.	Hresko MT, Labelle H, Roussouly P, et al. Classification of High-Grade Spondylolistheses Based on pelvic version and spine balance:possible rationale for reduction. Spine (Phila Pa 1976) , 2007, 32(20) :2208-2213.
7.	Roussouly P, Gollogly S, Berthonnaud E, et al. Sagittal alignment of the spine and pelvis in the presence of L₅-S1 isthmic lysis and low-grade spondylolisthesis. Spine (Phila Pa 1976) , 2006, 31(21) :2484-2490.
8.	Mac-Thiong JM, Wang Z, de Guise JA, et al. Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine (Phila Pa 1976) , 2008, 33(21) :2316-2325.
9.	Vialle R, Ilharreborde B, Dauzac C, et al. Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10) :1641-1649.
10.	Poussa M, Remes V, Lamberg T, et al. Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ:long-term clinical, radiologic, and functional outcome. Spine (Phila Pa 1976) , 2006, 31(5) :583-592.
11.	Helenius I, Lamberg T, Osterman K, et al. Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients:a long-term evaluation using the Scoliosis Research Society questionnaire. Spine (Phila Pa 1976) , 2006, 31(2) :190-196.
12.	Molinari RW, Bridwell KH, Lenke LG, et al. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine (Phila Pa 1976) , 1999, 24(16) :1701-1711.
13.	Ruf M, Koch H, Melcher RP, et al. Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis. Spine (Phila Pa 1976) , 2006, 31(3) :269-274.
14.	Lengert R, Charles YP, Walter A, et al. Posterior surgery in high-grade spondylolisthesis. Orthop Traumatol Surg Res, 2014, 100(5) :481-484.
15.	蒋伟宇,徐荣明,马维虎,等.复位在重度腰椎滑脱治疗中对脊柱骨盆参数的影响意义.中国骨伤, 2014, 27(9) :726-729.
16.	何守玉,朱锋,邱勇,等.成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数变化及其临床意义.中国脊柱脊髓杂志, 2014, 24(2) :109-115.
17.	Zhu F, Bao H, Liu Z, et al. Analysis of L₅ incidence in normal population use of L₅ incidence as a guide in reconstruction of lumbosacral alignment. Spine (Phila Pa 1976) , 2014, 39(2) :E140-146.
18.	刘世伟,林旭,谭伦,等.延长固定节段结合短节段融合在中重度腰椎滑脱治疗中的应用.临床骨科杂志, 2014, 17(5) :515-518.

1. Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1) :40-47.
2. Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J, 2007, 16(9) :1459-1467.
3. Yang X, Kong Q, Song Y, et al. The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases. Eur Spine J, 2014, 23(3) :569-575.
4. Barrey C, Jund J, Perrin G, et al. Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery, 2007, 61(5) :981-986.
5. 杨曦,宋跃明.脊柱-骨盆矢状位曲度对腰椎退变性疾病的影响.中国脊柱脊髓杂志, 2013, 23(10) :935-939.
6. Hresko MT, Labelle H, Roussouly P, et al. Classification of High-Grade Spondylolistheses Based on pelvic version and spine balance:possible rationale for reduction. Spine (Phila Pa 1976) , 2007, 32(20) :2208-2213.
7. Roussouly P, Gollogly S, Berthonnaud E, et al. Sagittal alignment of the spine and pelvis in the presence of L₅-S1 isthmic lysis and low-grade spondylolisthesis. Spine (Phila Pa 1976) , 2006, 31(21) :2484-2490.
8. Mac-Thiong JM, Wang Z, de Guise JA, et al. Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine (Phila Pa 1976) , 2008, 33(21) :2316-2325.
9. Vialle R, Ilharreborde B, Dauzac C, et al. Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10) :1641-1649.
10. Poussa M, Remes V, Lamberg T, et al. Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ:long-term clinical, radiologic, and functional outcome. Spine (Phila Pa 1976) , 2006, 31(5) :583-592.
11. Helenius I, Lamberg T, Osterman K, et al. Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients:a long-term evaluation using the Scoliosis Research Society questionnaire. Spine (Phila Pa 1976) , 2006, 31(2) :190-196.
12. Molinari RW, Bridwell KH, Lenke LG, et al. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine (Phila Pa 1976) , 1999, 24(16) :1701-1711.
13. Ruf M, Koch H, Melcher RP, et al. Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis. Spine (Phila Pa 1976) , 2006, 31(3) :269-274.
14. Lengert R, Charles YP, Walter A, et al. Posterior surgery in high-grade spondylolisthesis. Orthop Traumatol Surg Res, 2014, 100(5) :481-484.
15. 蒋伟宇,徐荣明,马维虎,等.复位在重度腰椎滑脱治疗中对脊柱骨盆参数的影响意义.中国骨伤, 2014, 27(9) :726-729.
16. 何守玉,朱锋,邱勇,等.成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数变化及其临床意义.中国脊柱脊髓杂志, 2014, 24(2) :109-115.
17. Zhu F, Bao H, Liu Z, et al. Analysis of L₅ incidence in normal population use of L₅ incidence as a guide in reconstruction of lumbosacral alignment. Spine (Phila Pa 1976) , 2014, 39(2) :E140-146.
18. 刘世伟,林旭,谭伦,等.延长固定节段结合短节段融合在中重度腰椎滑脱治疗中的应用.临床骨科杂志, 2014, 17(5) :515-518.

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Chinese Journal of Reparative and Reconstructive Surgery

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SPINO-PELVIC SAGITTAL ALIGNMENT IN PATIENTS WITH HIGH-GRADE L₅ ISTHMIC SPONDYLOLISTHESIS