How does sagittal spinopelvic alignment of lumbar multisegmental spondylolysis differ from monosegmental spondylolysis?

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  • 1 Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
  • 2 Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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OBJECTIVE

The aim of this study was to investigate sagittal alignment and compensatory mechanisms in patients with monosegmental spondylolysis (mono_lysis) and multisegmental spondylolysis (multi_lysis).

METHODS

A total of 453 adult patients treated for symptomatic low-grade spondylolytic spondylolisthesis were retrospectively studied at a single center. Patients were divided into 2 subgroups, the mono_lysis group and the multi_lysis group, based on the number of spondylolysis segments. A total of 158 asymptomatic healthy volunteers were enrolled in this study as the control group. Radiographic parameters measured on standing sagittal radiographs and the ratios of L4–S1 segmental lordosis (SL) to lumbar lordosis (L4–S1 SL/LL) and pelvic tilt to pelvic incidence (PT/PI) were compared between all experimental groups.

RESULTS

There were 51 patients (11.3%) with a diagnosis of multi_lysis in the spondylolysis group. When compared with the control group, the spondylolysis group exhibited larger PI (p < 0.001), PT (p < 0.001), LL (p < 0.001), and L4–S1 SL (p = 0.025) and a smaller L4–S1 SL/LL ratio (p < 0.001). When analyzing the specific spondylolysis subgroups, there were no significant differences in PI, but the multi_lysis group had a higher L5 incidence (p = 0.004), PT (p = 0.018), and PT/PI ratio (p = 0.039). The multi_lysis group also had a smaller L4–S1 SL/LL ratio (p = 0.012) and greater sagittal vertical axis (p < 0.001).

CONCLUSIONS

A high-PI spinopelvic pattern was involved in the development of spondylolytic spondylolisthesis, and a larger L5 incidence might be associated with the occurrence of consecutive multi_lysis. Unlike patients with mono_lysis, individuals with multi_lysis were characterized by an anterior trunk, insufficiency of L4–S1 SL, and pelvic retroversion.

ABBREVIATIONS LDI = lordosis distribution index; LL = lumbar lordosis; L5I = L5 incidence; mono_lysis = monosegmental spondylolysis; multi_lysis = multisegmental spondylolysis; ODI = Oswestry Disability Index; PI = pelvic incidence; PT = pelvic tilt; QOL = quality of life; SA = slip angle; SL = segmental lordosis; SP = slip percentage; SS = sacral slope; SVA = sagittal vertical axis; TK = thoracic kyphosis; VAS = visual analog scale.

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Contributor Notes

Correspondence Xu Sun: Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China. drsunxu@163.com.

INCLUDE WHEN CITING Published online April 17, 2020; DOI: 10.3171/2020.2.SPINE191415.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Fredrickson BE, Baker D, McHolick WJ, The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66(5):699707.

    • Search Google Scholar
    • Export Citation
  • 2

    He LC, Wang YX, Gong JS, Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women. Eur Radiol. 2014;24(2):441448.

    • Search Google Scholar
    • Export Citation
  • 3

    Belfi LM, Ortiz AO, Katz DS. Computed tomography evaluation of spondylolysis and spondylolisthesis in asymptomatic patients. Spine (Phila Pa 1976). 2006;31(24):E907E910.

    • Search Google Scholar
    • Export Citation
  • 4

    Sakai T, Sairyo K, Takao S, Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects. Spine (Phila Pa 1976). 2009;34(21):23462350.

    • Search Google Scholar
    • Export Citation
  • 5

    Endler P, Ekman P, Möller H, Gerdhem P. Outcomes of posterolateral fusion with and without instrumentation and of interbody fusion for isthmic spondylolisthesis: a prospective study. J Bone Joint Surg Am. 2017;99(9):743752.

    • Search Google Scholar
    • Export Citation
  • 6

    Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J. 2011;20(suppl 5):641646.

    • Search Google Scholar
    • Export Citation
  • 7

    Roussouly P, Gollogly S, Berthonnaud E, 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):24842490.

    • Search Google Scholar
    • Export Citation
  • 8

    Labelle H, Roussouly P, Berthonnaud E, Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976). 2004;29(18):20492054.

    • Search Google Scholar
    • Export Citation
  • 9

    Sterba M, Arnoux PJ, Labelle H, Biomechanical analysis of spino-pelvic postural configurations in spondylolysis subjected to various sport-related dynamic loading conditions. Eur Spine J. 2018;27(8):20442052.

    • Search Google Scholar
    • Export Citation
  • 10

    Toy JO, Tinley JC, Eubanks JD, Correlation of sacropelvic geometry with disc degeneration in spondylolytic cadaver specimens. Spine (Phila Pa 1976). 2012;37(1):E10E15.

    • Search Google Scholar
    • Export Citation
  • 11

    Harroud A, Labelle H, Joncas J, Mac-Thiong JM. Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis. Eur Spine J. 2013;22(4):849856.

    • Search Google Scholar
    • Export Citation
  • 12

    Yilgor C, Sogunmez N, Boissiere L, Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017;99(19):16611672.

    • Search Google Scholar
    • Export Citation
  • 13

    Yilgor C, Sogunmez N, Yavuz Y, Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis. Neurosurg Focus. 2017;43(6):E5.

    • Search Google Scholar
    • Export Citation
  • 14

    Rothenfluh DA, Mueller DA, Rothenfluh E, Min K. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J. 2015;24(6):12511258.

    • Search Google Scholar
    • Export Citation
  • 15

    Senteler M, Weisse B, Snedeker JG, Rothenfluh DA. Pelvic incidence-lumbar lordosis mismatch results in increased segmental joint loads in the unfused and fused lumbar spine. Eur Spine J. 2014;23(7):13841393.

    • Search Google Scholar
    • Export Citation
  • 16

    Liu X, Wang L, Yuan S, Multiple-level lumbar spondylolysis and spondylolisthesis. J Neurosurg Spine. 2015;22(3):283287.

  • 17

    Wu XD, Wang XW, Chen HJ, Twenty-nine-year follow-up of nonoperatively treated three-level lumbar spondylolysis: a case report and review of the literature. JBJS Case Connect. 2016;6(1):e13.

    • Search Google Scholar
    • Export Citation
  • 18

    Wáng YXJ, Deng M, Griffith JF, Lumbar spondylolisthesis progression and de novo spondylolisthesis in elderly Chinese men and women: a year-4 follow-up study. Spine (Phila Pa 1976). 2016;41(13):10961103.

    • Search Google Scholar
    • Export Citation
  • 19

    Oh SK, Chung SS, Lee CS. Correlation of pelvic parameters with isthmic spondylolisthesis. Asian Spine J. 2009;3(1):2126.

  • 20

    Duval-Beaupère G, Schmidt C, Cosson P. A barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992;20(4):451462.

    • Search Google Scholar
    • Export Citation
  • 21

    Ferrero E, Ould-Slimane M, Gille O, Guigui P. Sagittal spinopelvic alignment in 654 degenerative spondylolisthesis. Eur Spine J. 2015;24(6):12191227.

    • Search Google Scholar
    • Export Citation
  • 22

    Ferrero E, Simon AL, Magrino B, Double-level degenerative spondylolisthesis: what is different in the sagittal plane? Eur Spine J. 2016;25(8):25462552.

    • Search Google Scholar
    • Export Citation
  • 23

    Hresko MT, Labelle H, Roussouly P, Berthonnaud E. Classification of high-grade spondylolistheses based on pelvic version and spine balance: possible rationale for reduction. Spine (Phila Pa 1976). 2007;32(20):22082213.

    • Search Google Scholar
    • Export Citation
  • 24

    Zhu F, Bao H, Liu Z, 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):E140E146.

    • Search Google Scholar
    • Export Citation
  • 25

    Schwab F, Ungar B, Blondel B, Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37(12):10771082.

    • Search Google Scholar
    • Export Citation
  • 26

    Ravichandran G. Multiple lumbar spondylolyses. Spine (Phila Pa 1976). 1980;5(6):552557.

  • 27

    Park SJ, Lee CS, Chung SS, Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery. 2011;68(2)(Suppl Operative):355–363.

    • Search Google Scholar
    • Export Citation
  • 28

    Mehta VA, Amin A, Omeis I, Implications of spinopelvic alignment for the spine surgeon. Neurosurgery. 2012;70(3):707721.

  • 29

    Hey HWD, Lau ET, Tan KA, Lumbar spine alignment in six common postures: an ROM analysis with implications for deformity correction. Spine (Phila Pa 1976). 2017;42(19):14471455.

    • Search Google Scholar
    • Export Citation
  • 30

    Uehara M, Takahashi J, Ikegami S, Sagittal spinal alignment deviation in the general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry. Spine J. 2019;19(2):349356.

    • Search Google Scholar
    • Export Citation
  • 31

    McCunniff PT, Yoo H, Dugarte A, Bilateral pars defects at the L4 vertebra result in increased degeneration when compared with those at L5: an anatomic study. Clin Orthop Relat Res. 2016;474(2):571577.

    • Search Google Scholar
    • Export Citation
  • 32

    Berven S, Wadhwa R. Sagittal alignment of the lumbar spine. Neurosurg Clin N Am. 2018;29(3):331339.

  • 33

    Alzakri A, Labelle H, Hresko MT, Restoration of normal pelvic balance from surgical reduction in high-grade spondylolisthesis. Eur Spine J. 2019;28:20872094.

    • Search Google Scholar
    • Export Citation

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