J Korean Neurosurg Soc.  2016 May;59(3):292-295. 10.3340/jkns.2016.59.3.292.

Sagittal Pelvic Radius in Low-Grade Isthmic Lumbar Spondylolisthesis of Chinese Population

• Zhao Y
• Shen CL
• Zhang RJ
• Cheng DW
• Dong FL
• Wang J

• KMID: 2192109
• DOI: http://doi.org/10.3340/jkns.2016.59.3.292

Abstract

OBJECTIVE
To investigate the variation of pelvic radius and related parameters in low-grade isthmic lumbar spondylolisthesis.
METHODS
Seventy-four patients with isthmic lumbar spondylolisthesis and 47 controls were included in this study. There were 17 males and 57 females between 30 and 66 years of age, including 30 with grade I slippages and 44 grade II slippages; diseased levels included 34 cases on L4 and 40 cases on L5. Thoracic kyphosis (TK), the pelvic radius (PR), the pelvic angle (PA), pelvic morphology (PR-S1), and total lumbopelvic lordosis (PR-T12) were assessed from radiographs.
RESULTS
Statistically significant differences were found for the PA, PR-T12, and PR-S1 (24.5±6.6°, 83.7±9.8°, and 25.4±11.2°, respectively) of the patients with spondylolisthesis and the healthy volunteers (13.7±7.8°, 92.9±9.2°, and 40.7±8.9°, respectively). The TK/PR-T12 ratios were between 0.15 and 0.75. However, there were no differences in all the parameters between the L4 and L5 spondylolysis subgroups (p>0.05). The TK and PR-S1 of grade II were less than grade I, but the PA was greater. The PR-T12 of female patients were less than male patients, but the PA was greater (p<0.05).
CONCLUSION
Pelvic morphology differed in patients with low-grade isthmic lumbar spondylolisthesis compared to controls. Gender and the grade of slippage impacted the sagittal configuration of the pelvis, but the segment of the vertebral slip did not. Overall, the spine of those with spondylolisthesis remains able to maintain sagittal balance despite abnormal pelvic morphology.

Keyword

Isthmic lumbar spondylolisthesis; Pelvic radius; Sagittal balance

MeSH Terms

Animals
Asian Continental Ancestry Group*
Female
Healthy Volunteers
Humans
Kyphosis
Lordosis
Male
Pelvis
Radius*
Spine
Spondylolisthesis*
Spondylolysis

Figure

• 

  Fig. 1 Illustration showing the parameters included in this study : thoracic kyphosis (TK or T4–12), pelvic radius (PR), pelvic angle (PA), pelvic morphology (PR-S1) and total lumbopelvic Lordosis (PR-T12).

Reference

1. Barrey C, Roussouly P, Perrin G, Le Huec JC. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J. 2011; 20(Suppl 5):626–633. PMID: 21796393.

2. Berthonnaud E, Dimnet J, Roussouly P, Labelle H. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech. 2005; 18:40–47. PMID: 15687851.

3. Bourghli A, Aunoble S, Reebye O, Le Huec JC. Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J. 2011; 20(Suppl 5):663–668. PMID: 21809014.

4. Chanplakorn P, Wongsak S, Woratanarat P, Wajanavisit W, Laohacharoensombat W. Lumbopelvic alignment on standing lateral radiograph of adult volunteers and the classification in the sagittal alignment of lumbar spine. Eur Spine J. 2011; 20:706–712. PMID: 21107987.

5. Jackson RP, Hales C. Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine (Phila Pa 1976). 2000; 25:2808–2815. PMID: 11064527.

6. Jackson RP, Peterson MD, McManus AC, Hales C. Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine (Phila Pa 1976). 1998; 23:1750–1767. PMID: 9728376.

7. Jackson RP, Phipps T, Hales C, Surber J. Pelvic lordosis and alignment in spondylolisthesis. Spine (Phila Pa 1976). 2003; 28:151–160. PMID: 12544932.

8. Kim CH, Chung CK, Park SB, Yang SH, Kim JH. A change in lumbar sagittal alignment after single-level anterior lumbar interbody fusion for lumbar degenerative spondylolisthesis with normal sagittal balance. J Spinal Disord Tech. 2014; [Epub ahead of print].

9. Kim YB, Kim YJ, Ahn YJ, Kang GB, Yang JH, Lim H, et al. A comparative analysis of sagittal spinopelvic alignment between young and old men without localized disc degeneration. Eur Spine J. 2014; 23:1400–1406. PMID: 24610236.

10. Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis : a review and classification. Eur Spine J. 2011; 20(Suppl 5):641–646. PMID: 21809015.

11. Lim JK, Kim SM. Difference of sagittal spinopelvic alignments between degenerative spondylolisthesis and isthmic spondylolisthesis. J Korean Neurosurg Soc. 2013; 53:96–101. PMID: 23560173.

12. Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA, et al. Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976). 2009; 34:E519–E527. PMID: 19564757.

13. Marks M, Stanford C, Newton P. Which lateral radiographic positioning technique provides the most reliable and functional representation of a patient's sagittal balance? Spine (Phila Pa 1976). 2009; 34:949–954. PMID: 19532003.

14. Oh SK, Chung SS, Lee CS. Correlation of pelvic parameters with isthmic spondylolisthesis. Asian Spine J. 2009; 3:21–26. PMID: 20404942.

15. Park SJ, Lee CS, Chung SS, Kang KC, Shin SK. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery. 2011; 68(2 Suppl Operative):355–363. discussion 362-363. PMID: 21336205.

16. Rajnics P, Templier A, Skalli W, Lavaste F, Illés T. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech. 2002; 15:24–30. PMID: 11891447.

17. Roussouly P, Pinheiro-Franco JL. Sagittal parameters of the spine : biomechanical approach. Eur Spine J. 2011; 20(Suppl 5):578–585. PMID: 21796394.

18. Sergides IG, McCombe PF, White G, Mokhtar S, Sears WR. Lumbo-pelvic lordosis and the pelvic radius technique in the assessment of spinal sagittal balance : strengths and caveats. Eur Spine J. 2011; 20(Suppl 5):591–601. PMID: 21863464.

19. Vialle R, Ilharreborde B, Dauzac C, Lenoir T, Rillardon L, Guigui P. Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study. Eur Spine J. 2007; 16:1641–1649. PMID: 17437136.

20. Wang TP, Zheng ZM, Liu H, Zhang KB, Wang H. [Correlation of adult spinal sagittal imbalance and life quality]. Zhonghua Yi Xue Za Zhi. 2012; 92:1481–1485. PMID: 22944035.