CORRELATION OF CLINICAL OUTCOME AND SPINOPELVIC SAGITTAL ALIGNMENT AFTER SURGICAL POSTERIOR INTERVERTEBRAL FUSION COMBINED WITH PEDICLE SCREW FIXATION FOR LOW-GRADE ISTHMIC LUMBAR SPONDYLOLISTHESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Liang , SUI Haitao , YU Xuezhong , JIANG Baoen.

Department of Orthopaedics, Dongying People’s Hospital, Dongying Shandong, 257091, P.R.China. Corresponding author: LI Liang, E-mail: jiawei20100303@163.com;

Corresponding author：

Keywords：

Isthmic lumbar spondylolisthesis Spine and pelvic parameters; Sagittal balance; Posterior lumbar interbody fusion

DOI：

10.7507/1002-1892.20130291

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Objective To investigate the effect of the sagittal alignment of the spine and pelvis after surgical posterior intervertebral fusion combined with pedicle screw fixation for low-grade isthmic lumbar spondylolisthesis, and to assess the effectiveness. Methods Between October 2009 and October 2011, 30 patients with low-grade isthmic spondylolisthesis underwent surgical posterior intervertebral fusion combined with pedicle screw fixation, and the clinical data were retrospectively reviewed. There were 14 males and 16 females with an average age of 56.7 years (range, 48-67 years). The pre- and post-operative radiographic parameters, such as percentage of slipping (PS), intervertebral space height, angle of slip (AS), thoracic kyphosis (TK), thoracolumbar junction angle (TLJ), sagittal vertical axis (SVA), lumbar lordosis (LL), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured. The functional evaluation was made using the Oswestry Disability Index (ODI). Pearson correlation were used to investigate the association between all parameters and ODI score. Results PS, intervertebral space height, AS, and ODI were improved significantly compared with properative ones (P lt; 0.05). Significant differences were found in the other parameters between pre- and post-operation (P lt; 0.05) except TLJ and TK. The alteration of SVA showed significant correlation with the changes of PS, PI, PT, LL, SS, AS, SSA, and ODI. The alteration of SSA showed significant correlation with the changes of PS, PI, LL, SS, AS, PT, and ODI. Conclusion Surgical posterior intervertebral fusion combined with pedicle screw fixation for low-grade isthmic spondylolisthesis can effectively improve and maintain the spinal sagittal parameters. SVA and SSA are adequate to evaluate pre-and post-operative balance. The good clinical outcome is closely related with the improved of SVA and SSA.

Citation： LI Liang,SUI Haitao,YU Xuezhong,JIANG Baoen.. CORRELATION OF CLINICAL OUTCOME AND SPINOPELVIC SAGITTAL ALIGNMENT AFTER SURGICAL POSTERIOR INTERVERTEBRAL FUSION COMBINED WITH PEDICLE SCREW FIXATION FOR LOW-GRADE ISTHMIC LUMBAR SPONDYLOLISTHESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(11): 1338-1344. doi: 10.7507/1002-1892.20130291 Copy

1.	Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2): 157-162.
2.	Park SJ, Lee CS, Chung SS, et al. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative): 355-363.
3.	Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J, 2008, 8(5): 747-755.
4.	李鹏飞, 贾楠, 靳宪辉, 等. 椎间植骨粒体积对腰椎后路滑脱复位植骨融合内固定术后融合效果的影响. 中国修复重建外科杂志, 2013, 27(6): 696-702.
5.	Le Huec JC, Leijssen P, Duarte M, et al. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J, 2011, 20 Suppl 5: 669-680.
6.	海涌, 赵会, 邵楠, 等. 腰椎融合术后下腰痛与腰椎矢状位序列的关系. 中华医学杂志, 2013, 93(15): 1129-1132.
7.	Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine, 2011, 14(2): 184-191.
8.	Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: Review of current trends and controversies. Spine (Phila Pa 1976), 2005, 30(6): S71-81.
9.	Miyazaki M, Hymanson HJ, Morshita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(22): E870-876.
10.	Bourghli A, Aunoble S, Reebye O, et al. 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.
11.	贾俊峰, 赵杰, 陈志明, 等. 腰椎峡部裂型滑脱症矢状位参数分析. 中国矫形外科杂志, 2007, 15(11): 850-852.
12.	Legaye J, Duval-Beaupère G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J, 1998, 7(2): 99-103.
13.	Le Huec JC, Aunoble S, Philippe L, et al. Pelvic parameters: origin and significance. Eur Spine J, 2011, 20 Suppl 5: 564-571.
14.	Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976), 2008, 33(14): 1572-1578.
15.	刘勇, 刘臻, 朱锋, 等. 成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究. 中国脊柱脊髓杂志, 2013, 23(4): 307-311.
16.	Labelle H, Roussouly P, Chopin D, et al. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J, 2008, 17(9): 1170-1176.
17.	Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976), 2005, 30(3): 346-353.
18.	Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J, 2011, 20 Suppl 5: S641-646.
19.	Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
20.	Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976), 2009, 34(17): 1828-1833.
21.	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.
22.	Funao H, Tsuji T, Hosogane N, et al. Comparativestudy of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J, 2012, 21(11): 2181-2187.
23.	Roussouly P, Gollogly S, Noseda O, et al. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976), 2006, 31(11): E320-325.
24.	Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976), 2009, 34(17): E599-606.
25.	Mac-Thiong JM, Roussouly P, Berthonnaud E, et al. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976), 2010, 35(22): E1193-1198.
26.	Glassman S, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
27.	Kim MK, Lee S, Kim E, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study. BMC Musculoskelet Disord, 2011, 12: 69.
28.	Chang KW, Leng X, Zhao W, et al. Quality control of reconstructed sagittal balance for sagittal imbalance. Spine (Phila Pa 1976), 2011, 36(3): E186-197.
29.	徐宝山, 马信龙. 脊柱骨盆矢状力线在脊柱疾患中的意义. 中华骨科杂志, 2012, 32(1): 80-85.
30.	Kuntz C 4th, Levin LS, Ondra SL, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine, 2007, 6(2): 104-112.
31.	Mac-Thiong JM, Duong L, Parent S, et al. Reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976), 2012, 37(2): E95-102.
32.	Hakało J, Wroński J. The role of reduction in operative treatment of spondylolytic spondylolisthesis. Neurol Neurochir Pol, 2008, 42(4): 345-352.
33.	Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis beforeand after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
34.	Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
35.	Vialle R, Ilharreborde B, Dauzac C, et al. Is there asagittal imbalanceof the spine in isthmic: spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10): 1641-1649.
36.	Lee JH, Kim KT, Suk KS, et al. Analysis of spinapelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976), 2010, 35(24): E1386-1391.
37.	Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.

1. Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2): 157-162.
2. Park SJ, Lee CS, Chung SS, et al. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative): 355-363.
3. Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J, 2008, 8(5): 747-755.
4. 李鹏飞, 贾楠, 靳宪辉, 等. 椎间植骨粒体积对腰椎后路滑脱复位植骨融合内固定术后融合效果的影响. 中国修复重建外科杂志, 2013, 27(6): 696-702.
5. Le Huec JC, Leijssen P, Duarte M, et al. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J, 2011, 20 Suppl 5: 669-680.
6. 海涌, 赵会, 邵楠, 等. 腰椎融合术后下腰痛与腰椎矢状位序列的关系. 中华医学杂志, 2013, 93(15): 1129-1132.
7. Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine, 2011, 14(2): 184-191.
8. Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: Review of current trends and controversies. Spine (Phila Pa 1976), 2005, 30(6): S71-81.
9. Miyazaki M, Hymanson HJ, Morshita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(22): E870-876.
10. Bourghli A, Aunoble S, Reebye O, et al. 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.
11. 贾俊峰, 赵杰, 陈志明, 等. 腰椎峡部裂型滑脱症矢状位参数分析. 中国矫形外科杂志, 2007, 15(11): 850-852.
12. Legaye J, Duval-Beaupère G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J, 1998, 7(2): 99-103.
13. Le Huec JC, Aunoble S, Philippe L, et al. Pelvic parameters: origin and significance. Eur Spine J, 2011, 20 Suppl 5: 564-571.
14. Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976), 2008, 33(14): 1572-1578.
15. 刘勇, 刘臻, 朱锋, 等. 成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究. 中国脊柱脊髓杂志, 2013, 23(4): 307-311.
16. Labelle H, Roussouly P, Chopin D, et al. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J, 2008, 17(9): 1170-1176.
17. Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976), 2005, 30(3): 346-353.
18. Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J, 2011, 20 Suppl 5: S641-646.
19. Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
20. Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976), 2009, 34(17): 1828-1833.
21. 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.
22. Funao H, Tsuji T, Hosogane N, et al. Comparativestudy of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J, 2012, 21(11): 2181-2187.
23. Roussouly P, Gollogly S, Noseda O, et al. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976), 2006, 31(11): E320-325.
24. Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976), 2009, 34(17): E599-606.
25. Mac-Thiong JM, Roussouly P, Berthonnaud E, et al. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976), 2010, 35(22): E1193-1198.
26. Glassman S, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
27. Kim MK, Lee S, Kim E, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study. BMC Musculoskelet Disord, 2011, 12: 69.
28. Chang KW, Leng X, Zhao W, et al. Quality control of reconstructed sagittal balance for sagittal imbalance. Spine (Phila Pa 1976), 2011, 36(3): E186-197.
29. 徐宝山, 马信龙. 脊柱骨盆矢状力线在脊柱疾患中的意义. 中华骨科杂志, 2012, 32(1): 80-85.
30. Kuntz C 4th, Levin LS, Ondra SL, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine, 2007, 6(2): 104-112.
31. Mac-Thiong JM, Duong L, Parent S, et al. Reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976), 2012, 37(2): E95-102.
32. Hakało J, Wroński J. The role of reduction in operative treatment of spondylolytic spondylolisthesis. Neurol Neurochir Pol, 2008, 42(4): 345-352.
33. Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis beforeand after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
34. Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
35. Vialle R, Ilharreborde B, Dauzac C, et al. Is there asagittal imbalanceof the spine in isthmic: spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10): 1641-1649.
36. Lee JH, Kim KT, Suk KS, et al. Analysis of spinapelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976), 2010, 35(24): E1386-1391.
37. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.

Chinese Journal of Reparative and Reconstructive Surgery

CORRELATION OF CLINICAL OUTCOME AND SPINOPELVIC SAGITTAL ALIGNMENT AFTER SURGICAL POSTERIOR INTERVERTEBRAL FUSION COMBINED WITH PEDICLE SCREW FIXATION FOR LOW-GRADE ISTHMIC LUMBAR SPONDYLOLISTHESIS

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