CORRELATION ANALYSIS OF CHANGES OF SPINE-PELVIC SAGITTAL PARAMETERS BEFORE AND AFTER OPERATION AND EFFECTIVENESS IN PATIENTS WITH LUMBAR SPONDYLOLISTHESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

RENHangling , GENGWei ,  MAJinzhu , XUHui , LIZhong , PANGLianglong , LIKunpeng

Department of Spinal Surgery, Liaocheng Clinical College of Taishan Medical University, Liaocheng People's Hospital, Liaocheng Shandong, 252000, P. R. China;

Corresponding author：

MAJinzhu, Email: majzh819@163.com

Keywords：

Degenerative lumbar spondylolisthesis; Spine-pelvic sagittal parameter; Transforaminal lumbar interbody fusion; Effectiveness

DOI：

10.7507/1002-1892.20150275

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Objective To investigate the correlation between the effectiveness and the changes of spine-pelvic sagittal parameters for patients with spondylolisthesis before and after operation. Methods A retrospective analysis was made on the clinical data of 32 patients with single segmental degenerative lumbar spondylolisthesis at L₄ who accorded with the inclusion criteria between June 2011 and January 2014 (trial group). There were 13 males and 19 females, aged 51-67 years (mean, 59 years). According to Meyerding degree, there were 21 cases of degree I, 10 cases of degree Ⅱ, and 1 case of degree Ⅲ. All patients were treated with transforaminal lumbar interbody fusion (TLIF) surgery. Thirty-five healthy adults at the age of 46-67 years (mean, 57 years) were enrolled as normal controls (control group). The standing position lumbar lateral X-ray films (T₁₂-S₁, bilateral femoral head) were taken at pre- and post-operation to measure the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), disc height (DH), and slip percentage (SP); the visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded. Pearson correlation analysis was used to analyze the correlation between the preoperative various spine-pelvic sagittal parameters and the VAS score and the ODI. After operation, Pearson correlation analysis was used to evaluate the correlation between the changes of these parameters and the improve rates of VAS score and ODI. Results All patients of trial group were followed up 15-22 months (mean, 18 months). At last follow-up, the VAS score, ODI, PT, SS, LL, SP, and DH were significantly improved when compared with preoperative values (P<0.05), except for PI (t=-1.445, P=0.158). There was no significant difference in PT, SS, LL, and DH between trial and control groups at last follow-up (P>0.05); PI was slightly bigger than that of control group (t=8.531, P=0.043). Pearson correlation analysis showed that there was a correlation between spine-pelvic sagittal parameters of PI, PT, SS, and LL (P<0.05); preoperative parameters (except for LL and DH) had correlation with ODI and VAS scores (P<0.05). Postoperative parameters (except for PI) had correlation with the improve rates of ODI and VAS scores (P<0.05), especially for the changes of PT and the improvements of ODI and VAS scores. Conclusion There is a correlation between the changes of spine-pelvic sagittal parameters at pre- and post-operation and effectiveness in patients with lumbar spondylolisthesis. The correlation between the changes of PT and the improvement rates of ODI and VAS scores is more marked. The good effectiveness is closely related with the improved PT.

Citation： RENHangling, GENGWei, MAJinzhu, XUHui, LIZhong, PANGLianglong, LIKunpeng. CORRELATION ANALYSIS OF CHANGES OF SPINE-PELVIC SAGITTAL PARAMETERS BEFORE AND AFTER OPERATION AND EFFECTIVENESS IN PATIENTS WITH LUMBAR SPONDYLOLISTHESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1269-1274. doi: 10.7507/1002-1892.20150275 Copy

1.	Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance:a correlation study. Spine (Phila Pa 1976), 2004, 29(18):2049-2054.
2.	Roussouly P, Gollogly S, Berthonnaud E, et al. Sagital alignment of the spine and pelvis in the percence of L5-S1 isthmic lysis and lowgrade spondylolisthesis. Spine (Phila Pa 1976), 2006, 31(21):2484-2490.
3.	Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976), 2012, 27(1):59-64.
4.	Jackson RP, Phipps T, Hales C, et al. Pelvic lordosis and alignment in spondylolisthesis. Spine (Phila Pa 1976), 2003, 28(2):151-160.
5.	Feng Y, Chen L, Gu Y, et al. Influence of the posterior lumbar interbody fusion on the sagittal spino-pelvic parameters in isthmic L5-S1 spondylolisthesis. J Spinal Disord Tech, 2014, 27(1):E20-25.
6.	Adogwa O, Parker SL, Bydon A, et al. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion:2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech, 2011, 24(8):479-484.
7.	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.
8.	Hresko MT, Labelle H, Roussouly P, et al. Classification of highgrade spondylolisthesis based on pelvic version andspine balance: possible rationale for reduction. Spine (Phila Pa 1976), 2010, 32(20): 2208-2213.
9.	Phillips FM. The argument for noninstrumented posterolateral fusion for patients with spinal stenosis and degenerative spondylolisthesis. Spine (Phila Pa 1976), 2004, 29(2):170-172.
10.	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.
11.	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.
12.	苏锴, 郭营, 汤嘉军, 等. 微创经椎间孔腰椎体间融合术与传统开放手术对退变性腰椎滑脱症腰椎-骨盆矢状位参数的不同影响. 中国脊柱脊髓杂志, 2014, 24(3):204-209.
13.	Godde S, Fritsch E, Dienst M, et al. Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion. Spine (Phila Pa 1976), 2003, 28(15):1693-1699.
14.	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.
15.	Glassman SD, 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.
16.	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.
17.	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.
18.	Park JY, Cho YE, Kuh SU, et al. New prognostic factors for adjacentsegment degeneration after one-stage 360 degrees fgxation for spondylolytie spondylolisthesis:special reference to the usefulness of pelvic incidence angle. Neurosurg Spine, 2007, 7(2):139-144.
19.	Rajnics P, Templier A, Skalli W, et al. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord, 2012, 15(1):24-30.
20.	Satomi K, Hirabayashi K, Toyama Y, et al. A clinical study of degenerative spondylolisthesis:radiographic analysis and choice of treatment. Spine (Phila Pa 1976), 2013, 17(21):1329-1336.
21.	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.
22.	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):583-590.
23.	Goyal N, Wimberley DW, Hyatt A, et al. Radiographic and clinical outcomes after instrumented reduction and transforaminal lumbar interbody fusion of mid and high grade isthmic spondylolisthesis. J Spinal Disord Tech, 2009, 22(5):321-327.
24.	Hresko MT, Labelle H, Roussouly P, et al. Classification of highgrade spondylolisthesis based on pelvic version and spine balance. Spine (Phila Pa 1976), 2013, 32(20):2208-2213.

1. Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance:a correlation study. Spine (Phila Pa 1976), 2004, 29(18):2049-2054.
2. Roussouly P, Gollogly S, Berthonnaud E, et al. Sagital alignment of the spine and pelvis in the percence of L5-S1 isthmic lysis and lowgrade spondylolisthesis. Spine (Phila Pa 1976), 2006, 31(21):2484-2490.
3. Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976), 2012, 27(1):59-64.
4. Jackson RP, Phipps T, Hales C, et al. Pelvic lordosis and alignment in spondylolisthesis. Spine (Phila Pa 1976), 2003, 28(2):151-160.
5. Feng Y, Chen L, Gu Y, et al. Influence of the posterior lumbar interbody fusion on the sagittal spino-pelvic parameters in isthmic L5-S1 spondylolisthesis. J Spinal Disord Tech, 2014, 27(1):E20-25.
6. Adogwa O, Parker SL, Bydon A, et al. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion:2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech, 2011, 24(8):479-484.
7. 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.
8. Hresko MT, Labelle H, Roussouly P, et al. Classification of highgrade spondylolisthesis based on pelvic version andspine balance: possible rationale for reduction. Spine (Phila Pa 1976), 2010, 32(20): 2208-2213.
9. Phillips FM. The argument for noninstrumented posterolateral fusion for patients with spinal stenosis and degenerative spondylolisthesis. Spine (Phila Pa 1976), 2004, 29(2):170-172.
10. 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.
11. 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.
12. 苏锴, 郭营, 汤嘉军, 等. 微创经椎间孔腰椎体间融合术与传统开放手术对退变性腰椎滑脱症腰椎-骨盆矢状位参数的不同影响. 中国脊柱脊髓杂志, 2014, 24(3):204-209.
13. Godde S, Fritsch E, Dienst M, et al. Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion. Spine (Phila Pa 1976), 2003, 28(15):1693-1699.
14. 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.
15. Glassman SD, 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.
16. 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.
17. 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.
18. Park JY, Cho YE, Kuh SU, et al. New prognostic factors for adjacentsegment degeneration after one-stage 360 degrees fgxation for spondylolytie spondylolisthesis:special reference to the usefulness of pelvic incidence angle. Neurosurg Spine, 2007, 7(2):139-144.
19. Rajnics P, Templier A, Skalli W, et al. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord, 2012, 15(1):24-30.
20. Satomi K, Hirabayashi K, Toyama Y, et al. A clinical study of degenerative spondylolisthesis:radiographic analysis and choice of treatment. Spine (Phila Pa 1976), 2013, 17(21):1329-1336.
21. 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.
22. 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):583-590.
23. Goyal N, Wimberley DW, Hyatt A, et al. Radiographic and clinical outcomes after instrumented reduction and transforaminal lumbar interbody fusion of mid and high grade isthmic spondylolisthesis. J Spinal Disord Tech, 2009, 22(5):321-327.
24. Hresko MT, Labelle H, Roussouly P, et al. Classification of highgrade spondylolisthesis based on pelvic version and spine balance. Spine (Phila Pa 1976), 2013, 32(20):2208-2213.

Chinese Journal of Reparative and Reconstructive Surgery

CORRELATION ANALYSIS OF CHANGES OF SPINE-PELVIC SAGITTAL PARAMETERS BEFORE AND AFTER OPERATION AND EFFECTIVENESS IN PATIENTS WITH LUMBAR SPONDYLOLISTHESIS

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