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Restoration of normal pelvic balance from surgical reduction in high-grade spondylolisthesis

  • Abdulmajeed Alzakri
  • Hubert Labelle
  • Michael T. Hresko
  • Stefan Parent
  • Daniel J. Sucato
  • Lawrence G. Lenke
  • Michelle C. Marks
  • Jean-Marc Mac-ThiongEmail author
Original Article

Abstract

Purpose

To investigate the effectiveness of surgical reduction in high-grade spondylolisthesis in maintaining or restoring a normal pelvic balance, as related to the QoL.

Methods

It is a retrospective analysis of prospectively collected data of 60 patients (17 males, 43 females) aged 15 ± 3.1 years who underwent surgery for high-grade spondylolisthesis and were followed for a minimum of 2 years after surgery. Patients with a residual high-grade slip following surgery were referred to the postoperative high-grade (PHG) group, while patients with a residual low-grade slip were referred to the postoperative low-grade (PLG) group. Pelvic balance was assessed from pelvic tilt and sacral slope, in order to identify patients with a balanced pelvis or unbalanced pelvis. The SRS-22 questionnaire was completed before surgery and at last follow-up.

Results

Postoperatively, there were 36 patients with a balanced pelvis and 24 patients with an unbalanced pelvis. The improvement in QoL was better in patients with a postoperative balanced pelvis. There were 14 patients in the PHG group and 46 patients in the PLG group. Four of seven patients (57%) in the PHG group and 21 of 26 patients (81%) in the PLG group with a preoperative balanced pelvis maintained a balanced pelvis postoperatively (P = 0.1). None of the patients in the PHG group and 11 of 20 patients (55%) in the PLG group improved from an unbalanced to a balanced pelvis postoperatively (P < 0.05).

Conclusions

Surgical reduction in high- to low-grade slip is more effective in maintaining and restoring a normal pelvic balance postoperatively.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Quality of life Spine High-grade spondylolisthesis Pelvic balance Surgery 

Notes

Acknowledgements

This work was supported by a Standard Investigator Research Grant from the Scoliosis Research Society. This study is approved by Hospital’s Research Ethics Committee.

Compliance with ethical standards

Conflict of interest

J-M Mac-Thiong, H Labelle and S Parent are a co-founders, board members and shareholders of Spinologics Inc. J-M Mac-Thiong receives research support from Medtronic and Depuy-Synthes. S Parent receives research support from DePuy-Synthes. LG Lenke receives royalties from Medtronic and Quality Medical Publishing, is a consultant for Medtronic, and receives research support from EOS Imaging. DJ Sucato is a consultant from Globus.

Supplementary material

586_2019_5973_MOESM1_ESM.pptx (134 kb)
Supplementary material 1 (PPTX 134 kb)

References

  1. 1.
    Antoniades SB, Hammerberg KW, DeWald RL (2000) Sagittal plane configuration of the sacrum in spondylolisthesis. Spine 25(9):1085–1091CrossRefGoogle Scholar
  2. 2.
    Marty C et al (2002) The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J 11(2):119–125CrossRefGoogle Scholar
  3. 3.
    Rajnics P, Templier A, Skalli W, Lavaste F, Illés T (2002) The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Technol 15(1):24–30CrossRefGoogle Scholar
  4. 4.
    Wang Z, Parent S, Mac-Thiong J-M, Petit Y, Labelle H (2008) Influence of sacral morphology in developmental spondylolisthesis. Spine 33(20):2185–2191CrossRefGoogle Scholar
  5. 5.
    Mardjetko S et al (2005) Spine/SRS spondylolisthesis summary statement. Spine 30(6 Suppl):S3CrossRefGoogle Scholar
  6. 6.
    Hresko MT, Labelle H, Roussouly P, Berthonnaud E (2007) Classification of high-grade spondylolistheses based on pelvic version and spine balance: possible rationale for reduction. Spine 32(20):2208–2213CrossRefGoogle Scholar
  7. 7.
    Jiang G, Ye C, Luo J, Chen W (2017) Which is the optimum surgical strategy for spondylolisthesis: reduction or fusion in situ? A meta-analysis from 12 comparative studies. Int J Surg Lond Engl 42:128–137CrossRefGoogle Scholar
  8. 8.
    Hoel RJ, Brenner RM, Polly DW (2018) The challenge of creating lordosis in high-grade dysplastic spondylolisthesis. Neurosurg Clin N Am 29(3):375–387CrossRefGoogle Scholar
  9. 9.
    Joelson A, Danielson BI, Hedlund R, Wretenberg P, Frennered K (2018) Sagittal balance and health-related quality of life three decades after in situ arthrodesis for high-grade isthmic spondylolisthesis. J Bone Joint Surg Am 100(16):1357–1365CrossRefGoogle Scholar
  10. 10.
    Molinari RW, Bridwell KH, Lenke LG, Ungacta FF, Riew KD (1999) Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine 24(16):1701–1711CrossRefGoogle Scholar
  11. 11.
    Petraco DM, Spivak JM, Cappadona JG, Kummer FJ, Neuwirth MG (1996) An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction. Spine 21(10):1133–1138 (discussion 1139) CrossRefGoogle Scholar
  12. 12.
    Poussa M et al (2006) Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine 31(5):583–590 (discussion 591–592) CrossRefGoogle Scholar
  13. 13.
    Bourassa-Moreau É, Mac-Thiong J-M, Joncas J, Parent S, Labelle H (2013) Quality of life of patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and nonsurgical treatments. Spine J 13(7):770–774CrossRefGoogle Scholar
  14. 14.
    Labelle H, Roussouly P, Chopin D, Berthonnaud E, Hresko T, O’Brien M (2008) Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J 17(9):1170–1176CrossRefGoogle Scholar
  15. 15.
    Fu K-MG et al (2011) Morbidity and mortality in the surgical treatment of six hundred five pediatric patients with isthmic or dysplastic spondylolisthesis. Spine 36(4):308–312CrossRefGoogle Scholar
  16. 16.
    Gandhoke GS et al (2017) A multicenter evaluation of clinical and radiographic outcomes following high-grade spondylolisthesis reduction and fusion. Clin Spine Surg 30(4):E363–E369CrossRefGoogle Scholar
  17. 17.
    Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V (2014) Evidence-based surgical management of spondylolisthesis: reduction or arthrodesis in situ. J Bone Joint Surg Am 96(1):53–58CrossRefGoogle Scholar
  18. 18.
    Crawford CH et al (2017) current evidence regarding the treatment of pediatric lumbar spondylolisthesis: a report from the scoliosis research society evidence based medicine committee. Spine Deform 5(5):284–302CrossRefGoogle Scholar
  19. 19.
    Mac-Thiong J-M, Wang Z, de Guise JA, Labelle H (2008) Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine 33(21):2316–2325CrossRefGoogle Scholar
  20. 20.
    Bourassa-Moreau E, Mac-Thiong J-M, Labelle H (2010) Redefining the technique for the radiologic measurement of slip in spondylolisthesis. Spine 35(14):1401–1405CrossRefGoogle Scholar
  21. 21.
    Gutman G et al (2017) Measurement properties of the scoliosis research society outcomes questionnaire in adolescent patients with spondylolisthesis. Spine 42(17):1316–1321CrossRefGoogle Scholar
  22. 22.
    Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O’Brien M (2005) The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine 30(6 Suppl):S27–S34CrossRefGoogle Scholar
  23. 23.
    Gussous Y, Theologis AA, Demb JB, Tangtiphaiboontana J, Berven S (2018) Correlation between lumbopelvic and sagittal parameters and health-related quality of life in adults with lumbosacral spondylolisthesis. Glob Spine J 8(1):17–24CrossRefGoogle Scholar
  24. 24.
    Maciejczak A, Jabłońska-Sudoł K (2017) Correlation between correction of pelvic balance and clinical outcomes in mid- and low-grade adult isthmic spondylolisthesis. Eur Spine J 26(12):3112–3121CrossRefGoogle Scholar
  25. 25.
    Redaelli A, Berjano P, Aebi M (2018) Focal disorders of the spine with compensatory deformities: how to define them. Eur Spine J 27(Suppl 1):59–69CrossRefGoogle Scholar
  26. 26.
    David EN, Skaggs L (2018) Surgical treatment of spondylolisthesis in adolescents has a 46% re-operation rate: a multi-center retrospective cohort study. Presented at the ACP, vol 142, no 1Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Abdulmajeed Alzakri
    • 1
    • 2
    • 4
  • Hubert Labelle
    • 1
    • 3
  • Michael T. Hresko
    • 5
  • Stefan Parent
    • 1
    • 2
    • 3
  • Daniel J. Sucato
    • 6
  • Lawrence G. Lenke
    • 7
  • Michelle C. Marks
    • 8
  • Jean-Marc Mac-Thiong
    • 1
    • 2
    • 3
    • 9
    Email author
  1. 1.University of MontrealMontrealCanada
  2. 2.Hôpital du Sacré-CœurMontrealCanada
  3. 3.Division of Orthopaedic SurgeryCHU Sainte-JustineMontrealCanada
  4. 4.Orthopedic Department, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
  5. 5.Department of Orthopaedic Surgery, Boston Children’s HospitalHarvard Medical SchoolBostonUSA
  6. 6.Texas Scottish Rite HospitalDallasUSA
  7. 7.Columbia University College of Physicians and SurgeonsNew YorkUSA
  8. 8.Setting Scoliosis Straight FoundationSan DiegoUSA
  9. 9.Department of SurgeryHôpital du Sacré-Coeur de MontréalMontrealCanada

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