Lumbar spinal fusion of low-grade degenerative spondylolisthesis (Meyerding grade I and II): Do reduction and correction of the radiological sagittal parameters correlate with better clinical outcome?



Lumbar and lumbosacral spinal fusion is an established procedure for the treatment of degenerative spondylolisthesis. However, the impact of reduction in the affected segment and of improvement in the radiological sagittal parameters on the clinical outcome remains unclear. Purpose of the study is to analyze the correlation between the radiological sagittal parameters and clinical outcome after lumbar spinal fusion in low-grade degenerative spondylolisthesis.

Materials and methods

In a monocentric prospective, clinical study, patients with low-grade degenerative spondylolisthesis of a single lumbar segment have been included. All patients received a lumbar spinal fusion according to the pathology of the treated segment. Patients attended clinical and radiological follow-up examination 1 and 2 years postoperatively. Clinical outcome was assessed using the Core Outcome Measurement Index (COMI), the Oswestry Disability Index (ODI) and the EuroQol 5D. The sagittal spinopelvic radiological parameters, sagittal rotation and anterior displacement of the affected segment and lumbar lordosis were assessed. The correlation between the sagittal radiological parameters and clinical outcome was analyzed using Spearman-Rho bi-serial test.


Sixty-two patients (35 female and 27 male) with an average age of 59.3 years were included in the study. All patients completed the follow-up examinations. Significant improvement in COMI, ODI and EuroQol 5D scores was shown in all follow-up examinations. Significant reduction in the anterior displacement was measured postoperatively, which was preserved during the follow-up. However, no correlation could be demonstrated between reduction in anterior displacement and improvement in clinical outcome. Nonetheless, correlation between correction of sagittal rotation and clinical outcome was shown.


Reduction in anterior displacement of the affected segment in the surgical treatment of low-grade degenerative spondylolisthesis does not have an impact on the clinical outcome.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI (2005) United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 30(12):1441–1445 (discussion 1446–7)

    Article  Google Scholar 

  2. 2.

    Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ (2009) Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976) 34(2):199–205.

    Article  Google Scholar 

  3. 3.

    Yoshihara H, Yoneoka D (2015) National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009. Spine J 15(2):265–271.

    Article  PubMed  Google Scholar 

  4. 4.

    Chaléat-Valayer E, Mac-Thiong JM, Paquet J, Berthonnaud E, Siani F, Roussouly P (2011) Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine 20(Suppl 5):634–640.

    Article  Google Scholar 

  5. 5.

    Lazennec JY, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9(1):47–55

    CAS  Article  Google Scholar 

  6. 6.

    Kim MK, Lee SH, Kim ES, Eoh W, Chung SS, Lee CS (2011) The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord 12:69.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

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

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Kumar MN, Baklanov A, Chopin D (2011) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10(4):314–319

    Article  Google Scholar 

  9. 9.

    Wegmann K, Gundermann S, Siewe J, Eysel P, Delank KS, Sobottke R (2013) Correlation of reduction and clinical outcome in patients with degenerative spondylolisthesis. Arch Orthop Trauma Surg 133(12):1639–1644.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Bai X, Chen J, Liu L, Li X, Wu Y, Wang D, Ruan D (2017) Is reduction better than arthrodesis in situ in surgical management of low-grade spondylolisthesis? A system review and meta analysis. Eur Spine J 26(3):606–618.

    Article  PubMed  Google Scholar 

  11. 11.

    Wiltse LL, Winter RB (1983) Terminology and measurement of spondylolisthesis. J Bone Joint Surg Am 65(6):768–772

    CAS  Article  Google Scholar 

  12. 12.

    Boxall D, Bradford DS, Winter RB, Moe JH (1979) Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 61(4):479–495

    CAS  Article  Google Scholar 

  13. 13.

    Liang HF, Liu SH, Chen ZX, Fei QM (2017) Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. Eur Spine J 26(12):3084–3095.

    Article  PubMed  Google Scholar 

  14. 14.

    Chen Z, Xie P, Feng F, Chhantyal K, Yang Y, Rong L (2018) Decompression alone versus decompression and fusion for lumbar degenerative spondylolisthesis: a meta-analysis. World Neurosurg 111:e165–e177.

    Article  PubMed  Google Scholar 

  15. 15.

    Dijkerman ML, Overdevest GM, Moojen WA, Vleggeert-Lankamp CLA (2018) Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review. Eur Spine J 27(7):1629–1643.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Schulte TL, Ringel F, Quante M, Eicker SO, Muche-Borowski C, Kothe R (2016) Surgery for adult spondylolisthesis: a systematic review of the evidence. Eur Spine J 25(8):2359–2367.

    Article  PubMed  Google Scholar 

  17. 17.

    Rhee C, Visintini S, Dunning CE, Oxner WM, Glennie RA (2017) Does restoration of focal lumbar lordosis for single level degenerative spondylolisthesis result in better patient-reported clinical outcomes? A systematic literature review. J Clin Neurosci 44:95–100.

    Article  PubMed  Google Scholar 

  18. 18.

    Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S (2015) Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop 39(1):87–95.

    Article  PubMed  Google Scholar 

  19. 19.

    Kawakami M, Tamaki T, Ando M, Yamada H, Hashizume H, Yoshida M (2002) Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976) 27(1):59–64

    Article  Google Scholar 

  20. 20.

    Lian XF, Hou TS, Xu JG, Zeng BF, Zhao J, Liu XK, Zhao C, Li H (2013) Posterior lumbar interbody fusion for aged patients with degenerative spondylolisthesis: is intentional surgical reduction essential? Spine J 13(10):1183–1189.

    Article  PubMed  Google Scholar 

  21. 21.

    Tay KS, Bassi A, Yeo W, Yue WM (2016) Intraoperative reduction does not result in better outcomes in low-grade lumbar spondylolisthesis with neurogenic symptoms after minimally invasive transforaminal lumbar interbody fusion—a 5-year follow-up study. Spine J 16(2):182–190.

    Article  PubMed  Google Scholar 

  22. 22.

    Hagenmaier HS, Delawi D, Verschoor N, Oner F, van Susante JL (2013) No correlation between slip reduction in low-grade spondylolisthesis or change in neuroforaminal morphology and clinical outcome. BMC Musculoskelet Disord 14:245.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Longo UG, Loppini M, Romeo G, Maffuli N, Denaro V (2014) Evidence-based surgical management of spondylolisthesis: reduction or arthrodesis in situ. J Bone Joint Surg Am 96(1):53–58.

    Article  PubMed  Google Scholar 

  24. 24.

    Shi L, Chen Y, Miao J, Shi J, Chen D (2018) Reduction of slippage influences surgical outcomes of grade II and III lumbar isthmic spondylolisthesis. World Neurosurg 120:e1017–e1023.

    Article  PubMed  Google Scholar 

  25. 25.

    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 (Phila Pa 1976) 32(20):2208–2213

    Article  Google Scholar 

  26. 26.

    Radovanovic I, Urquhart JC, Ganapathy V, Siddiqi F, Gurr KR, Bailey SI, Bailey CS (2017) Influence of postoperative sagittal balance and spinopelvic parameters on the outcome of patients surgically treated for degenerative lumbar spondylolisthesis. J Neurosurg Spine 26(4):448–453.

    Article  PubMed  Google Scholar 

Download references


This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information



Corresponding author

Correspondence to Stavros Oikonomidis.

Ethics declarations

Conflict of interest

Stavros Oikonomidis, Carolin Meyer, Max Joseph Scheyerer, David Grevenstein, Peer Eysel and Jan Bredow declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of our institutional committee (Number 09-182) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Oikonomidis, S., Meyer, C., Scheyerer, M.J. et al. Lumbar spinal fusion of low-grade degenerative spondylolisthesis (Meyerding grade I and II): Do reduction and correction of the radiological sagittal parameters correlate with better clinical outcome?. Arch Orthop Trauma Surg 140, 1155–1162 (2020).

Download citation


  • Degenerative spondylolisthesis
  • Anterior displacement
  • Lumbar fusion
  • Sagittal alignment
  • Spinopelvic parameters