Skip to main content

Advertisement

Log in

Double-level degenerative spondylolisthesis: what is different in the sagittal plane?

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Degenerative spondylolisthesis (DS) is a common disease. The importance of sagittal malalignment in the DS population has been widely described. However, there is no study reporting sagittal alignment analysis in double-level DS. This study aims to analyze patients with double-level DS and compare them with single-level DS patients in terms of demographic and radiographic data.

Methods

Retrospective multicenter (n = 13) study. Adult patients with one (uni_DS) or two-level DS (multi_DS) were included. Sagittal radiographic parameters were measured by an experienced observer: pelvic, spinal and global parameters with C7 sagittal tilt (C7 tilt, angle between the center of C7 vertebral body and the middle of the sacral endplate with the vertical reference line). After a descriptive analysis, radiographic and demographic data were compared between single and multi_DS.

Results

78 patients were included in multi_DS group and 576 in uni_DS group. Multi_DS were older than uni_DS (70.2 ± 9.4 vs 66.9 ± 10.6 years, p = 0.009). C7tilt was greater in multi_DS (6.2° ± 5.3 vs. 4.8° ± 3.8, p = 0.003). Multi_DS had a greater pelvic incidence (62.4° ± 11.3 vs. 58.3° ± 11.1, p = 0.002). Pelvic tilt was larger in multi-DS (26.0° ± 7.5 vs. 22.6° ± 8.1, p = 0.001). L4S1 lordosis represented 40.4 % of the LLmax in multi_DS and 45.8 % in uni_DS group (p = 0.013).

Conclusions

Multi_DS have different sagittal alignment than single DS with greater PI. In multi_DS, malalignment is more important with larger anterior tilt, loss of lumbosacral lordosis and more compensatory mechanisms such as pelvic retroversion. These findings highlight the need for an adapted surgical correction in these older patients with greater sagittal malalignment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Vining RD, Potocki E, McLean I, Seidman M, Morgenthal AP, Boysen J et al (2014) Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications. J Manipulative Physiol Ther 37(9):678–687

    Article  PubMed  PubMed Central  Google Scholar 

  2. MACNAB I (1950) Spondylolisthesis with an intact neural arch; the so-called pseudo-spondylolisthesis. J Bone Joint Surg Br 32-B(3):325–333

    CAS  PubMed  Google Scholar 

  3. Newman PH (1955) Spondylolisthesis, its cause and effect. Ann R Coll Surg Engl 16(5):305–323

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Benoist M (2003) Natural history of the aging spine. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 12(Suppl 2):S86–S89

    Article  Google Scholar 

  5. Aono K, Kobayashi T, Jimbo S, Atsuta Y, Matsuno T (2010) Radiographic analysis of newly developed degenerative spondylolisthesis in a mean twelve-year prospective study. Spine 35(8):887–891

    Article  PubMed  Google Scholar 

  6. Berlemann U, Jeszenszky DJ, Bühler DW, Harms J (2005) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord 12(1):68–73

    Google Scholar 

  7. Guigui P, Bizot P, Wodecki P, Metral B, Barre E, Deburge A (2000) Role of osteosynthesis in the consolidation of posterolateral arthrodesis: a comparative study in patients operated for lumbar stenosis. Rev Chir Orthopédique Réparatrice Appar Mot. 86(5):452–463

    CAS  Google Scholar 

  8. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6(6):461–472

    Article  CAS  PubMed  Google Scholar 

  9. Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson ANA et al (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91(6):1295–1304

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22(24):2807–2812

    Article  CAS  PubMed  Google Scholar 

  11. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029

    Article  PubMed  Google Scholar 

  12. Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy J-PC, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27(4):387–392

    Article  PubMed  Google Scholar 

  13. Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, et al (2013) Radiographic spino-pelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine

  14. Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 20(Suppl 5):609–618

    Article  Google Scholar 

  15. Kim MK, Lee S-H, Kim E-S, Eoh W, Chung S-S, Lee C-S (2011) The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a Pilot study. BMC Musculoskelet Disord 5(12):69

    Article  Google Scholar 

  16. Morel E, Ilharreborde B, Lenoir T, Hoffmann E, Vialle R, Rillardon L et al (2005) Sagittal balance of the spine and degenerative spondylolisthesis. Rev Chir Orthopédique Réparatrice Appar Mot 91(7):615–626

    Article  CAS  Google Scholar 

  17. Barrey C, Jund J, Perrin G, Roussouly P (2007) Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery 61(5):981–986 (discussion 986)

    Article  PubMed  Google Scholar 

  18. Schuller S, Charles YP, Steib J-P (2011) Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20(5):713–719

    Article  Google Scholar 

  19. Ferrero E, Ould-Slimane M, Gille O, Guigui P, French Spine Society (SFCR) (2015) Sagittal spinopelvic alignment in 654 degenerative spondylolisthesis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc

  20. Smorgick Y, Park DK, Baker KC, Lurie JD, Tosteson TD, Zhao W et al (2013) Single- versus multilevel fusion for single-level degenerative spondylolisthesis and multilevel lumbar stenosis: four-year results of the spine patient outcomes research trial. Spine 38(10):797–805

    Article  PubMed  PubMed Central  Google Scholar 

  21. Berlemann U, Jeszenszky DJ, Bühler DW, Harms J (1999) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord 12(1):68–73

    Article  CAS  PubMed  Google Scholar 

  22. Fujiwara A, Tamai K, An HS, Kurihashi T, Lim TH, Yoshida H et al (2000) The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord 13(5):444–450

    Article  CAS  PubMed  Google Scholar 

  23. Matsunaga S, Sakou T, Morizono Y, Masuda A, Demirtas AM (1990) Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage. Spine 15(11):1204–1210

    Article  CAS  PubMed  Google Scholar 

  24. Funao H, Tsuji T, Hosogane N, Watanabe K, Ishii K, Nakamura M et al (2012) Comparative study of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J 21(11):2181–2187. doi:10.1007/s00586-012-2374-0

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fitzgerald JA, Newman PH (1976) Degenerative spondylolisthesis. J Bone Joint Surg Br 58(2):184–192

    CAS  PubMed  Google Scholar 

  26. Rosenberg NJ (1975) Degenerative spondylolisthesis. Predisposing factors. J Bone Joint Surg Am 57(4):467–474

    CAS  PubMed  Google Scholar 

  27. Faro FD, Marks MC, Pawelek J, Newton PO (2004) Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine 29(20):2284–2289

    Article  PubMed  Google Scholar 

  28. Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F et al (2011) Standardized way for imaging of the sagittal spinal balance. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20(5):602–608

    Article  Google Scholar 

  29. Maillot C, Ferrero E, Fort D, Heyberger C, Le Huec J-C (2015) Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements: Keops(®). Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc

  30. Rillardon L, Levassor N, Guigui P, Wodecki P, Cardinne L, Templier A et al (2003) Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Rev Chir Orthopédique Réparatrice Appar Mot 89(3):218–227

    CAS  Google Scholar 

  31. Duval-Beaupère G, Schmidt C, Cosson P (1992) A barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20(4):451–462

    Article  PubMed  Google Scholar 

  32. Mac-Thiong J-M, Roussouly P, Berthonnaud E, Guigui P (2011) Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 20(5):572–577

    Article  Google Scholar 

  33. Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I et al (2014) Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 36(5):E18

    Article  PubMed  Google Scholar 

  34. Blamoutier A, Guigui P, Charosky S, Roussouly P, Chopin D (2012) Surgery of lumbar and thoracolumbar scolioses in adults over 50. Morbidity and survival in a multicenter retrospective cohort of 180 patients with a mean follow-up of 4.5 years. Orthop Traumatol Surg Res OTSR 98(5):528–535

    Article  CAS  PubMed  Google Scholar 

  35. Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D (2012) Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine 37(8):693–700

    Article  PubMed  Google Scholar 

  36. Maier S, Smith JS, Schwab F, Obeid I, Mundis G, Klineberg E et al (2014) Revision surgery after three-column osteotomy in 335 adult spinal deformity patients: inter-center variability and risk factors. Spine (Phila Pa 1976). doi:10.1097/BRS.0000000000000304

    Google Scholar 

  37. Hassanzadeh H, Jain A, El Dafrawy MH, Ain MC, Mesfin A, Skolasky RL et al (2013) Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications. Spine 38(9):726–731

    Article  PubMed  Google Scholar 

  38. Iguchi T, Wakami T, Kurihara A, Kasahara K, Yoshiya S, Nishida K (2002) Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech 15(2):93–99

    Article  PubMed  Google Scholar 

  39. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87(2):260–267

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emmanuelle Ferrero.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferrero, E., Simon, AL., Magrino, B. et al. Double-level degenerative spondylolisthesis: what is different in the sagittal plane?. Eur Spine J 25, 2546–2552 (2016). https://doi.org/10.1007/s00586-016-4384-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4384-9

Keywords

Navigation