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



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


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.


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).


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.


Quality of life Spine High-grade spondylolisthesis Pelvic balance Surgery 



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)


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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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