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The Association of Sacral Table Angle Measurements With Spondylolytic and Spondylolisthetic Defects at the Lumbosacral Articulation: A Radiographic Analysis

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Abstract

Study Design

Retrospective radiographic study of 6 patients with L5 spondylolysis observed prospectively before the onset of lysis through adulthood. A radiographic analysis of 50 pediatric control subjects was compared with the study group.

Objective

To determine whether sacral table angle (STA) measurements bear etiologic association with the development of spondylolysis and/or subsequent spondylolisthesis.

Summary of Background Data

Although radiographic parameters in association with spondylolysis and isthmic spondylolisthesis have been studied, no parameter has been shown to definitively have a role in development of this disease process. The STA is a recently described radiographic parameter useful in measuring anatomic changes across the lumbosacral articulation. This measurement’s role as a predictor of pars lysis and subsequent slippage remains unknown.

Methods

The researchers examined the longitudinal plain radiographs of 6 patients observed from childhood, before the development of spondylolysis, through adulthood. Measurements of STA and percent slippage were performed. Fifty pediatric control subjects’ radiographs were also examined with STA measurements. Statistical analysis was conducted on results.

Results

Mean STA of the study group before the development of spondylolysis was 95° ± 5.5°. Mean STA from the control group was 97.5° ± 4.3°. No statistical difference was found between groups (p O.05). No index patient had an abnormal STA before spondylolysis (less than 89°, defined as being outside 2 standard deviations from the control mean). Four of 6 index patients with spondylolysis developed spondylolisthesis. A negative correlation (r =.54) was seen for STA as a function of increasing percent slip when assessed longitudinally.

Conclusions

Abnormal STA measurement was not seen before the development of spondylolysis in this study population. Decreasing STAs were seen secondarily in patients with L5 spondylolisthetic progression. This finding points to anatomic change and secondary remodeling of the upper sacrum as a result of slippage.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, SUNY Upstate Medical University, 6620 Fly Road, Suite 200, East Syracuse, NY, 13057, USA

    Richard A. Tallarico MD, Bruce E. Fredrickson MD & William F. Lavelle MD

  2. Department of Orthopaedics, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, 30320, USA

    Thomas E. Whitesides Jr MD

Authors
  1. Richard A. Tallarico MD
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  2. Bruce E. Fredrickson MD
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  3. Thomas E. Whitesides Jr MD
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  4. William F. Lavelle MD
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Corresponding author

Correspondence to William F. Lavelle MD.

Additional information

Author disclosures: RAT (none); BEF (none); TEW (none); WFL (grants from DePuy Spine, outside the submitted work).

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Tallarico, R.A., Fredrickson, B.E., Whitesides, T.E. et al. The Association of Sacral Table Angle Measurements With Spondylolytic and Spondylolisthetic Defects at the Lumbosacral Articulation: A Radiographic Analysis. Spine Deform 3, 372–379 (2015). https://doi.org/10.1016/j.jspd.2014.11.007

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  • DOI: https://doi.org/10.1016/j.jspd.2014.11.007

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