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Current Evidence Regarding the Diagnostic Methods for Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee

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Abstract

Study Design

Structured literature review.

Objectives

The Scoliosis Research Society (SRS) requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis with the goal of identifying what is known and what gaps remain in further understanding the diagnostic methods for pediatric spondylolisthesis.

Summary of Background Data

Spondylolisthesis in the lumbar spine is common among children and adolescents and no formal synthesis of the published literature regarding diagnostic methods has been previously performed.

Methods

A comprehensive literature search was performed. Abstracts were reviewed and data from included studies were analyzed by the committee. From 6600 initial citations with abstract, 663 articles underwent full-text review. The best available evidence for the clinical questions regarding diagnostic methods was provided by 26 included studies. Six of the studies were graded as Level III (retrospective comparative), and represent the current best available evidence whereas 20 of the studies were graded as Level IV (retrospective case series) evidence. No Level V (expert opinion) studies were included in the final list. None of the studies were graded as Level I or Level II.

Results

Plain radiography is the workhorse imaging modality for diagnosing spondylolisthesis. No association between radiologic grade of spondylolisthesis and clinical presentation were noted; however, grade III and IV slips more often required surgery, and increasing slip angles were associated with worse baseline outcome scores.

There is Level III evidence that the Meyerding grade appears to be more accurate for measuring slip percentage whereas the Lonstein Slip angle and Dubousset Lumbosacral Kyphosis angles are the best for measuring lumbosacral kyphosis in spondylolisthesis. In addition, higher sacral table index, pelvic incidence, sacral slope, and lower sacral table angle were associated with spondylolisthesis. True incidence could not be determined by the current literature available. However, studies in adolescent athletes demonstrated an incidence of 6% to 7% across studies.

Conclusions

The current “best available” evidence to guide the diagnosis and characterization of pediatric spondylolisthesis is presented. Future studies are needed to provide more high-quality evidence to answer these clinically relevant questions.

Level of Evidence

Level III, review of Level III studies.

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Authors and Affiliations

  1. Spine Service, Hospital for Special Surgery, 523 East 72nd Street, 2nd Floor, New York, NY, 10021, USA

    Han Jo Kim MD

  2. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Charles H. Crawford III MD

  3. Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY, 40202, USA

    Charles H. Crawford III MD

  4. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA

    Charles Ledonio MD

  5. Denver International Spine Center, Presbyterian St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Denver, CO, 80218, USA

    Shay Bess MD

  6. Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    A. Noelle Larson MD

  7. Greater New York Hospital Association, 555 W 57th Street, NY, NY, 10019, USA

    Marilyn Gates MD

  8. Children’s National Health System, Division of Orthopaedics and Sports Medicine, 111 Michigan Avenue, NW, Washington, DC, 20010, USA

    Matthew Oetgen MD

  9. Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA

    James O. Sanders MD

  10. University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3017, Kansas City, KS, 66160-7387, USA

    Douglas Burton MD

Authors
  1. Han Jo Kim MD
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  2. Charles H. Crawford III MD
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  3. Charles Ledonio MD
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  4. Shay Bess MD
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  5. A. Noelle Larson MD
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  6. Marilyn Gates MD
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  7. Matthew Oetgen MD
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  8. James O. Sanders MD
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  9. Douglas Burton MD
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Corresponding author

Correspondence to Han Jo Kim MD.

Additional information

HJK (personal fees from Zimmer Biomet, K2M, and AOSpine, outside the submitted work); CHC (personal fees from Alphatec Spine, personal fees from Medtronic, personal fees from Titan Spine, outside the submitted work); CL (personal fees from Greatbatch, Inc, outside the submitted work); SB (grants from DePuy Synthes, NuVasive, BioMet, Orthofix, Innovasis, Stryker, and K2 Medical, outside the submitted work); ANL (grants from NIH and Scoliosis Research Society, other from Orthopediatrics and K2M, outside the submitted work); MG (none); MO (none); JOS (holds stock in General Electric, Abvie, Abbot Labs, GreenSun, and Biomedical Enterprises; receives payment for speaking on spinal growth from NuVasive); DB (reports grants and personal fees from DePuy Spine; nonfinancial support from International Spine Study Group, Scoliosis Research Society, and University of Kansas Physicians, outside the submitted work).

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Kim, H.J., Crawford, C.H., Ledonio, C. et al. Current Evidence Regarding the Diagnostic Methods for Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee. Spine Deform 6, 185–188 (2018). https://doi.org/10.1016/j.jspd.2017.08.010

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  • DOI: https://doi.org/10.1016/j.jspd.2017.08.010

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