Abstract
Sagittal sacro-pelvic morphology and orientation modulate the geometry of the lumbar spine and consequently, the mechanical stresses at the lumbo-sacral junction. In L5–S1 spondylolisthesis, sacro-pelvic morphology is frequently abnormal and can create an abnormal sacro-pelvic orientation as well as a disturbed global sagittal balance of the spine. These findings have important implications for the evaluation and treatment of patients with spondylolisthesis, and especially for those with a high-grade slip. The goal of this chapter is to review current knowledge on this topic, with a special emphasis on pelvic measurements such as Pelvic Incidence, Sacral Slope, and Pelvic Tilt. When compared with normal populations, these measurements are abnormal and tend to increase in a direct linear fashion as severity of the spondylolisthesis increases. A classification system in six different sagittal spino-pelvic postures is described, based on the radiographic measurement of slip grade and spino-pelvic alignment. For low-grade spondylolisthesis, three types of sacro-pelvic balance are identified using Pelvic Incidence measures, while three other types are recognized in high-grade spondylolisthesis, using Sacral Slope, Pelvic Tilt, C7-plumbline, lumbo-sacral kyphosis, and proximal femoral angle measures. The clinical relevance of this classification is to recognize the abnormal features observed in L5–S1spondylolisthesis and to provide a treatment algorithm based on sagittal spino-pelvic alignment.
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References
Labelle H, Roussouly P, Berthonnaud E, et al. The importance of spino-pelvic balance in L5–S1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine. 2005;30:S27–34.
Duval-Beaupère G, Schimdt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992;20:451–62.
Legaye J, Duval-Beaupère G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for 3D regulation of spinal sagittal curves. Eur Spine J. 1998;7:99–103.
Mangione P, Gomez D, Senegas J. Study of the course of the incidence angle during growth. Eur Spine J. 1997;6:163–7.
MacThiong JM, Labelle H, Berthonnaud E, et al. Sagittal alignment of the spine and pelvis during growth. Spine. 2004;29:1642–7.
Vaz G, Roussouly P, Berthonnaud E, et al. Morphology and equilibrium of pelvis and spine. Eur Spine J. 2002;11:80–7.
Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech. 2005;18:40–7.
Mac-Thiong J-M, Labelle H, Berthonnaud É, et al. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J. 2007;16:227–34.
Gutman G, Labelle H, Barchi S, et al. Normal sagittal parameters of global spinal balance in children and adolescents: a prospective study of 646 asymptomatic subjects. Eur Spine J. 2016;25:3650–7.
Mac-Thiong J-M, Roussouly P, Berthonnaud É, Guigui P. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine. 2010;35:E1193–8.
Mac-Thiong J-M, Roussouly P, Berthonnaud É, Guigui P. Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults. Eur Spine J. 2011;20:S572–7.
Curylo LJ, Edwards C, DeWald RW. Radiographic markers in spondyloptosis: implications for spondylolisthesis progression. Spine. 2002;27:2021–5.
Labelle H, Roussouly P, Berthonnaud É, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine. 2004;29:2049–954.
Whitesides TE Jr, Horton WC, Hutton WC, et al. Spondylotic spondylolisthesis: a study of pelvic and lumbosacral parameters of possible etiologic effect in two genetically and geographically distinct groups with high occurrence. Spine. 2005;30(6S):S12–21.
Mac-Thiong J-M, Wang Z, de Guise JA, et al. Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine. 2008;33(21):2316–25.
Harroud A, Labelle H, Joncas J, Mac-Thiong JM. Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis. Eur Spine J. 2013;22(4):849–56.
Kuntz C IV, Shaffrey CI, Ondra SL, Durrani AA, Mummaneni PV, Levin LS, Pettigrew DB. Spinal deformity: a new classification derived from neutral upright spinal alignment measurements in asymptomatic juvenile, adolescent, adult, and geriatric individuals. Neurosurgery. 2008;63:A25–39.
Roussouly P, Gollogly S, Berthonnaud É, et al. Sagittal alignment of the spine and pelvis in the presence of L5–S1 isthmic lysis and low-grade spondylolisthesis. Spine. 2006;31:2484–90.
Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis classification based on spinopelvic alignment. In: Presented at the Scoliosis Research Society annual meeting; September 2009; San Antonio, TX.
Marchetti PC, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In: Bridwell KH, DeWald RL, Hammerberg KW, et al., editors. The textbook of spinal surgery. 2nd ed. Philadelphia: Lippincott-Raven; 1997. p. 1211–54.
Hresko MT, Labelle H, Roussouly P, et al. Classification of high-grade spondylolisthesis based on pelvic version and spine balance: possible rationale for reduction. Spine. 2007;32:2208–13.
Tanguay F, Labelle H, Wang Z, Joncas J, de Guise JA, Mac-Thiong JM. Clinical significance of lumbosacral kyphosis in adolescent spondylolisthesis. Spine. 2012;37(4):304–8.
Mac-Thiong J-M, Parent S, Joncas J, et al. The importance of proximal femoral angle on sagittal balance and quality of life in children and adolescents with high-grade lumbosacral spondylolisthesis. Eur Spine J. 2018;27:2038–43.
Nahle IS, Labelle H, Parent S, et al. The impact of surgical reduction of high-grade lumbosacral spondylolisthesis on proximal femoral angle and quality of life. Spine J. 2019;19:670–6.
Mac-Thiong J-M, Hresko TM, Alzakri A, et al. Criteria for surgical reduction of high-grade lumbosacral spondylolisthesis based on quality of life measures. Eur Spine J. 2019;28:2060–9.
Wiltse LL, Newman PH, Macnab I. Classification of spondylolysis and spondylolisthesis. Clin Orthop. 1976;117:23–9.
Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J. 2011;20(5):641–6.
Mac-Thiong J-M, Labelle H. Section 2.1: Pathophysiology of Congenital and Developmental Disorders. Chapter 23: Developmental Spondylolisthesis. In: Steinmetz MP, Berven S, Benzel EC, editors. Benzel’s Textbook of Spinal Disorders: Pathophysiology, Management, Techniques and Complication Avoidance. 5th ed. Philadelphia, PA: Elsevier Health Sciences; 2021. p. 230–6.
Mac-Thiong JM, Duong L, Parent S, Hresko MT, Dimar JR 2nd, Weidenbaum M, Labelle H. Reliability of the SDSG classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976). 2012;37(2):E95–102.
Alzakri A, Labelle H, Hresko MT, et al. Restoration of normal pelvic balance from surgical reduction of high-grade spondylolisthesis. Eur Spine J. 2019;28:2087–94.
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Labelle, H., Mac-Thiong, JM. (2023). Role of the Pelvis in the Diagnosis and Management of L5–S1 Spondylolisthesis. In: Wollowick, A.L., Sarwahi, V. (eds) Spondylolisthesis. Springer, Cham. https://doi.org/10.1007/978-3-031-27253-0_8
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DOI: https://doi.org/10.1007/978-3-031-27253-0_8
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