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Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis

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Abstract

Purpose

Global sagittal alignment is considered as an important aspect in the management of spinal disorders, but the evidence establishing its clinical impact in lumbosacral spondylolisthesis is still poor. This study evaluated the impact of global sagittal alignment on the health-related quality of life (HRQOL) of patients with spondylolisthesis.

Methods

A retrospective study of 149 consecutive unoperated children and adolescents presenting with lumbosacral spondylolisthesis (117 low-grade and 32 high-grade) was performed. Two global sagittal alignment parameters were measured on standing lateral radiographs: spinal tilt (ST) and C7 plumbline deviation (C7P deviation). All patients completed the SRS-22 questionnaire to assess HRQOL. Pearson’s correlations were calculated between parameters of global sagittal alignment and HRQOL. Multiple regression analyses were also undertaken to account for slip percentage and lumbosacral kyphosis (LSK).

Results

Both global sagittal alignment parameters were correlated with the SRS-22 total score. When analyzed separately, the correlation was absent in patients with a low-grade slip but remained significant for patients with a high-grade slip (r = 0.35 for ST; r = −0.35 for C7P deviation). The relation was strengthened in high-grade spondylolisthesis when considering only patients with a C7P in front of the posterior corner of upper sacral endplate (r = 0.48 for ST; r = –0.48 for C7P deviation) and was also positive for the SRS-22 pain and appearance domains. For these last patients, the relationship with global sagittal alignment remained significant in the multiple regression analysis. HRQOL was particularly worse for high-grade patients with a C7P in front of the hip axis.

Conclusions

In high-grade spondylolisthesis, an increasing positive sagittal alignment was related to a poorer SRS-22 total score, especially when the C7P is in front of the hip axis. Global sagittal alignment should particularly be assessed in patients with high-grade spondylolisthesis.

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Conflict of interest

This study has been funded by the Fonds de Recherche Québec - Santé (FRQS) and by the Ressources humaines et développement des compétences Canada (RHDCC).

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Authors and Affiliations

  1. Faculty of Medicine, University of Montréal, Montréal, Canada

    Adil Harroud, Hubert Labelle & Jean-Marc Mac-Thiong

  2. Division of Orthopedics, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada

    Hubert Labelle, Julie Joncas & Jean-Marc Mac-Thiong

  3. Division of Orthopaedic Surgery, Hôpital Du Sacré-Coeur de Montréal, Montréal, Canada

    Jean-Marc Mac-Thiong

Authors
  1. Adil Harroud
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  2. Hubert Labelle
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  3. Julie Joncas
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  4. Jean-Marc Mac-Thiong
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Correspondence to Jean-Marc Mac-Thiong.

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Harroud, A., Labelle, H., Joncas, J. et al. Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis. Eur Spine J 22, 849–856 (2013). https://doi.org/10.1007/s00586-012-2591-6

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  • DOI: https://doi.org/10.1007/s00586-012-2591-6

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