Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study

脊椎滑脱 医学 骨盆倾斜 矢状面 后凸 腰骶关节 脊椎峡部裂 骶骨 骨盆 腰椎 入射(几何) Oswestry残疾指数 前凸 腰椎 脊柱融合术 口腔正畸科 神经外科 脊柱侧凸 柯布角
作者
Raphaël Vialle,Brice Ilharreborde,C. Dauzac,T. Lenoir,L. Rillardon,P. Guigui
出处
期刊:European Spine Journal [Springer Science+Business Media]
卷期号:16 (10): 1641-1649 被引量:100
标识
DOI:10.1007/s00586-007-0348-4
摘要

Recent studies suggested a predominant role of spinopelvic parameters to explain lumbosacral spondylolisthesis pathogeny. We compare the pelvic incidence and other parameters of sagittal spinopelvic balance in adolescents and young adults with developmental spondylolisthesis to those parameters in a control group of healthy volunteers. We compared the angular parameters of the sagittal balance of the spine in a cohort of 244 patients with a developmental L5–S1 spondylolisthesis with those of a control cohort of 300 healthy volunteers. A descriptive and correlation study was performed. The L5 anterior slipping and lumbosacral kyphosis in spondylolisthesis patients was described using multiple regression analysis study. Our study demonstrates that the related measures of sagittal spinopelvic alignment are disturbed in adolescents and young adults with developmental spondylolisthesis. These subjects stand with an increased sacral slope, pelvic tilt and lumbar lordosis but with a decreased thoracic kyphosis. Pelvic incidence was significantly higher in spondylolisthesis patients as compared with controls but was not clearly correlated with the grade of slipping. We showed the same “sagittal balance strategy” in spondylolisthesis patients as in the control group regarding correlations between pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis. We believe that the lumbosacral kyphosis is a stronger factor than pelvic incidence which need to be taken into account as a predominant factor in theories of pathogenesis of lumbosacral spondylolithesis. We thus believe that increased lumbar lordosis associated with L5–S1 spondylolisthesis is secondary to the high pelvic incidence and is an important factor causing high shear stresses at the L5–S1 pars interarticularis. However, the “local” sagittal imbalance of the lumbosacral junction is compensated by adjacent mobile segments in the upper lumbar spine, the pelvis orientation and the thoracic spine. The result is not optimal but a satisfactory global sagittal balance of the trunk, even in the most severe grade of slipping.
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