Abstract
Introduction
The impact of sagittal plane imbalance has been demonstrated for adult deformity and pediatric spondylolisthesis. The association between lumbopelvic parameters, global sagittal balance, and health status has not been well-defined in adults with lumbosacral spondylolisthesis. The role for deformity reduction in lumbosacral spondylolisthesis in the adult has not been well-defined. The purpose of this study is to evaluate the impact of sagittal alignment and lumbosacral parameters on health status in adults with L5-S1 spondylolisthesis.
Methods
Secondary analysis of data from a multicenter, prospective study. Health status measures included SF-12 and SRS-30. Radiographic predictor variables included: C7 sagittal vertical axis deviation (SVA), T1 and T9 spinopelvic inclinations, pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), slip angle, Meyerding slip grade, and Labele classification. Pearson's correlations were calculated between each radiographic parameter and health status measure.
Results
Forty-five patients were included (male 15, female 30; average age 40.5 ± 18.7) as summarized in Table 1. For low-grade slips, SVA had strong negative correlations with SF12-MCS, SRS-30 appearance, mental, and satisfaction domains (−0.57, −0.60, −0.58, −0.53, respectively; p < 0.05). PI had strong negative correlations with SRS-30 total, mental, and subscore domains (−0.57, −0.53, −0.57, respectively; p≤0.05). SS also had a strong negative correlation with SF12-MCS (−0.61; p = 0.02), while thoracic kyphosis had a strong positive correlation with SRS-activity (0.62; p = 0.02). For high-grade slips, slip angle had a moderate negative correlation with SF12-MCS (−0.36; p = 0.05). SVA had strong negative correlations with SF12-PCS, SRS-30 appearance, activity domains (−0.48, −0.48, 0.45; p < 0.05) and a moderate negative correlation with SRS-30 subscore (−0.37; p < 0.05). T1PI had a moderate negative correlation with SF12-PCS and SRS-22 appearance (−0.37, −0.36; p≤0.05).
Conclusion
Lumbosacral spondylolisthesis in adults negatively impacts mental and physical HRQoL. While HRQoL are similar between patients with low- and high-grade slips, multiple global and local radiographic sagittal parameters negatively impact HRQoLs for both groups. Improvement of global sagittal balance and lumbopelvic parameters in adults with lumbosacral spondylolisthesis may be useful in improving health status in adults.
|
Total |
Low grade |
High grade |
P-value |
|
|---|---|---|---|---|
|
Abbreviations: LL, lumbar lordosis; MCS, mental component score; PCS, physical component score; PI, pelvic incidence; PT, pelvic tilt; SS, sacral slope; SVA, sagittal vertical axis deviation; T1PI, T1 pelvic inclination; T9PI, T9 pelvic inclination; TK, thoracic kyphosis. |
||||
|
*2 patients without Labele classification. |
||||
|
N |
45 |
14 |
31 |
n/a |
|
Age |
40.5 ± 18.7 |
51.9 ± 17.6 |
35.3 ± 16.9 |
<0.01 |
|
Gender |
||||
|
Male |
15 |
5 |
10 |
|
|
Female |
30 |
9 |
21 |
|
|
Meydering Grade |
||||
|
1 |
0 |
0 |
n/a |
n/a |
|
2 |
14 |
14 |
n/a |
n/a |
|
3 |
20 |
n/a |
20 |
n/a |
|
4 |
9 |
n/a |
9 |
n/a |
|
5 |
2 |
n/a |
2 |
n/a |
|
Labele* |
||||
|
1 |
0 |
0 |
n/a |
n/a |
|
2 |
1 |
1 |
n/a |
n/a |
|
3 |
12 |
12 |
n/a |
n/a |
|
4 |
16 |
n/a |
16 |
n/a |
|
5 |
13 |
n/a |
13 |
n/a |
|
6 |
1 |
n/a |
1 |
n/a |
|
Radiographic |
||||
|
PI |
79.6 ± 10.7 |
79.4 ± 11.0 |
79.7 ± 10.7 |
0.94 |
|
SS |
50.7 ± 10.3 |
49.5 ± 9.2 |
51.2 ± 10.9 |
0.63 |
|
PT |
29.5 ± 6.2 |
29.9 ± 6.6 |
29.2 ± 6.2 |
0.74 |
|
LL |
66.6 ± 16.0 |
62.2 ± 16.9 |
68.7 ± 15.4 |
0.21 |
|
TK |
44.5 ± 11.0 |
49.5 ± 8.2 |
42.2 ± 11.4 |
0.04 |
|
SVA |
26.0 ± 51.4 |
20.2 ± 55.3 |
28.7 ± 50.4 |
0.61 |
|
Slip angle |
5.5 ± 14.5 |
-4.26 ± 7.8 |
9.8 ± 14.7 |
<0.01 |
|
T1PI |
-5.7 ± 3.9 |
-5.9 ± 4.4 |
-5.6 ± 3.7 |
0.83 |
|
T9PI |
-8.6 ± 4.9 |
-10.5 ± 4.2 |
-7.7 ± 5.0 |
0.08 |
|
Outcomes |
||||
|
SF-12 |
||||
|
PCS |
36.4 ± 8.1 |
34.4 ± 8.8 |
37.3 ± 7.6 |
0.28 |
|
MCS |
47.9 ± 11.5 |
46.5 ± 10.4 |
48.5 ± 24.4 |
0.58 |
|
SRS-30 |
||||
|
Pain |
2.5 ± 0.8 |
2.2 ± 0.6 |
2.6 ± 0.8 |
0.08 |
|
Appearance |
2.9 ± 0.7 |
3.0 ± 0.9 |
2.8 ± 0.6 |
0.55 |
|
Activity |
2.9 ± 0.8 |
2.7 ± 0.9 |
3.0 ± 0.8 |
0.19 |
|
Mental Health |
3.4 ± 0.9 |
3.3 ± 0.9 |
3.5 ± 0.9 |
0.46 |
|
Subscore |
2.9 ± 0.6 |
2.8 ± 0.7 |
3.0 ± 0.6 |
0.29 |
|
Satisfaction |
3.0 ± 1.3 |
3.0 ± 1.5 |
3.0 ± 1.3 |
0.84 |
|
Total |
2.9 ± 0.6 |
2.8 ± 0.7 |
3.0 ± 0.6 |
0.37 |