Jean-Marc Mac-Thiong1,2,3, M Timothy Hresko4, Abdulmajeed Alzakri5,6,7,8, Stefan Parent5,6,7, Dan J Sucato9, Lawrence G Lenke10, Michelle Marks11, Hubert Labelle5,6. 1. University of Montreal, Montreal, Canada. macthiong@gmail.com. 2. Division of Orthopedic Surgery, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. macthiong@gmail.com. 3. Hôpital du Sacré-Coeur, Montreal, Canada. macthiong@gmail.com. 4. Boston Children's Hospital, Boston, MA, USA. 5. University of Montreal, Montreal, Canada. 6. Division of Orthopedic Surgery, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. 7. Hôpital du Sacré-Coeur, Montreal, Canada. 8. King Saud University, Riyadh, Saudi Arabia. 9. Texas Scottish Rite Hospital, Dallas, TX, USA. 10. The Spine Hospital New York-Presbyterian, New York, NY, USA. 11. Setting Straight Scoliosis Foundation, San Diego, CA, USA.
Abstract
PURPOSE: Although surgical reduction in high-grade lumbosacral spondylolisthesis is often performed in young patients, criteria for defining adequate reduction leading to optimal outcomes have yet to be defined. The purpose of this study is to determine if surgical reduction in pelvic balance, slip grade, lumbosacral angle and L5 incidence are associated with quality of life after surgery, based on specific criteria proposed previously in the literature. METHODS: A prospective cohort of 61 patients (14.4 ± 2.7 years) with high-grade lumbosacral spondylolisthesis was followed for a minimum of 2 years after surgery. SRS-22 scores, slip grade, lumbosacral angle, pelvic balance and L5 incidence were assessed before surgery and at the latest follow-up. Multivariable regression analyses were performed using postoperative SRS domain and total scores as the dependent variables. Independent variables consisted of the preoperative SRS scores, and specific criteria of pelvic balance, slip grade, lumbosacral angle and L5 incidence. The influence of slip grade, lumbosacral angle and L5 incidence on pelvic balance was also assessed. RESULTS: Obtaining a balanced pelvis postoperatively was mainly predictive of improved satisfaction with surgery and self-image and also tended to be associated with higher scores for other domains. Improved mental health was associated with reduction to a low-grade slip. Reduction in lumbosacral angle was not predictive of quality of life. Postoperative pelvic balance was mainly associated with preoperative pelvic balance, but there was a tendency for achieving normal pelvic balance when the postoperative L5 incidence was 60° or smaller. CONCLUSIONS: When performing surgery in young patients with high-grade lumbosacral spondylolisthesis, achieving normal pelvic balance is the key because it is associated with improved quality of life. Reduction to a low-grade slip is predictive of improved mental health, but reduction in lumbosacral angle is not associated with postoperative quality of life. There was a tendency for obtaining normal postoperative balance in patients with postoperative L5 incidence 60° or smaller. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Although surgical reduction in high-grade lumbosacral spondylolisthesis is often performed in young patients, criteria for defining adequate reduction leading to optimal outcomes have yet to be defined. The purpose of this study is to determine if surgical reduction in pelvic balance, slip grade, lumbosacral angle and L5 incidence are associated with quality of life after surgery, based on specific criteria proposed previously in the literature. METHODS: A prospective cohort of 61 patients (14.4 ± 2.7 years) with high-grade lumbosacral spondylolisthesis was followed for a minimum of 2 years after surgery. SRS-22 scores, slip grade, lumbosacral angle, pelvic balance and L5 incidence were assessed before surgery and at the latest follow-up. Multivariable regression analyses were performed using postoperative SRS domain and total scores as the dependent variables. Independent variables consisted of the preoperative SRS scores, and specific criteria of pelvic balance, slip grade, lumbosacral angle and L5 incidence. The influence of slip grade, lumbosacral angle and L5 incidence on pelvic balance was also assessed. RESULTS: Obtaining a balanced pelvis postoperatively was mainly predictive of improved satisfaction with surgery and self-image and also tended to be associated with higher scores for other domains. Improved mental health was associated with reduction to a low-grade slip. Reduction in lumbosacral angle was not predictive of quality of life. Postoperative pelvic balance was mainly associated with preoperative pelvic balance, but there was a tendency for achieving normal pelvic balance when the postoperative L5 incidence was 60° or smaller. CONCLUSIONS: When performing surgery in young patients with high-grade lumbosacral spondylolisthesis, achieving normal pelvic balance is the key because it is associated with improved quality of life. Reduction to a low-grade slip is predictive of improved mental health, but reduction in lumbosacral angle is not associated with postoperative quality of life. There was a tendency for obtaining normal postoperative balance in patients with postoperative L5 incidence 60° or smaller. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Quality of life; Sagittal balance; Spinal deformity; Spine; Spondylolisthesis; Surgery
Authors: John R Dimar; Leah Y Carreon; Hubert Labelle; Mladen Djurasovic; Mark Weidenbaum; Courtney Brown; Pierre Roussouly Journal: Eur Spine J Date: 2008-08-23 Impact factor: 3.134
Authors: C Faldini; F Barile; M Ialuna; M Manzetti; G Viroli; F Vita; M Traversari; A Rinaldi; T Cerasoli; A Paolucci; G D'Antonio; A Ruffilli Journal: Musculoskelet Surg Date: 2022-10-01