J Korean Neurosurg Soc.  2014 Jun;55(6):331-336. 10.3340/jkns.2014.55.6.331.

Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis

• Lim JK
• Kim SM

• KMID: 2191112
• DOI: http://doi.org/10.3340/jkns.2014.55.6.331

Abstract

OBJECTIVE
The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS).
METHODS
Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and > or =50 mm). Spinopelvic parameters/PI ratios were assessed and compared between the groups.
RESULTS
The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group.
CONCLUSION
Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

Keyword

Sagittal spinopelvic alignment; Pelvic incidence; SVA; Lumbar lordosis; Degenerative spondylolisthesis; Degenerative spinal stenosis

MeSH Terms

Animals
Axis, Cervical Vertebra
Humans
Incidence
Kyphosis
Lordosis
Spinal Stenosis*
Spine
Spondylolisthesis*

Figure

• 

  Fig. 1 Illustration showing the spinopelvic parameters included in this study. A : This illustration displays the pelvic incidence (PI), the sacral slope (SS) and the pelvic tilt (PT). B : This illustration displays the thoracic kyphosis (TK), lumbar lordosis (LL), the segmental lumbar lordosis (SLL) and the sagittal vertical axis from the C7 plumb line (SVA).

• 

  Fig. 2 Plot graph of spinopelvic parameters in DSPL and DSS patients. All values were within 2-standard deviation. PI : pelvic incidence, PT : pelvic tilt, SS : sacral slope, LL : lumbar lordosis, SLL : segmental lumbar lordosis, TK : thoracic kyphosis, SVA : sagittal vertical axis from C7 plumb line, DSPL : degenerative spondylolisthesis, DSS : degenerative spinal stenosis.

• 

  Fig. 3 Plot graph of spinopelvic parameters/PI ratios in DSPL and DSS patients. All values were within 2-standard deviation. PI : pelvic incidence, PT : pelvic tilt, SS : sacral slope, LL : lumbar lordosis, SLL : segmental lumbar lordosis, TK : thoracic kyphosis, SVA : sagittal vertical axis from C7 plumb line, DSPL : degenerative spondylolisthesis, DSS : degenerative spinal stenosis.

• 

  Fig. 4 Illustration showing the difference of sagittal spinopelvic alignment between DSPL (A) and DSS (B). A : This illustration displays the sagittal spinopelvic alignment of DSPL. B : This illustration displays the sagittal spinopelvic alignment of DSS. DSPL : degenerative spondylolisthesis, DSS : degenerative spinal stenosis, LL : lumbar lordosis, SLL : segmental lumbar lordosis, PT : pelvic tilt, PI : pelvic incidence, SVA : sagittal vertical axis from C7 plumb line.

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