Classification of high-grade spondylolistheses based on pelvic version and spine balance - Possible rationale for reduction

被引:144
作者
Hresko, Michael T.
Labelle, Hubert
Roussouly, Pierre
Berthonnaud, Eric
机构
[1] Harvard Univ, Sch Med, Childrens Hosp, Dept Orthopaed Surg, Boston, MA 02115 USA
[2] Hosp St Justine, Div Orthopaed, Montreal, PQ, Canada
[3] Ctr Massues, Lyon, France
[4] Grp Biomecan Clin, Lyon, France
关键词
spondylolisthesis; spine deformity; pelvic incidence; posture; sagittal balance;
D O I
10.1097/BRS.0b013e31814b2cee
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. Retrospective review of a radiographic database of high-grade spondylolisthesis patients in comparison with asymptomatic controls. Objective. To analyze the sagittal spinopelvic alignment in high-grade spondylolisthesis patients and identify subgroups that may require reduction to restore sagittal balance. Summary of Background Data. High-grade spondylolisthesis is associated with an abnormally high pelvic incidence (PI); however, the spatial orientation of the pelvis, determined by sacral slope (SS) and pelvic tilt ( PT), is not known. We hypothesized that sagittal spinal alignment would vary with the pelvic orientation. Methods. Digitized sagittal radiographs of 133 high-grade spondylolisthesis patients ( mean age, 17 years) were measured to determined sagittal alignment. K-means cluster analysis identified 2 groups based on the PT and SS, which were compared by paired t test. Comparisons were made to asymptomatic controls matched for PI. Results. High-grade spondylolisthesis patients had a mean PI of 78.9 +/- 12.1. Cluster analysis identified a retroverted, unbalanced pelvis group with high PT (36.5 +/- 8.0)/low SS (40.3 +/- 9.0) and a balanced pelvic group with low PT ( mean 21.3 +/- 8.2)/high SS (59.9 +/- 11.2). The retroverted pelvis group had significantly greater L5 incidence and lumbosacral angle with less thoracic kyphosis than the balanced pelvic group. A total of 83% of controls had a "balanced pelvis" based on the categorization by SS and PT. Conclusion. Analysis of sagittal alignment of high-grade spondylolisthesis patients revealed distinct groups termed "balanced" and "unbalanced" pelvis. The PT and SS were similar in controls and balanced pelvis patients. Unbalanced pelvis patients had a sagittal spinal alignment that differed from the balanced pelvis and control groups. Treatment strategies for high-grade spondylolisthesis should reflect the different mechanical strain on the spinopelvic junction in each group; reduction techniques might be considered in patients with an unbalanced pelvis high-grade spondylolisthesis.
引用
收藏
页码:2208 / 2213
页数:6
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