T1 PELVIC ANGLE IN IMPROVEMENT OF PAIN IN HIGH-GRADE LUMBAR SPONDYLOLISTHESIS

José Alberto Alves Oliveira,Guilherme De Rezende Lopes,Paulo Cesar Almeida,Alexandre Peixoto De Mello,Luis Eduardo Carelli Teixeira Da Silva,Ricardo De Souza Portes Meireles,Luiz Eduardo Pereira Costa Assis De Almeida Almeida,Vinícius Tapie Guerra E Silva

doi:10.1590/s1808-185120201902224228

José Alberto Alves Oliveira, Guilherme De Rezende Lopes + Show 6 more

Open Access

https://doi.org/10.1590/s1808-185120201902224228

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Abstract

ABSTRACT Objective To evaluate the correlation between global sagittal alignment variables and pain improvement after surgery for High-Grade Spondylolisthesis (HGS). Methods A sample with 20 patients with L5-S1 HGS, submitted to arthrodesis with instrumentation from 01/2004 to 12/2016. Patients’ demographic data, types of surgeries, complications, sagittal alignment parameters, and Visual Analog Scale (VAS) score (ranging from 0 to 4) were recorded before surgery and at the last follow-up. The data were processed in SPSS 22.0. The confidence level was 0.05. Results The majority of the sample were women, 17 (85%); age at surgery: 52.60 ± 17.15 years; mean follow-up: 3.58 ± 1.62 years; isthmic etiology, 16 (80%) and dysplastic, 4 (20%); Meyerding Grading 3: 12 (60%), Grading 4: 3 (15%) and Grading 5: 5 (25%); SDSG type 4: 6 (30%), type 5a: 3 (15%), 5b: 3 (15%), type 6: 7 (35%) and not classified 1 (5%); surgery: in situ fusion 3 (15%) and reduction 17 (85%); fusion levels: L3-S1: 1 (5%), L3-Iliac: 1 (5%), L4-S1: 1 (5%), L4-Iliac: 6 (30%) and L5-S1: 11 (55%). Comparing the pre- and postoperative parameters, a significant improvement (p <0.05) was seen in the VAS, T1 slope, T1 pelvic angle (TPA), slip angle, Dubousset’s lumbosacral angle and slip %. Evaluating the correlation between the variation in sagittal parameters and the improvement in VAS scale, it was found that the TPA showed a strong correlation (r = 0.709, p = 0.032). Conclusions the present study found a strong correlation between the improvement/reduction in TPA values and the reduction in pain intensity in the VAS. Level of evidence IV; Case Series.

Highlights

Spondylolisthesis is an anterior or posterior displacement between adjacent vertebrae
Compensation first occurs through an increase in lumbar lordosis (LL), followed by the increase in pelvic retroversion that leads to an increase in the pelvic tilt (PT), reducing the sacral slope
This main aim of this study is to evaluate the correlation between changes in global sagittal alignment and improvement in pain levels after High-Grade Spondylolisthesis (HGS) surgery

Summary

Introduction

Spondylolisthesis is an anterior or posterior displacement between adjacent vertebrae. There is generally kyphosis of the L5 vertebra in relation to the S1 In these patients, compensation first occurs through an increase in lumbar lordosis (LL), followed by the increase in pelvic retroversion that leads to an increase in the pelvic tilt (PT), reducing the sacral slope. Compensation first occurs through an increase in lumbar lordosis (LL), followed by the increase in pelvic retroversion that leads to an increase in the pelvic tilt (PT), reducing the sacral slope When these mechanisms of physiological compensation are ineffective in neutralizing the L5-S1 kyphosis, the patient develops a positive global sagittal imbalance, which is posteriorly compensated by flexing the knees and hip, leading to Phalen-Dickson gait.[2].

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