Shalini Agarwal¹*, Ramneet Kaur² and Ravi Rohilla²

¹Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma, Post Graduate Institute of Medical Sciences, Haryana, India
²Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India

*Corresponding Author: Shalini Agarwal, Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma, Post Graduate Institute of Medical Sciences, Haryana, India.

Received: June 16, 2023; Published: August 23, 2023

Abstract

Background: Abnormal spinopelvic parameters lead to sagittal imbalance and contribute to multiple spinal conditions, including degenerative spondylolisthesis, deformity of the spine, and isthmic spondylolysis. The restoration and maintenance of these parameters is crucial to avoid fixed sagittal imbalance following surgery. Many authors have found variations in these parameters. We undertook this prospective study to evaluate and correlate the spinopelvic alignment in young Indian adults presenting with low backache and spondylolisthesis.

Method: We included one hundred young (≤40 yrs) patients (mean age 29.60 ± 6yrs; M:F = 49:51) presenting with low backache. We divided them into a spondylolisthesis (SPL) group with 43 patients and no spondylolisthesis (NSPL) group with 57 patients. We measured the following parameters on whole spine radiographs in a standing position: sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), sacrofemoral distance (SFD), lumbar lordosis (LL), Cobb angle, coronal imbalance (CIB), segmental lumbar lordosis (SLL), and thoracic kyphosis (TK). We also assessed the ratios of various parameters/ PI.

Results: The sacral slope of the SPL group was significantly lower than the NSPL group (33.47 ± 6.48 vs 36.92 ± 6.98; p = 0.013). There was a significant positive correlation between PI and PT, SFD and PT, LL and SS, SLL and LL, LL/PI, SS/PI and SLL/PI, and TK/PI and SLL/PI in the SPL group. While, in the NSPL group there was a significant positive correlation between PI and SS, PT and PI, SFD and PT, LL and SS, LL/PI and SS/PI, SLL/PI and LL/PI, and TK/PI, SLL/PI and LL/PI in the NSPL group. There was a strong negative correlation between SS/PI and PT/PI in the SPL group. All patients with spondylolisthesis had grade 1 disease (Meyerding classification) and all except 04 had a single-level disease.

Conclusion: Our patient population revealed a significantly low sacral slope (SS) in the SPL group.

Keywords: Spino-Pelvic Alignment; Spondylolesthesis; Spinal Degenerative Disease

References

1. Lai Q., et al. “Correlation between the sagittal spino-pelvic alignment and degenerative lumbar spondylolesthesis: A retrospective study”. BMC Musculoskeletal Disorders 19 (2018): 1-6.
2. Schuller S., et al. “Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis”. European Spine Journal 20 (2011): 713-719.
3. Junghanns H. “Spondylolisthesis ohne Spalt im Zwischengelenkstu¨ck”. Archiv fur Orthopadische und Unfall-Chirurgie 29 (1930): 118-127.
4. Steiger F., et al. “Surgery in lumbar degenerative spondylolisthesis: indications, outcomes and complications. A systematic review”. European Spine Journal 23 (2014): 945-973.
5. Lim JK and Kim SM. “Difference of sagittal spinopelvic alignments between degenerative spondylolisthesis and isthmic spondylolisthesis”. Journal of Korean Neurosurgical Society 53 (2013): 96-101.
6. Legaye J., et al. “Equlibre sagittal du rachis. Relations entre basin et courbures rachidiennes sagittales en position debout”. Rachis 5 (1993): 215-226.
7. Raof R. “Vertebral growth and its mechanical control”. The Journal of Bone and Joint Surgery. British Volume 42-B (1960): 40-59.
8. Vialle R., et al. “Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects”. The Journal of Bone and Joint Surgery. American Volume 87 (2005): 260-267.
9. Izumi Y and Kumano K. “Analysis of sagittal lumbar alignment before and after posterior instrumentation: risk factors for adjacent unfused segment”. European Journal of Orthopaedic Surgery and Traumatology 1 (2001): 9-13.
10. Legaye J., et al. “Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves”. European Spine Journal 7 (1998): 99-103.
11. Kobayashi T., et al. “A longitudinal study of congruent sagittal spinal alignment in adult cohort”. Spine 29 (2004): 671-676.
12. Wei X., et al. “Correlations between the sagittal plane parameters of the spine and pelvis and lumbar disc degeneration”. Journal of Orthopaedic Surgery and Research 13 (2018): 1-9.
13. Vialle R., et al. “Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects”. The Journal of Bone and Joint Surgery. American Volume 87 (2005): 260-267.
14. Endo K., et al. “Sagittal spinal alignment in patients with lumbar disc degeneration”. European Spine Journal 19 (2010): 435-438.
15. Anono K., et al. “Radiographic analysis of newly developed degenerative spondylolisthesis in a mean twelve -year prospective study”. Spine 35 (2010): 887-891.
16. Hanson DS., et al. “Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis” Spine 27 (2002): 2026-2029.
17. Labelle H., et al. “Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study”. Spine 29 (2004): 2049-2054.
18. Vaz G., et al. “Sagittal morphology and equilibrium of pelvis and spine”. European Spine Journal 11 (2002): 80-87.
19. Barrey C., et al. “Sagittal balance of the pelvis – spine complex and lumbar degenerative diseases. A comparative study about 85 case”. European Spine Journal 16 (2007): 1459-1467.
20. Singh R., et al. “Spino=pelvic radiological parameters in normal Indian Population”. SICOT-Journal (2014).
21. Bhat MA., et al. “Observations on Sagittal Alignment of Lumbo-Sacral Spine in asymptomatic adults in Kashmir”.
22.  Mahato PK., et al. “A Study to find correlation between the Lumbar Lordosis, Pelvic Incidence, Sacral Slope and Pelvic Tilt and Functional Status of Patients with Chronic Low Backache in Haryana (North Indian) Population”. International Journal of Medical Research Professionals 3.6 (2017): 459-463.
23. Wang T., et al. “Sagittal spino-pelvic parameters in 2- level lumbar degenerative spondylolisthesis- A retrospective study”. Medicine 35 (2016): 50.
24. Roussouly P., et al. “Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position”. Spine 30 (2005): 346-353.
25. Yang X., et al. “The characteristics of spino-pelvic sagittal alignment in patients with lumbar disc degenerative disease”. European Spine Journal 23 (2014): 569-575.

Citation

Citation: Shalini Agarwal., et al. “Spino-Pelvic Alignment in Young Indian Patients with Spondylolesthesis: A Crossectional Study". Acta Scientific Orthopaedics 6.9 (2023): 50-55.

Copyright

Copyright: © 2023 Shalini Agarwal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.