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  • Sacral Biomechanics Influences Pathogenesis of Lumbar Spondylolisthesis

    Final Number:
    1382

    Authors:
    Robert Koffie MD PhD; Jean-Valery Coumans MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Lumbar spondylolisthesis can be related to facet arthropathy and disc degeneration or to a fracture of the pars interarticularis, but the mechanistic underpinnings of spondylolisthesis remain unclear. There is growing evidence that spinopelvic parameters relate to lumbar lordiosis and are pivotal to understanding the occurrence of spondylolisthesis. We posit that high sacral slope is associated with pars fractures.

    Methods: To investigate this hypothesis, we retrospectively studied sacral biomechanics in 131 patients who underwent single level fusion in our institution for L5-S1 spondylolisthesis. We measured sacral slope in each patient and compared the sacral inclination in patients with a pars fracture to those of patients without a pars fracture. We also calculated the sacral inclination vector force by multiplying the trigonometric sine of the sacral angle with patients’ weight and compared this vector between the two groups.

    Results: We found that patients with pars fractures had steeper sacral slopes (43.2° +/-10.1°) compared to those without pars fractures (36.8° +/- 8.1°) (p = 0.0007). Interestingly, despite having not significant differences in weight (82.7 +/- 17.2 kg vs 87.3 +/- 17.2 kg, p=0.189), patients with pars fractures had 49% higher sacral inclination vector forces compared to those without pars fractures (586 +/- 158 N vs 394 +/- 90 N, p<0.0001).

    Conclusions: Taken together, these data suggest a strong association between high sacral slopes and presence of pars fracture, and further shows that sacral biomechanics influences the pathogenesis of spondylolisthesis.

    Patient Care: We believe that surgeons should be aware of sacral biomechanics when evaluating patients with spondylolisthesis. High sacral slope is associated with pars fractures, and could predispose patients to progressing from lower grade listhesis to higher-grade listhesis. Patients with high sacral inclination and high sacral inclination vector forces on the pars may also be at increased risk for developing new pars interarticularis fractures, leading to worsening listhesis. Thus, sacral biomechanics should be studied to ascertain risk of instability after decompression and progression of disease in patients with low grade spondylolisthesis as well as considered when selecting patients for fusion.

    Learning Objectives: Understand how spinopelvic biomechanics influences pathogenesis of spondylolisthesis

    References: [1] Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JV, Harrington JF, Amin-Hanjani S, Schwartz JS,Sonntag VK, Barker FG 2nd, Benzel EC, Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis., N Engl J Med. 2016 Apr 14;374(15):1424-34 [2] Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, Öhagen P, Michaëlsson K, Sandén B., A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med. 2016 Apr 14;374(15):1413-23. [3] Weiss AJ, Elixhausera A, Andrews RM. Characteristics of operating room procedures in U.S. hospitals, 2011. HCUP statistical brief #170. February 2014 [4] Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 2007;356:2257-2270 [5] Resnick DK, Watters WC III, Sharan A, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine — part 9: lumbar fusion for stenosis with spondylolisthesis. J Neurosurg Spine 2014;21:54-61 [6] Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991;73:802-808 [7] Rampersaud YR, Fisher C, Yee A, et al. Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study. Can J Surg 2014;57:E126-33 [8] Kelleher MO, Timlin M, Persaud O, Rampersaud YR. Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity. Spine (Phila Pa 1976) 2010;35:E981-7 [9] Blumenthal , Curran J, Benzel EC, Potter R, Magge SN, Harrington JF, Coumans JV, Ghogawala Z. Radiographic predictors of delayed instabilityfollowing decompression without fusion for degenerative grade I lumbar spondylolisthesis: Clinical article. J Neurosurg Spine 2013;4:340-346 [10] Boulay C, Tardieu C, Hecquet J et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15(4):415-422, 2006. [11] Hollenberg GM1, Beattie PF, Meyers SP, Weinberg EP, Adams MJ., Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine (Phila Pa 1976). 2002 Jan 15;27(2):181-6. [12] Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 76 suppl1:S42-56, 2015. [13] Sahin MS, Ergun A, Aslan A. The relationship between osteoarthritis of the lumbar facet joints and lumbosacropelvic morphology. Spine 40(19):E1058-62, 2015. [14] Lim JK, Kim SM, Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis. J Korean Neurosurg Soc. 2014 Jun;55(6):331-6

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