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01-12-2017 | Original Article

A new classification system for degenerative spondylolisthesis of the lumbar spine

Authors: Olivier Gille, Houssam Bouloussa, Simon Mazas, Claudio Vergari, Vincent Challier, Jean-Marc Vital, Pierre Coudert, Soufiane Ghailane

Published in: European Spine Journal | Issue 12/2017

Abstract

Purpose

There is no consensus for a comprehensive analysis of degenerative spondylolisthesis of the lumbar spine (DSLS). A new classification system for DSLS based on sagittal alignment was proposed. Its clinical relevance was explored.

Methods

Health-related quality-of-life scales (HRQOLs) and clinical parameters were collected: SF-12, ODI, and low back and leg pain visual analog scales (BP-VAS, LP-VAS). Radiographic analysis included Meyerding grading and sagittal parameters: segmental lordosis (SL), L1–S1 lumbar lordosis (LL), T1–T12 thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were classified according to three main types—1A: preserved LL and SL; 1B: preserved LL and reduced SL (≤5°); 2A: PI–LL ≥10° without pelvic compensation (PT < 25°); 2B: PI–LL ≥10° with pelvic compensation (PT ≥ 25°); type 3: global sagittal malalignment (SVA ≥40 mm).

Results

166 patients (119 F: 47 M) suffering from DSLS were included. Mean age was 67.1 ± 11 years. DSLS demographics were, respectively: type 1A: 73 patients, type 1B: 3, type 2A: 8, type 2B: 22, and type 3: 60. Meyerding grading was: grade 1 (n = 124); grade 2 (n = 24). Affected levels were: L4–L5 (n = 121), L3–L4 (n = 34), L2–L3 (n = 6), and L5–S1 (n = 5). Mean sagittal parameter values were: PI: 59.3° ± 11.9°; PT: 24.3° ± 7.6°; SVA: 29.1 ± 42.2 mm; SL: 18.2° ± 8.1°. DSLS types were correlated with age, ODI and SF-12 PCS (ρ = 0.34, p < 0.05; ρ = 0.33, p < 0.05; ρ = −0.20, and p = 0.01, respectively).

Conclusion

This classification was consistent with age and HRQOLs and could be a preoperative assessment tool. Its therapeutic impact has yet to be validated.

Level of evidence

Herbiniaux G (1782) Traité sur Diverse Accouchements Laborieux et sur les Polypes de la Matrice

Kilian HF (1854) Schilderungen neuer Beckenformen und ihres Verhaltens im Leben. Bassermann & Mathy

Jacobsen S, Sonne-Holm S, Rovsing H et al (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen osteoarthritis study. Spine 32:120–125CrossRefPubMed

Love TW, Fagan AB, Fraser RD (1999) Degenerative spondylolisthesis. Bone Jt J 81:670–674CrossRef

Matsunaga S, Sakou T, Morizono Y et al (1990) Natural history of degenerative spondylolisthesis: pathogenesis and natural course of the slippage. Spine 15:1204–1210CrossRefPubMed

Iguchi T, Wakami T, Kurihara A et al (2002) Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. Clin Spine Surg 15:93–99

Kepler CK, Hilibrand AS, Sayadipour A et al (2015) Clinical and radiographic degenerative spondylolisthesis (CARDS) classification. Spine J 15:1804–1811CrossRefPubMed

MacNab I (1950) Spondylolisthesis with an intact neural arch—the so-called pseudo-spondylolisthesis. Bone Jt J 32:325–333

Meyerding HW (1932) Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet 54:371–377

10.

Wiltse LL, Newman PH, Macnab IAN (1976) Classification of spondyloisis and spondylolisthesis. Clin Orthop 117:23–29

11.

Funao H, Tsuji T, Hosogane N et al (2012) Comparative study of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J 21:2181–2187CrossRefPubMedPubMedCentral

12.

Kim MK, Lee S-H, Kim E-S et al (2011) The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord 12:1CrossRef

13.

Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20:609–618CrossRefPubMedPubMedCentral

14.

Schwab FJ, Blondel B, Bess S et al (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 38:E803–E812CrossRefPubMed

15.

Liu H, Li S, Zheng Z et al (2015) Pelvic retroversion is the key protective mechanism of L4–5 degenerative spondylolisthesis. Eur Spine J 24:1204–1211CrossRefPubMed

16.

Protopsaltis T, Schwab F, Bronsard N et al (2014) The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Jt Surg Am 96:1631–1640CrossRef

17.

Schwab F, Patel A, Ungar B et al (2010) Adult spinal deformity—postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224–2231CrossRefPubMed

18.

Gille O, Challier V, Parent H et al (2014) Degenerative lumbar spondylolisthesis. Cohort of 670 patients, and proposal of a new classification. Orthop Traumatol Surg Res 100:S311–S315CrossRefPubMed

19.

Lowe T, Berven SH, Schwab FJ, Bridwell KH (2006) The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems. Spine 31:S119–S125CrossRefPubMed

20.

Terran J, Schwab F, Shaffrey CI et al (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73:559–568CrossRefPubMed

21.

Matz PG, Meagher RJ, Lamer T et al (2016) Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 16:439–448CrossRefPubMed

22.

Challier V, Boissiere L, Obeid I et al (2017) One-level lumbar degenerative spondylolisthesis and posterior approach: is transforaminal lateral interbody fusion mandatory?: a randomized controlled trial with 2-year follow-up. Spine 42:531–539CrossRefPubMed

23.

Kumar M, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319CrossRefPubMedPubMedCentral

24.

Cummins J, Lurie JD, Tosteson T et al (2006) Descriptive epidemiology and prior healthcare utilization of patients in the spine patient outcomes research trial’s (sport) three observational cohorts: disc herniation, spinal stenosis and degenerative spondylolisthesis. Spine 31:806CrossRefPubMedPubMedCentral

25.

Rosenberg NJ (1975) Degenerative spondylolisthesis. Predisposing factors. J Bone Jt Surg Am 57:467–474CrossRef

26.

Mac-Thiong J-M, Roussouly P, Berthonnaud É, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35:E1193–E1198CrossRefPubMed

27.

Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16:1459–1467CrossRefPubMedPubMedCentral

28.

Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606CrossRefPubMed

29.

Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353CrossRefPubMed

30.

Buckland AJ, Vira S, Oren JH et al (2016) When is compensation for lumbar spinal stenosis a clinical sagittal plane deformity? Spine J 16:971–981CrossRefPubMed

31.

Liang H-F, Liu S-H, Chen Z-X, Fei Q-M (2017) Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. Eur Spine J. doi:10.1007/s00586-017-5200-x

Title: A new classification system for degenerative spondylolisthesis of the lumbar spine
Authors: Olivier Gille
Houssam Bouloussa
Simon Mazas
Claudio Vergari
Vincent Challier
Jean-Marc Vital
Pierre Coudert
Soufiane Ghailane
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 12/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5275-4

At a glance: The STEP trials

Springer Medicine

A new classification system for degenerative spondylolisthesis of the lumbar spine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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