Affection Of Pelvic Anatomy And Sagittal Balance Of The Spine To Isthmic Spondylolisthesis Etiology And Clinical Symptom

Objectives:To investigate the affection of pelvic anatomy and sagittal balance of the spine to isthmic spondylolisthesis etiology and clinical symptom.Methods:A retrospective study of the sagittal alignment in a population of 68 patients with isthmic spondylolisthesis and a control group of asymptomatic volunteers.Following spinopelvic parameters were analyzed on preoperative full spine x-rays in a standardized standing position.:pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT),lumbar lordosis(LL),thoracic kyphosis(TK),sacro-femoral distance(SFD), SC7D,T9 tilting angle,and grade of spondylolisthesis.T-tests were used to compare the parameters between the control group and patients with isthmic spondylolisthesis.T-tests were used to compare the parameters between different low back pain score team.Pearson's correlation coefficients were used to investigate the association between all parameters and low back pain score.Result:PI,PT,SS,LL,SFD,T9 tilting angle and SC7D were significantly greater and LL/SFD,TK/LL,LL/PI were significantly smaller for patients with isthmic spondylolisthesis compared with the control group(P＜0.05).PI,PT,SS,SFD,LL increase in a direct linear fashion as the severity of the spondylolisthesis increases.PT,T9 tilting angle,SFD,SC7D were significantly greater and SS,LL,TK,LL/SFD, TK/LL,LL/PI were significantly smaller for patients with severe low back pain compared with less low back pain group(P＜0.05).A significant correlation existed between PI,SFD,LL,and the severity of the spondylolisthesis increases.NO significant correlation existed between JOA scores,Oswestry Disability Index and spinopelvic parameters.Conclusion:1.Abnormal pelvic anatomy is relative to isthmic spondylolisthesis etiology and progression.It seems that patients with an increased PI and SFD could be predisposed to isthmic spondylolisthesis and a higher risk of progression of isthmic spondylolisthesis2.Low back pain symptom of isthmic spondylolisthesis is relative to associated affection of several pelvic-spinal parameters.NO significant correlation existed between Low back pain symptom and single parameters3.Sagittal pelvic-spine curve of isthmic spondylolisthesis could divides into three kinds:"unbalanced"group,"compensated"group,and "unbalanced-compensated-re-unbalanced" group."Unbalanced"group: The symptom is more serious.Curve characteristic:pelvis back tilt,a smaller LL and TK,an anterior translation of the C7 plumb line; "Compensated'group:The symptom is not serious.Curve characteristic: pelvis anterior tilt,a bigger LL and TK,no anterior translation of the C7 plumb line;"Unbalanced-compensated-re-unbalanced" group:The symptom is most serious.Curve characteristic:pelvis back tilt seriously,a bigger LL and smaller TK,T9 anterior tilt seriously,an serious anterior translation of the C7 plumb line;4.Abnormal LL/SFD,LL/PI,TK/LL ratio is relative to isthmic spondylolisthesis etiology and clinical symptom.