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Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis

Journal article
Authors Anders Joelson
Barbro Danielson
Rune Hedlund
Per Wretenberg
Karin Frennered
Published in Journal of Bone and Joint Surgery-American Volume
Volume 100
Issue 16
Pages 1357-1365
ISSN 0021-9355
Publication year 2018
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages 1357-1365
Language en
Keywords lumbosacral spondylolisthesis, idiopathic scoliosis, pelvic incidence, alignment, fusion, questionnaire, adolescents, children, spine, classification, Orthopedics, Surgery
Subject categories Orthopaedics, Orthopedics


Background: This case series of consecutive patients evaluated sagittal balance and health-related quality of life (HRQoL) 3 decades after in situ arthrodesis for high-grade isthmic spondylolisthesis. Methods: Global sagittal balance, pelvic parameters, and compensatory mechanisms were evaluated on standing lateral radiographs of the spine and pelvis for 28 of 39 consecutive patients, 28 to 41 years after in situ arthrodesis for high-grade L5 to S1 spondylolisthesis. The mean age at surgery was 14 years (range, 9 to 24 years), and the mean age at the time of follow-up was 48 years (range, 39 to 59 years). A subset of the radiographic parameters was compared with the corresponding data from an 8-year follow-up examination of the same patients. HRQoL was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire. Results: We found that 3 of the 28 patients had a global sagittal imbalance (T1 spinopelvic inclination of > 0 degrees). Signs of compensatory mechanisms, such as reduced thoracic kyphosis and pelvic retroversion, were frequent. There was a significant decrease in sacral slope compared with 8-year follow-up data (p = 0.01). The median SRS-22r subscore was on the same level as Swedish normative data. We found no association between radiographic parameters and SRS-22r outcome. Conclusions: Three decades after in situ arthrodesis for high-grade spondylolisthesis, radiographic signs of non-compensated sagittal imbalance were observed in only a few individuals. The patients had normal SRS-22r scores. There was no association between any radiographic parameter and SRS-22r outcome. The findings are relevant in the controversial discussion on whether to perform a reduction procedure to treat high-grade spondylolisthesis.

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