Volume 7 | Issue 2 | May – August 2019 | Page: 2-7 | Mrinal B Shetty , Vinayak Venugopal
Authors: Mrinal B Shetty , Vinayak Venugopal .
 Department of Orthopaedics, Division of Spine Surgery, Father Muller Medical College, Kankanady, Mangalore, Karnataka,
 Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India.
Address of Correspondence
Dr. Vinayak Venugopal,
Department of Orthopaedics, Father Muller Medical College,
Kankanady, Mangalore, Karnataka, India.
Purpose: Spondylolisthesis, with abnormal sacropelvic morphology, tends to disturb the normal spinopelvic sagittal balance and results in abnormal sacropelvic orientation. Publications have emphasized the techniques of reduction and associated complications, but there is little knowledge of the effect of the reduction of sagittal plane translation in spondylolisthesis on the sagittal balance of spine and pelvis in post-operative patients. Therefore, there is a need for more studies concerning the spinopelvic parameters in patients undergoing surgical reduction for isthmicspondylolisthesis.
Our aim through this study is to describe the clinical and radiological impact of the reduction of sagittal plane translation and rotation in isthmic spondylolisthesis at lumbosacral junction following reduction and interbody fusiontransforaminal lumbar interbody fusion (TLIF) on pelvic and spinal parameters.
Materials and Methods: Adult patients undergoing surgical reduction and TLIF for isthmic spondylolisthesis at lumbosacral junction satisfying inclusion and exclusion criteria who have been admitted or treated under Unit of Spine Surgery, Department of Orthopaedics at Father Muller Medical College between August 1, 2016,and June 1, 2018.From the 18 patients included in the study, collected data were analyzed by frequency, percentage, mean, and standard deviation. Tests such as Friedman test were used to compare the parameters over different time point and posthoc analysis was carried out using Wilcoxon signed-rank test.
Results: Of the 18 patients included in the study followed up for a period of 1 year,77.8% were female and 22.2% were male. Average lumbar lordosis (LL) improved from 46.17° ± 7.57° to 57.87°± 1.95° at the end of 1 year(P = 0.000).Mean pelvic tilt (PT) preoperatively was 25°± 8.95°, which reduced to 18.10°± 2.29° at the end of 1 year. Average pre-operative sacral slope(SS)was 32.33° which increased to 39.23° at the end of 1 year. Pelvic incidence remained a constant irrespective of the intervention. Preoperatively, the average sagittal vertical axis (SVA) was 4.03cm which indicates sagittal imbalance; at the end of 1 year, SVA was 2.40cm which indicates a well-balanced spine. The mean pre-operative Oswestry Disability Index (ODI) was 55.67± 9.46 which suggested moderate-to-severe disability as per the ODI scoring system, which improved to 12.00± 3.36 which indicates minimal disability. Preoperatively, average visual analog scale (VAS) score was 8 which reduced to 0.17 at the end of 1 year, which is a significant decline in the pain with minimal or no pain by the end of 12months.
Conclusion: The procedure resulted in adequate reduction of listhesis, restoration of sagittal balance of spine, improvement of other spinopelvic parameters (PT, SS and LL), adequate fusion of the lumbosacral junction, and less morbidity (indicated by VAS and ODI score). Hence, the measurement of spinopelvic parameters is of utmost importance in pre-operative planning, with the aim of surgery then being to restore these deranged parameters to normal ranges. Reduction of translational as well as rotational component of spondylolisthesis with interbody fusion (TLIF) is an effective technique which restores the sagittal balance of spine, improves LL, improves fusion rate, and reduces the rate of adjacent segment disease as well as morbidity.
Keywords: Isthmic spondylolisthesis, reduction of listhesis, spinopelvic parameters.
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|How to Cite this article: Shetty M B, Venugopal V. The Effect of Surgical Reduction of Isthmic Spondylolisthesis at the Lumbosacral Junction on Spinopelvic Morphology. Journal of Karnataka Orthopaedic Association May-Aug 2019; 7(2): 2-7.|