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Lumbar Retrolisthesis Compensates Spinal Kyphosis.

Abstract

STUDY DESIGN

Large cohort study.

OBJECTIVE

To investigate the role of lumbar retrolisthesis in spinopelvic alignment and health-related quality of life (HRQOL) among volunteers aged >50 years.

SUMMARY OF BACKGROUND DATA

Lumbar retrolisthesis pathology has not been sufficiently elucidated.

METHODS

We included 639 volunteers (257 men, average age 73 [50-92] years). Sagittal vertical axis (SVA), maximum thoracic kyphosis (maxTK), lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were measured using whole-spine and pelvic radiographs taken in standing position. MaxTK was measured from the upper to the lower end vertebrae of spinal kyphosis in the sagittal plane using Cobb's method. HRQOL was evaluated using the Oswestry Disability Index (ODI). Subjects with ≥3 mm posterior lumbar vertebral slip and those with multiple retrolisthesis were included in R(+) and multiple groups, respectively. In single lumbar retrolisthesis subjects, those above L3-L4 were defined as the superior group and below L4-L5 as the inferior group.

RESULTS

The R(+) group had 259 (41%) subjects. Of the posterior slipped vertebrae, 235 (91%) were consistent with the lower end vertebra of the maxTK or its adjacent one. The R(+) group had significantly more males; subjects were older than those in the R(-) group. They also had significantly greater SVA, TK, maxTK, and PI-LL and smaller LL and PI. Multivariate analysis revealed that sex, maxTK, and LL were independent predictors of lumbar retrolisthesis. The inferior group had a significantly greater SVA, PT and PI-LL, and smaller LL and PI than the R(-), superior, and multiple groups. The inferior group also had significantly worse ODI than the R(-) group.

CONCLUSIONS

Subjects with lumbar retrolisthesis showed greater spinal kyphosis and worse spinopelvic alignments. Subjects with lower-generated lumbar retrolisthesis showed worse spinopelvic alignment and HRQOL than subjects with upper-generated lumbar retrolisthesis and multiple ones and those without it.

LEVEL OF EVIDENCE

Level IV.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan. Electronic address: haramibunka@hotmail.co.jp.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu Medical Center, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    ,

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Hamamatsu, Shizuoka Prefecture 431-3125, Japan.

    Source

    Spine deformity 7:4 2019 Jul pg 602-609

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31202378

    Citation

    Mihara, Yuki, et al. "Lumbar Retrolisthesis Compensates Spinal Kyphosis." Spine Deformity, vol. 7, no. 4, 2019, pp. 602-609.
    Mihara Y, Togawa D, Hasegawa T, et al. Lumbar Retrolisthesis Compensates Spinal Kyphosis. Spine Deform. 2019;7(4):602-609.
    Mihara, Y., Togawa, D., Hasegawa, T., Yamato, Y., Yoshida, G., Kobayashi, S., ... Matsuyama, Y. (2019). Lumbar Retrolisthesis Compensates Spinal Kyphosis. Spine Deformity, 7(4), pp. 602-609. doi:10.1016/j.jspd.2018.11.013.
    Mihara Y, et al. Lumbar Retrolisthesis Compensates Spinal Kyphosis. Spine Deform. 2019;7(4):602-609. PubMed PMID: 31202378.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Lumbar Retrolisthesis Compensates Spinal Kyphosis. AU - Mihara,Yuki, AU - Togawa,Daisuke, AU - Hasegawa,Tomohiko, AU - Yamato,Yu, AU - Yoshida,Go, AU - Kobayashi,Sho, AU - Yasuda,Tatsuya, AU - Banno,Tomohiro, AU - Arima,Hideyuki, AU - Oe,Shin, AU - Ushirozako,Hiroki, AU - Matsuyama,Yukihiro, PY - 2018/05/17/received PY - 2018/11/18/revised PY - 2018/11/24/accepted PY - 2019/6/17/entrez PY - 2019/6/17/pubmed PY - 2019/6/17/medline KW - Compensation mechanism KW - Health-related quality of life KW - Lumbar retrolisthesis KW - Spinopelvic alignment KW - Whole-spine radiograph SP - 602 EP - 609 JF - Spine deformity JO - Spine Deform VL - 7 IS - 4 N2 - STUDY DESIGN: Large cohort study. OBJECTIVE: To investigate the role of lumbar retrolisthesis in spinopelvic alignment and health-related quality of life (HRQOL) among volunteers aged >50 years. SUMMARY OF BACKGROUND DATA: Lumbar retrolisthesis pathology has not been sufficiently elucidated. METHODS: We included 639 volunteers (257 men, average age 73 [50-92] years). Sagittal vertical axis (SVA), maximum thoracic kyphosis (maxTK), lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were measured using whole-spine and pelvic radiographs taken in standing position. MaxTK was measured from the upper to the lower end vertebrae of spinal kyphosis in the sagittal plane using Cobb's method. HRQOL was evaluated using the Oswestry Disability Index (ODI). Subjects with ≥3 mm posterior lumbar vertebral slip and those with multiple retrolisthesis were included in R(+) and multiple groups, respectively. In single lumbar retrolisthesis subjects, those above L3-L4 were defined as the superior group and below L4-L5 as the inferior group. RESULTS: The R(+) group had 259 (41%) subjects. Of the posterior slipped vertebrae, 235 (91%) were consistent with the lower end vertebra of the maxTK or its adjacent one. The R(+) group had significantly more males; subjects were older than those in the R(-) group. They also had significantly greater SVA, TK, maxTK, and PI-LL and smaller LL and PI. Multivariate analysis revealed that sex, maxTK, and LL were independent predictors of lumbar retrolisthesis. The inferior group had a significantly greater SVA, PT and PI-LL, and smaller LL and PI than the R(-), superior, and multiple groups. The inferior group also had significantly worse ODI than the R(-) group. CONCLUSIONS: Subjects with lumbar retrolisthesis showed greater spinal kyphosis and worse spinopelvic alignments. Subjects with lower-generated lumbar retrolisthesis showed worse spinopelvic alignment and HRQOL than subjects with upper-generated lumbar retrolisthesis and multiple ones and those without it. LEVEL OF EVIDENCE: Level IV. SN - 2212-1358 UR - https://www.unboundmedicine.com/medline/citation/31202378/Lumbar_Retrolisthesis_Compensates_Spinal_Kyphosis L2 - https://linkinghub.elsevier.com/retrieve/pii/S2212-134X(18)30291-0 DB - PRIME DP - Unbound Medicine ER -