Clinical and radiological outcomes of treatment of patients with spondylolysis spondylolisthesis

Indicators of the coxo-vertebral complex determine the orientation of the pelvis in the sagittal plane, and their correct ratio is the factor that reflects the spatial position of the pelvis and spinal column during the verticalization of the body. We have evaluated changes in these parameters of the spinal-pelvic balance in patients with spondylolisthesis of various degrees of displacement.

PURPOSE OF THE STUDY. Analysis of clinical and radiological results of surgical treatment of patients with spondylolytic spondylolisthesis of the L5 vertebra and spino-pelvic imbalance.

MATERIALS AND METHODS. The study analyzed the results of surgical treatment of 320 patients (146 men with an average age of 52.4 years, 174 women with an average age of 55.8 years) with spondylolytic spondylolisthesis of the L5 vertebra, who undergone operation in the period 2016–2020., using the method of repositioning-stabilizing spondylosynthesis with implantation of transpedicular screws and the formation of interbody fusion by implantation of a cage filled with autologous bone. Difficulties with the complete removal of the L5 vertebra were solved using angular osteotomy of the S 1 vertebra. The patients were divided into groups depending on the classification of J.M. Mac-Thiong, H. Labelle and Meyerding H.W. The pain syndrome was assessed according to the VAS, by the degree of dysfunction according to the Oswestry questionnaire in the presurgery and postsurgery examinations, the result of surgical treatment were assessed according to the MacNab subjective scale in the postsurgery examination. Measurement of the parameters of the spinal pelvic balance was performed using standard tools in the RadiAnt DICOM Viewer and WEASIS.

RESULTS. After surgical treatment, there is a decrease in sacral slope (SS), correction of global lumbar lordosis (GLL), and a decrease in the indices of pelvic tilt (PT) with reduction of the L5 vertebra. Changes in pelvic incidence (PI) after elimination of spondylolisthesis by reduction of the L5 vertebra is associated with sacral osteotomy and a change in the inclination of the upper endplate. Striving for a complete reduction of the displaced vertebra and bringing the coxovertebral indicators to normal, made it possible to achieve a significant reduction in pain in the lower back and lower extremities and improve the quality of life.

CONCLUSION. Surgical treatment of patients with spondylolytic spondylolisthesis of the L5 vertebra brings the coxo-vertebral parameters closer to normal, thereby making it possible to correct the sagittal balance and reduce the “mechanical conflict” between the spine and the pelvis.

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