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Hubert Labelle - One of the best experts on this subject based on the ideXlab platform.
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Spondylolisthesis, Sacro-Pelvic Morphology, and Orientation in Young Gymnasts.
Journal of spinal disorders & techniques, 2015Co-Authors: Charles-william Toueg, Jean-marc Mac-thiong, Guy Grimard, Benoit Poitras, Stefan Parent, Hubert LabelleAbstract:STUDY DESIGN Cross-sectional evaluation of sacro-pelvic morphology and orientation as well as Spondylolisthesis prevalence in a cohort of young gymnasts. OBJECTIVE To evaluate the prevalence of Spondylolisthesis in a cohort of gymnasts, as well as the associated demographic characteristics and sacro-pelvic morphology and orientation. SUMMARY OF BACKGROUND DATA Numerous studies have shown that sagittal sacro-pelvic morphology and orientation is abnormal in Spondylolisthesis. Sacro-pelvic morphology and orientation in gymnasts and their relationship with Spondylolisthesis have never been analyzed. METHODS Radiologic evaluation of 92 gymnasts was performed to identify Spondylolisthesis, and to measure pelvic incidence, pelvic tilt, sacral slope, and sacral table angle. In the presence of Spondylolisthesis, the slip percentage was measured. Different demographic and training characteristics were evaluated. Radiographic parameters were compared with reference values published for asymptomatic children and adolescents, and for subjects with Spondylolisthesis. RESULTS A 6.5% prevalence of Spondylolisthesis was found in our cohort. The weekly training schedule was the only statistically significant different demographic characteristic between the 2 groups, at 20.6±5.4 versus 14.4±5.6 h/wk for subjects with and without Spondylolisthesis, respectively. Pelvic incidence, pelvic tilt, sacral slope, and sacral table angle were 69±20, 15±13, 54±11, and 88±7 degrees in gymnasts with Spondylolisthesis, and 53±11, 10±6, 43±9, and 94±6 degrees in gymnasts without Spondylolisthesis, respectively. When compared with asymptomatic individuals, pelvic incidence and pelvic tilt were slightly superior in gymnasts without Spondylolisthesis. Pelvic incidence, sacral slope, and sacral table angle were significantly different between gymnasts with and without Spondylolisthesis. CONCLUSIONS The prevalence of Spondylolisthesis in young gymnasts was similar to that observed in the general population. Sagittal sacro-pelvic morphology and orientation was abnormal in gymnasts with Spondylolisthesis. Sagittal sacro-pelvic morphology and orientation was also slightly different in gymnasts without Spondylolisthesis when compared with the normal population. The present study supports an association between Spondylolisthesis and abnormal sacro-pelvic orientation and morphology.
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Prevalence of Spondylolisthesis in a population of gymnasts.
Studies in health technology and informatics, 2010Co-Authors: Charles-william Toueg, Jean-marc Mac-thiong, Guy Grimard, Benoit Poitras, Stefan Parent, Hubert LabelleAbstract:Spondylolysis occurs in 6 % of the general population. Of these, approximately 75% will develop Spondylolisthesis. According to multiple studies, an increased prevalence of spondylolysis and Spondylolisthesis exists in groups of athletes practicing certain sports such as gymnastics. In the literature, prevalence of Spondylolisthesis in gymnasts can reach up to 40 to 50 %. However, the specific risk factors associated with the development of Spondylolisthesis in gymnasts are not known. The main purpose of this study was to evaluate the prevalence of spondylolysis and Spondylolisthesis in a population of gymnasts, as well as the associated epidemiological characteristics. In order to achieve this goal, we presented our project to the two most renowned gymnastics centers in the city of Montreal, which allowed us to recruit a total of 93 gymnasts (19 males and 74 females). A radiological evaluation, with the low emission radiographic system, EOS, allowed us to identify the subjects that were affected by spondylolysis and Spondylolisthesis. Additionally, standardized questionnaires allowed us to evaluate and compare different epidemiologic parameters such as age, height, weight, number of years of practice, number of hours of training per week. Of the 93 gymnasts evaluated clinically and radiographically, we identified 6 (1 male, 5 females) gymnasts presenting a spondylolysis and/or Spondylolisthesis. This 6.5% prevalence found in our population is similar to the one reported in the general population. Gender did not seem to be a determinant factor. Also, gymnasts with and without spondylolysis and/or Spondylolisthesis seemed to be similar in terms of height. However, gymnasts with spondylolysis and/or Spondylolisthesis seemed to be heavier than gymnasts without one of these two affections, older and training with greater intensity. These results suggest that the real prevalence rate of spondylolysis and Spondylolisthesis in gymnasts may have been overestimated in previous studies. A selection bias, due to the high competitive level in the two gymnastics centers where our recruitment took place, could be involved. Our findings could also be the result of new or different training methods compared to those used in past studies. This might suggest that with intense training schedules, heavier individuals could potentially be prone to increased loads at the lumbosacral junction, thus favoring the development of spondylolysis and Spondylolisthesis. These hypotheses should be explored in further details in the near future, especially with investigation of radiological parameters of the spine and pelvis.
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Influence of sacral morphology in developmental Spondylolisthesis.
Spine, 2008Co-Authors: Zhi Wang, Stefan Parent, Jean-marc Mac-thiong, Yvan Petit, Hubert LabelleAbstract:STUDY DESIGN A radiographic study was conducted to investigate sacral morphology in a children and adolescent population with developmental L5-S1 Spondylolisthesis. OBJECTIVE To determine the relationship between sacral morphology and developmental L5-S1 Spondylolisthesis. SUMMARY AND BACKGROUND DATA The morphology of the adult sacrum has been recently shown to be abnormal in low grade Spondylolisthesis. However, sacral morphology has never been evaluated in a pediatric population where remodeling and secondary changes are less pronounced. It remains unknown if these changes in sacral morphology are primary or secondary in developmental L5-S1 Spondylolisthesis. METHODS The lateral standing radiographs of 131 subjects, aged 6 to 20 years old with developmental L5-S1 Spondylolisthesis (91 low grade and 40 high grade) were analyzed with a dedicated software allowing to measure the following parameters, which were analyzed for each subject by the same individual and compared to a cohort of 120 subjects without any spinal pathology with similar age and sex distribution: the sacral table index (STI), sacral table angle (STA), sacral kyphosis (SK), S1 superior angle, S2 inferior angle, and grade of Spondylolisthesis. Student t test was used to compare the parameters between the groups. RESULTS This study demonstrated that STA is significantly smaller (P < 0.01) in children and adolescents with L5-S1 Spondylolisthesis compared to a similar control group. Furthermore, STA is significantly smaller in high-grade Spondylolisthesis when compared to subjects with low grade. There is also a significant difference in segmental sacral morphology (S1 and S2 anatomy) in the Spondylolisthesis group. Increasing sacral kyphosis is also found to be significantly associated with Spondylolisthesis. CONCLUSION The sagittal sacral morphology is a constant anatomic variable specific to each individual and unaffected by the position of the patient in space. The anatomy of the sacrum in children and adolescents with L5-S1 Spondylolisthesis is particular and different from a control group. This study suggests that sacral anatomy may have a direct influence on the progression of Spondylolisthesis; a lower STA and higher sacral kyphosis may be 2 factors predisposing to vertebral slip in developmental Spondylolisthesis.
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Spondylolisthesis pelvic incidence and spinopelvic balance a correlation study
Spine, 2004Co-Authors: Hubert Labelle, Pierre Roussouly, Eric Berthonnaud, Timothy Hresko, Michael J Obrien, D Chopin, Ensor E Transfeldt, Joannes DimnetAbstract:STUDY DESIGN: A retrospective study of the sagittal alignment in developmental Spondylolisthesis. OBJECTIVES: To investigate the role of pelvic anatomy and its effect on the global balance of the trunk in developmental Spondylolisthesis. SUMMARY OF BACKGROUND DATA: Pelvic incidence (PI) is a fundamental anatomic parameter that is specific and constant for each individual, and independent of the three-dimensional orientation of the pelvis. Recent studies have suggested an association between a high PI and patients with isthmic Spondylolisthesis. METHODS: The lateral standing radiographs of the spine and pelvis of 214 subjects with developmental L5-S1 Spondylolisthesis were analyzed with a dedicated software allowing the calculation of the following parameters: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), and grade of Spondylolisthesis. All measurements were done by the same individual and compared to those of a cohort of 160 normal subjects. Student's tests were used to compare the parameters between the curve types and Pearson's correlation coefficients were used to investigate the association between all parameters (alpha = 0.01). RESULTS: PI, SS, PT, and LL are significantly greater (P < 0.01) in subjects with Spondylolisthesis, while TK is significantly decreased. PI has a direct linear correlation (0.41-0.65) with SS, PT, and LL. Furthermore, the differences between the two populations increase in a direct linear fashion as the severity of the Spondylolisthesis increases. CONCLUSIONS: Since PI is a constant anatomic pelvic variable specific to each individual and strongly determines SS, PT, and LL, which are position-dependent variables, this study suggests that pelvic anatomy has a direct influence on the development of a Spondylolisthesis.Study participants with an increased pelvic incidence appear to be at higher risk of presenting a Spondylolisthesis, and an increased PI may be an important factor predisposing to progression in developmental Spondylolisthesis.
Lars Hackenberg - One of the best experts on this subject based on the ideXlab platform.
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clinical and radiologic 2 4 year results of transforaminal lumbar interbody fusion in degenerative and isthmic Spondylolisthesis grades 1 and 2
Spine, 2006Co-Authors: Sebastian Lauber, Tobias L Schulte, Ulf Liljenqvist, H Halm, Lars HackenbergAbstract:Study design Prospective clinical study. Objective To evaluate the clinical and radiographic result of the transforaminal lumbar interbody fusion (TLIF) as an alternative new technique in degenerative and isthmic lower grade Spondylolisthesis. Summary of background data TLIF is a new alternative surgical technique used for spinal fusion avoiding the ventral approach and can theoretically prevent typical complications, such as those seen in anterior and posterior lumbar interbody fusion. Materials and methods There were 19 degenerative, 19 isthmic, and 1 dysplastic spondylolistheses operated on with TLIF. The clinical follow-up used the Oswestry Disability Index, the radiologic follow-up radiograph, analyzing segmental lordosis, intervertebral space, reduction, and fusion rate. The minimum follow-up was 24 months, mean clinical follow-up was 50 months, and radiologic follow-up was 35 months. Results The medium of the Oswestry Disability Index in all patients decreased from 23.5 to 13.5 points, in isthmic spondylolistheses from 20.5 to 10.95 after 2 years. The radiographic fusion rate was 94.8%. The sagittal translation was reduced from 23% to 15%. There were 3 (7.6%) serious postoperative complications observed, which required operative revision. Conclusions TLIF is a safe and effective method to treat low-grade Spondylolisthesis, which can theoretically prevent typical complications of anterior and posterior lumbar interbody fusion. The results of isthmic spondylolistheses were significantly better compared to degenerative spondylolistheses.
Bronek M Boszczyk - One of the best experts on this subject based on the ideXlab platform.
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the management of high grade Spondylolisthesis and co existent late onset idiopathic scoliosis
European Spine Journal, 2016Co-Authors: Abhishek Srivastava, Edward Bayley, Bronek M BoszczykAbstract:It is relatively common for a scoliosis deformity to be associated with a lumbar Spondylolisthesis in adolescents (up to 48 % of spondylolistheses). In the literature two types of curve have been described: ‘sciatic’ or ‘olisthetic’. However, there is no consensus in the literature on how best to treat these deformities. Some authors advocate a single surgical intervention, where both deformities are corrected; whereas, others advocate treating them as separate entities. In this situation, it has been shown that the scoliosis will correct with treatment of the Spondylolisthesis. We present a 12-year-old girl who had a concomitant high-grade Spondylolisthesis and scoliosis. Her main complaints were those of low back pain and an L5 radiculopathy. We took the decision to treat the Spondylolisthesis surgically, but observe the scoliosis, rather than correcting them both surgically at the same sitting. Although the immediately post-operative radiographs showed persistence of the scoliosis, 1-year follow-up demonstrated full resolution of the deformity. This young lady also had relief of her low back pain and leg pain following the surgery. There are no standard guidelines and therefore, we discuss the management of this difficult problem, exemplifying a case of a young girl who had high-grade Spondylolisthesis along with a clinically non-flexible scoliosis treated at our institution. We demonstrate that it is safe to observe the scoliosis, even in high-grade spondylolistheses.
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The management of high-grade Spondylolisthesis and co-existent late-onset idiopathic scoliosis
European Spine Journal, 2016Co-Authors: Abhishek Srivastava, Edward Bayley, Bronek M BoszczykAbstract:Introduction It is relatively common for a scoliosis deformity to be associated with a lumbar Spondylolisthesis in adolescents (up to 48 % of spondylolistheses). In the literature two types of curve have been described: ‘sciatic’ or ‘olisthetic’. However, there is no consensus in the literature on how best to treat these deformities. Some authors advocate a single surgical intervention, where both deformities are corrected; whereas, others advocate treating them as separate entities. In this situation, it has been shown that the scoliosis will correct with treatment of the Spondylolisthesis. Materials and methods We present a 12-year-old girl who had a concomitant high-grade Spondylolisthesis and scoliosis. Her main complaints were those of low back pain and an L5 radiculopathy. We took the decision to treat the Spondylolisthesis surgically, but observe the scoliosis, rather than correcting them both surgically at the same sitting. Results Although the immediately post-operative radiographs showed persistence of the scoliosis, 1-year follow-up demonstrated full resolution of the deformity. This young lady also had relief of her low back pain and leg pain following the surgery. Conclusion There are no standard guidelines and therefore, we discuss the management of this difficult problem, exemplifying a case of a young girl who had high-grade Spondylolisthesis along with a clinically non-flexible scoliosis treated at our institution. We demonstrate that it is safe to observe the scoliosis, even in high-grade spondylolistheses.
Hyung Gook Kim - One of the best experts on this subject based on the ideXlab platform.
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adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic Spondylolisthesis
Spine, 1997Co-Authors: Se Il Suk, Choon Ki Lee, Won Kim, Ji Ho Lee, Kyu Jung Cho, Hyung Gook KimAbstract:STUDY DESIGN This is a retrospective study analyzing 76 patients treated by decompression, pedicle screw instrumentation, and fusion for spondylolytic spondyiolisthesis with symptomatic spinal stenosis. OBJECTIVES To verify the advantages of adding posterior lumbar interbody fusion to the usual posterolateral fusion with pedicle screw instrumentation. SUMMARY OF BACKGROUND DATA Stabilization after decompression of spondylolytic Spondylolisthesis is difficult because of a lack of fusional bone bases, gap between the transverse process bases, and incompetent anterior disc support. Posterior lumbar interbody fusion offers anterior support, reduction, and a broad fusion base. METHODS Forty patients were treated with posterolateral fusion, and 36 were treated with additional posterior lumbar interbody fusion. They were compared for union, reduction of the deformity, and clinical results. RESULTS The patients were followed up for more than 2 years. Nonunion was observed in three patients who underwent posterolateral fusion (7.5%), and no cases of nonunion was found in patients who underwent posterior lumbar interbody fusion. Reduction of slippage was 28.3% in those who underwent posterolateral fusion and 41.6% in those who had posterior lumbar interbody fusion (P = 0.05). In the posterolateral fusion group, eight patients (20%) had recurrence of deformity, with loss of reduction more than 50%. Hardware failures occurred in two patients who had posterolateral fusion. There was no major neurologic complications in both groups. Both groups had satisfactory results in more than 90% of patients, with marked improvement of claudication. However, subjective improvement of back pain by Kirkaldy-Willis criteria revealed differences in the excellent results. An excellent result was reported by 45% in the posterolateral fusion group and by 75% in posterior lumbar interbody fusion group. CONCLUSIONS The addition of posterior lumbar interbody fusion to posterolateral fusion after a complete decompression and pedicle screw fixation is a recommended procedure for the treatment of spondylolytic spondylolishesis with spinal stenosis.
James W Ogilvie - One of the best experts on this subject based on the ideXlab platform.
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Complications in Spondylolisthesis surgery.
Spine, 2005Co-Authors: James W OgilvieAbstract:Selected references are cited to illustrate the current status of approaches to surgical complications in isthmic Spondylolisthesis surgery. To minimize untoward events and outcomes in the surgical treatment of Spondylolisthesis, an awareness of complications and pitfalls specific to Spondylolisthesis surgery is necessary. Pseudarthrosis is the most common complication, and factors that contribute are vertebral geometry, bone grafting options and technique, and immobilization with instrumentation constructs or an orthosis. There has been an increase in neurologic deficits associated with Spondylolisthesis surgery during the period of 1996 to 2002. Neurologic sequelae can include cauda equina syndrome, root lesions, autonomic dysfunction, and chronic pain. These can result from reduction maneuvers, instrumentation, and after surgery, although neurologic deficit can occur without identifiable causes. Restoring or maintaining the physiologic sagittal contour of the lumbar spine is a necessary component of surgical planning. Literature review. Problems and complications associated with the surgical treatment of Spondylolisthesis are well documented in the medical literature. The occurrence of pseudarthrosis, neurologic deficits, and transition syndromes such as Spondylolisthesis acquisita, S1-S2 deformity, and adjacent segment syndrome can be minimized with proper planning and attention to surgical technique.
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Complications in Spondylolisthesis Surgery
Spine, 2005Co-Authors: James W OgilvieAbstract:STUDY DESIGN Selected references are cited to illustrate the current status of approaches to surgical complications in isthmic Spondylolisthesis surgery. OBJECTIVE To minimize untoward events and outcomes in the surgical treatment of Spondylolisthesis, an awareness of complications and pitfalls specific to Spondylolisthesis surgery is necessary. SUMMARY OF BACKGROUND DATA Pseudarthrosis is the most common complication, and factors that contribute are vertebral geometry, bone grafting options and technique, and immobilization with instrumentation constructs or an orthosis. There has been an increase in neurologic deficits associated with Spondylolisthesis surgery during the period of 1996 to 2002. Neurologic sequelae can include cauda equina syndrome, root lesions, autonomic dysfunction, and chronic pain. These can result from reduction maneuvers, instrumentation, and after surgery, although neurologic deficit can occur without identifiable causes. Restoring or maintaining the physiologic sagittal contour of the lumbar spine is a necessary component of surgical planning. METHODS Literature review. RESULTS Problems and complications associated with the surgical treatment of Spondylolisthesis are well documented in the medical literature. CONCLUSIONS The occurrence of pseudarthrosis, neurologic deficits, and transition syndromes such as Spondylolisthesis acquisita, S1-S2 deformity, and adjacent segment syndrome can be minimized with proper planning and attention to surgical technique.
