Wednesday, September 26, 2018 10:35 AM – 12:00 PM Understanding Lumbar Stenosis/Spondylolisthesis

BACKGROUND CONTEXT The importance of sagittal balance and spinopelvic parameters are recognized in the management and outcomes of adult spinal deformity and isthmic spondylolisthesis, but less is known regarding their role in degenerative lumbar spondylolisthesis (DLS). The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. PURPOSE The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. STUDY DESIGN/SETTING Prospective, multi-center study from the Canadian Spine Outcome and Research Network (CSORN). PATIENT SAMPLE Patients with DLS were enrolled in a prospective, multi-center study between 2015 and 2017. Inclusion into this study required DLS at 1 or 2 levels and symptoms of neurogenic claudication or radicular pain with our without back pain. Patients were excluded if they had previous lumbar spine surgery or the presence of another condition which significantly affected function OUTCOME MEASURES Patient-rated outcome measures included the Numeric Pain Rating Scale (NPRS) for back pain and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Component Summary score (PCS) and Mental Component Summary score (MCS), EQ-5D. Pelvic parameter measurements included: sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), lumbar lurdosis (LL), thoracic kyphosis (TK), T1 spino-pelvic inclination (T1 SPI), and T9 spino-pelvic inclination (T9 SPI). METHODS Baseline patient demographics, radiographic spinopelvic parameters, and sagittal alignment were analyzed for possible correlation to HRQOL using Pearson correlations. RESULTS A total of 154 patients were analyzed (mean age: 65.8, BMI: 29.1) with grade I (72%) or II (28%) DLS, of which 95 were females. Primary symptoms were related to neurogenic claudication (80%), radiculopathy (15.3%) or back pain (4.7%). On average, symptom duration was greater than 2 years in 71% of patients. Patients had moderate to severe symptoms and disability (mean NRS back: 7.2, NRS leg: 7.3, ODI: 45.6, PCS-12: 33.2, MCS-12: 49.6, EQ-5D: 0.54). Baseline measurements of radiographic alignment included sacral slope (SS=34.9±16.7°), pelvic tilt (PT=24.8±9.5°), pelvic incidence (PI=57.4±13.8°), sagittal vertical axis (SVA=35.8±40.8mm), lumbar lordosis (LL=45.7±13.6°), thoracic kyphosis (TK=36.8±13.0°), T9-spinopelvic inclination (T9SPI=9.62±4.0°), and T1-spinopelvic inclination (T1SPI=4.43±10.4°). There were 54% of patients who had an insufficient lumbar lordosis based on the relationship between PI and LL (LL CONCLUSIONS Patients with DLS have global sagittal misalignment compared to published normative controls, highlighted by less lumbar lordosis, a PI to LL mismatch, and increased PT. Spinopelvic alignment was not associated with patient outcomes, although positive sagittal balance may also be influenced by spinal stenosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.