Clinical analysis of adolescent dysplastic lumbar spondylolisthesis associated with scoliosis

English Keywords:Dysplastic lumbar spondylolisthesis  Scoliosis  Adolescent

English Abstract:

  【Abstract】 Objectives: To investigate adolescent dysplastic lumbar spondylolisthesis associated with scoliosis, and to make a follow-up of scoliosis after reduction and fusion surgery of spondylolisthesis. Methods: Twenty-eight young patients of L5 dysplastic spondylolisthesis undergoing spinal surgery, including reduction of the olisthetic vertebra with fixation and fusion between March 2007 and October 2017 in our hospital were studied retrospectively. The patients were divided into severe spondylolisthesis group(n=15, Meyerding grade Ⅲ, Ⅳ and Ⅴ) and mild spondylolisthesis group(n=13, Meyerding grade Ⅰ and Ⅱ). The pre-op whole-spine X-ray of the patients were analyzed to find out the scoliosis cases(Cobb angle ≥10°). The sagittal parameters(pelvic incidence, sacral slope, pelvic tilt) and slip parameters(slippage grade, Dubousset′s lumbar-sacral-angle) were also compared between the two groups. Scoliosis in adolescent spondylolisthesis was divided into two types: idiopathic scoliosis and spasm/antalgic scoliosis. The latter group was further divided into pure spasm scoliosis and spasm scoliosis combined to olisthetic scoliosis, mainly caused by the rotation of the olisthetic vertebra. The scoliosis angle of the patients was measured at the last follow-up to evaluate the correction of the scoliosis after the reduction and fusion of the olisthetic vertebra. Results: There were 15 severe spondylolisthesis patients (age, 12.5±2.6y; 2 males, 13 females) and 13 mild spondylolisthesis patients (age,14.5±2.6y; 6 males, 7 females). No significant difference was found of age, sex ratio or sagittal parameter between groups(P＞0.05). Dubousset′s LSA was different significantly between severe group and mild group(55.6°±17.0° vs. 83.3°±18.4°, P＜0.05). 14 of 28 dysplastic lumbar spondylolisthesis patients were associated with scoliosis. The ratio of scoliosis[86.7%(13/15) vs. 7.7%(1/13), Fisher Test, P＜0.001] and the coronal Cobb angle(18.1°±13.0° vs. 4.6°±3.7°, t=3.619, P=0.001) of the severe spondylolisthesis group were significantly higher than those of the mild group. Scoliosis in severe group included 5 idiopathic scoliosis(Cobb angle 30.2°±17°, 11.6°-52.6°), 8 spasm/antalgic scoliosis with 4 pure spasm scoliosis(Cobb angle 12.5°-17.5°, 14.8°±2.1°) and 4 olisthetic scoliosis (Cobb angle 11.2°-12.6°, 11.9°±0.6°). 12 of 13 dysplastic severe lumbar spondylolisthesis patients were followed up, with an average of 23.8±28.7 months follow-up(range, 1-100 months). Correction rates at last follow-up were 7.5% of idiopathic scoliosis, 92% of pure spasm scoliosis and 4% of olisthetic scoliosis. Conclusions: In adolescent dysplastic lumbar spondylolisthesis patients, the severe olisthetic ones have a higher ratio of scoliosis than the mild ones. Adolescent dysplastic severe lumbar spondylolisthesis may be related to scoliosis. Pure spasm scoliosis can be mostly spontaneously corrected after reduction and fusion of the olisthetic vertebra.