Risk Factors For the Development of a Mobile Degenerative Spondylolisthesis at L4-L5

Spine Deform. 2015 Jan;3(1):98-104. doi: 10.1016/j.jspd.2014.06.012. Epub 2014 Dec 18.


Objective: The purpose of this study was to identify factors that may be important in determining whether a degenerative spondylolisthesis at L4-L5 is mobile.

Summary of background data: Degenerative scoliosis is a common condition among middle-aged and elderly adults. Sacropelvic morphology and orientation modulate the geometry of the lumbar spine and, consequently, the mechanical stresses at the lumbo-sacral junction. To date, no in vivo data exist to describe the relationship between these pelvic parameters and their association with a mobile spondylolisthesis.

Method: Sixty consecutive patients with a degenerative spondylolisthesis (DS) at L4-L5 with adequate imaging were identified. Patient groups were defined on the basis of whether the DS was mobile (Group A) or nonmobile (Group B) when comparing the upright plain lumbar radiograph to the supine magnetic resonance imaging (MRI). We assessed the grade of slip, lumbar lordosis, pelvic parameters, and facet characteristics (angles, tropism, presents of effusion, degenerative score-cartilage and sclerosis values) as well as disc degenerative score (Pfirrmann) at L4-L5.

Results: There were 40 patients in Group A and 20 in Group B. No significant differences were found between groups for pelvic incidence (p = .409), pelvic tilt (p = .476), sacral slope (p = .785), lumbar lordosis (p = .695), degree of facet tropism (p = .38), and magnitude of the facet effusions (p = .01). Facet angle differences between groups approached significance (p = .058). Significant differences between groups were found in cartilage degenerative score (p = .01), facet sclerosis grade (p = .01), and disc degenerative score (p < .0001). In Group A, 10 of 40 (25%) reduced fully and were not apparent on the supine MRI.

Conclusions: Sagittal pelvic parameters do not play a significant role in differentiating between mobile and nonmobile DS at L4-L5. However, DS does appear to be associated with more sagittally orientated facets, higher Pfirrmann grade, and higher facet cartilage and sclerosis degenerative scores.

Keywords: Degenerative spondylolisthesis; Pelvic parameters; Risk factors.