The Impact of Surgical Reduction of High-Grade Lumbosacral Spondylolisthesis on Proximal Femoral Angle and Quality of Life

Publication date: Available online 5 October 2018

Source: The Spine Journal

Author(s): Imad S Nahle, Hubert Labelle, Stefan Parent, Julie Joncas, Jean-Marc Mac-Thiong

Abstract

Backgound Context: Abnormal proximal femoral angle (PFA) was recently found to be associated with deteriorating sagittal balance and quality of life (QoL) in high-grade spondylolisthesis (HGS). However, the influence of PFA on the QoL of patients undergoing surgery remains unknown.

Purpose: This study compares the pre- and postoperative measurements of sagittal balance including PFA in patients with lumbosacral HGS after surgery. It also determines if PFA is a radiographic parameter that is associated with QoL in patients undergoing surgery.

Study Design: Retrospective cohort study.

Patient Sample: Thirty-three patients (mean age 15.6±3.0 years) operated for L5-S1 HGS between July 2002 and April 2015. Thirteen had in situ fusion and 20 had reduction to a low-grade slip.

Outcome Measures: The outcome measures included PFA and QoL scores measured from the Scoliosis Research Society SRS-30 QoL questionnaire.

Methods: The minimum follow-up was 2 years. PFA and QoL were compared pre- and postoperatively. Statistical analysis used non-parametric Mann-Whitney and Wilcoxon Signed Rank tests, Chi square tests to compare proportions, and bivariate correlations with Spearman's coefficients.

Results: A decreasing PFA correlated with less pain (R=-0.56, p=0.010), improved function (R=-0.51, p=0.022) and better self-image (R=-0.46, p=0.044) post-reduction. Reduction decreased PFA by 5.1° (p=0.002), while in situ fusion did not alter PFA significantly. Patients with normal preoperative PFA had similar postoperative QoL regardless of the type of surgery, except for self-image, which improved further with reduction (3.73±0.49 to 4.26±0.58, p=0.015). Patients with abnormal preoperative PFA tended to have a higher QoL in all domains after reduction.

Conclusion: Decreasing PFA correlates with less pain, better function and self-image. Reduction of HGS decreases PFA. Reduction also relates to a better postoperative QoL when the preoperative PFA is abnormal. When the preoperative PFA is normal, in situ fusion is equivalent to reduction except for self-image, which is better improved after reduction.

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