Abstract
Sagittal sacro-pelvic morphology and orientation modulate the geometry of the lumbar spine and consequently, the mechanical stresses at the lumbo-sacral junction. In L5-S1 spondylolisthesis, sacro-pelvic morphology is frequently abnormal and can create an abnormal sacro-pelvic orientation as well as a disturbed global sagittal balance of the spine. These findings have important implications for the evaluation and treatment of patients with spondylolisthesis, and especially for those with a high-grade slip. The goal of this chapter is to review current knowledge on this topic, with a special emphasis on pelvic measurements such as Pelvic Incidence, Sacral Slope, and Pelvic Tilt. When compared with normal populations, these measurements are abnormal and tend to increase in a direct linear fashion as severity of the spondylolisthesis increases. A classification system in six different sagittal spino-pelvic postures is described, based on the radiographic measurement of slip grade and spino-pelvic alignment. For low-grade spondylolisthesis, three types of sacro-pelvic balance are identified using Pelvic Incidence measures, while three other types are recognized in high-grade spondylolisthesis, using Sacral Slope, Pelvic Tilt, C7-plumbline, and lumbo-sacral measures. The clinical relevance of this classification is to identify low-grade spondylolisthesis at risk of progression in children and adolescents, and to provide a treatment algorithm for high grade L5-S1 spondylolisthesis based on sagittal spino-pelvic alignment.
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Labelle, H., Mac-Thiong, JM. (2015). Role of the Pelvis in the Diagnosis and Management of L5-S1 Spondylolisthesis. In: Wollowick, A., Sarwahi, V. (eds) Spondylolisthesis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7575-1_8
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DOI: https://doi.org/10.1007/978-1-4899-7575-1_8
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