What Radiographic and Spinopelvic Parameters do Spine Surgeons Consider in Decision-Making for Treatment of Degenerative Lumbar Spondylolisthesis?

Juan P Cabrera; Michael S Virk; Samuel K Cho; Sathish Muthu; Luca Ambrosio; S Tim Yoon; Zorica Buser; Jeffrey C Wang; Ashish D Diwan; Patrick C Hsieh; The Ao Spine Knowledge Forum Degenerative

doi:10.1177/21925682241306105

What Radiographic and Spinopelvic Parameters do Spine Surgeons Consider in Decision-Making for Treatment of Degenerative Lumbar Spondylolisthesis?

Global Spine J. 2024 Dec 4:21925682241306105. doi: 10.1177/21925682241306105. Online ahead of print.

Authors

Juan P Cabrera^{1

2}, Michael S Virk³, Samuel K Cho⁴, Sathish Muthu^{5

6

7}, Luca Ambrosio^{8

9}, S Tim Yoon¹⁰, Zorica Buser^{11

12}, Jeffrey C Wang¹³, Ashish D Diwan^{14

15}, Patrick C Hsieh^{13

16}, The Ao Spine Knowledge Forum Degenerative¹⁷

Affiliations

¹ Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile.
² Faculty of Medicine, University of Concepción, Concepción, Chile.
³ Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA.
⁴ Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, India.
⁶ Department of Orthopaedics, Government Medical College, Karur, India.
⁷ Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, India.
⁸ Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
⁹ Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
¹⁰ Department of Orthopedics, Emory University, Atlanta, GA, USA.
¹¹ NY Orthopedics PC, Brooklyn, NY, USA.
¹² Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA.
¹³ USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁴ Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, Australia.
¹⁵ St. George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; and Spinal Unit | Royal Adelaide Hospital | University of Adelaide, Australia.
¹⁶ Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁷ Research Department, AO Spine, AO Foundation, Davos, Switzerland.

Abstract

Study design: Cross-sectional survey.

Objective: Surgical treatment of degenerative lumbar spondylolisthesis is remarkably varied due to heterogeneity of clinical-radiological presentations. This study aimed to assess which spinopelvic radiological parameters were considered for decision-making.

Methods: Survey distributed to International AO Spine members to analyze surgeons' considerations for treatment. Data collected includes demographics, training background, years of experience, and treatment decisions based on various radiographical findings, including segmental and global spinopelvic parameters.

Results: From 479 responses, the most frequently radiological parameter considered was slippage on dynamic X-rays (79.1%), followed by disc height (78.9%), global sagittal balance SVA (71.4%), and PI-LL mismatch (69.7%), while the least important was absolute spondylolisthesis on static lateral radiograph (22.8%). Fellowship-trained surgeons were likelier to use SVA (OR = 1.73, 95% CI = 1.02-2.99, P = 0.049), and disc height (2.13, 1.14-3.98, P < 0.05). There was no difference between orthopedics and neurosurgery in applying SVA and PI-LL mismatch. Surgeons from Asia Pacific emphasizes segmental lordosis (2.39, 1.11-5.15, P = 0.026) as from Latin America (2.55, 1.09-5.95, P = 0.030) and Middle East (4.33, 1.66-11.28, P = 0.003). However, surgeons from Latin America and Middle East also significant consider disc height (2.95, 1.07-8.15, P = 0.037) and (3.03, 1.04-8.83, P = 0.043), respectively. Additionally, the surgeons' age was associated with using angular motion on flexion-extension radiographs, and volume of treated cases yearly with consideration for disc height.

Conclusions: Treatment of degenerative lumbar spondylolisthesis was influenced by slippage on dynamic radiographs, disc height, global alignment, and PI-LL mismatch. Surgeons' age and Region, fellowship-trained, and volume of treated cases were significantly associated to apply these radiological parameters.

Keywords: lumbar degenerative spondylolisthesis; lumbar instability; lumbar spine surgery; management; spinal fusion.