Lumbar Retrolisthesis Compensates Spinal Kyphosis

Abstract

Study design: Large cohort study.

Objective: To investigate the role of lumbar retrolisthesis in spinopelvic alignment and health-related quality of life (HRQOL) among volunteers aged >50 years.

Summary of background data: Lumbar retrolisthesis pathology has not been sufficiently elucidated.

Methods: We included 639 volunteers (257 men, average age 73 [50-92] years). Sagittal vertical axis (SVA), maximum thoracic kyphosis (maxTK), lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were measured using whole-spine and pelvic radiographs taken in standing position. MaxTK was measured from the upper to the lower end vertebrae of spinal kyphosis in the sagittal plane using Cobb's method. HRQOL was evaluated using the Oswestry Disability Index (ODI). Subjects with ≥3 mm posterior lumbar vertebral slip and those with multiple retrolisthesis were included in R(+) and multiple groups, respectively. In single lumbar retrolisthesis subjects, those above L3-L4 were defined as the superior group and below L4-L5 as the inferior group.

Results: The R(+) group had 259 (41%) subjects. Of the posterior slipped vertebrae, 235 (91%) were consistent with the lower end vertebra of the maxTK or its adjacent one. The R(+) group had significantly more males; subjects were older than those in the R(-) group. They also had significantly greater SVA, TK, maxTK, and PI-LL and smaller LL and PI. Multivariate analysis revealed that sex, maxTK, and LL were independent predictors of lumbar retrolisthesis. The inferior group had a significantly greater SVA, PT and PI-LL, and smaller LL and PI than the R(-), superior, and multiple groups. The inferior group also had significantly worse ODI than the R(-) group.

Conclusions: Subjects with lumbar retrolisthesis showed greater spinal kyphosis and worse spinopelvic alignments. Subjects with lower-generated lumbar retrolisthesis showed worse spinopelvic alignment and HRQOL than subjects with upper-generated lumbar retrolisthesis and multiple ones and those without it.

Level of evidence: Level IV.

Keywords: Compensation mechanism; Health-related quality of life; Lumbar retrolisthesis; Spinopelvic alignment; Whole-spine radiograph.