Changes in spinopelvic relationships in children with spondylolisthesis after surgical treatment and their correlation with the assessment of quality of life

Objective. To assess sagittal balance parameters in children with spondylolisthesis before and after surgical treatment and to analyze their correlation with quality of life.

Material and Methods. A retrospective analysis of postural radiographs of 98 children and adolescents was performed. The patients were divided into 2 groups: Group 1 included 43 patients under 17 years of age (mean age 12.0 ± 2.6 years) without spinal pathology, and Group 2 – 55 patients under 17 years of age (mean age 13.3 ± 2.5 years) with spondylolisthesis before and after surgical treatment. In patients of Group 1, the main spinopelvic parameters (PT, PI, SS, LL, PI-LL, TK) were calculated and studied. In patients of Group 2, parameters characterizing local lumbosacral kyphosis (SA, Dub-LSA, LSJA) were calculated and studied in addition to the main ones. The obtained results were compared with the conditional norm for children. The intensity of pain syndrome and quality of life were assessed using questionnaires and scales (Ped`s QL, ODI, VAS) before surgical treatment, at the time of discharge from the hospital, and after 3 months since surgery. Statistical data analysis was carried out using the statistical programming language and the R environment (version 3.6.1) in RStudio IDE (version 1.2.1335) with representation in the M ± SD format for normally distributed random variables and Me [Q1; Q3] for variables with abnormal distribution. Categorical indicators were presented as an absolute number and a percentage ratio. The null hypothesis in statistical tests was rejected at a significance level of p < 0.05

Results. A decrease in the intensity of pain syndrome and an improvement in the quality of life were observed after surgical treatment in all cases. Statistical analysis of the relationship between parameters characterizing local lumbosacral kyphosis (Dub-LSA, SA, LSJA) and the results of using questionnaires and scales (Ped`s QL, ODI, VAS) showed a statistically significant positive correlation (r = 0.57; p = 0.004) of the LSJA score and pain intensity assessed before surgery, as well as a statistically significant negative correlation (r = -0.47; p = 0.004) of the LSJA score before surgery and the results of the PED`s QL questionnaire after surgery. In a comparison group analysis, it was found that after surgical treatment, there was a tendency towards normalization of sagittal parameters, though their complete recovery to normal values was not achieved. Local lumbosacral kyphosis was completely eliminated in all cases.

Conclusion. Correction of the angle of lumbosacral kyphosis during surgical treatment of children with spondylolisthesis directly correlates with indicators characterizing the quality of life, which makes its elimination the main purpose of the operation. The degree of correction of the sagittal balance parameters (PT, SS, LL) has no significant impact on the quality of life, and their correction to the target calculated values is not required at an initially high PI value. In cases of decompensation of the sagittal and coronal balances of the trunk with low grades of spondylolisthesis, combined with impaired gait and anterior inclination of the torso (lumbar-femoral rigidity syndrome), the instrumental restoration of segmental lordosis at the level of L5–S1 and decompression of neural structures lead to correction of sagittal balance and normalization of gait.

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