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Master Thesis

Le spondylolisthésis dégénératif lombaire, un élément d’instabilité dans un équilibre sagittal précaire : proposition d’une nouvelle classification - Etude de reproductibilité et impact clinique de la nouvelle classification

Abstract : Purpose: there is no consensus for a comprehensive analysis of Degenerative Spondylolisthesis of the Lumbar Spine (DSLS). A new classification system for DSLS based on sagittal alignment was proposed. Its clinical relevance was explored. Methods: Health-Related Quality of Life Scales (HRQOLs) and clinical parameters were collected: SF-12, ODI, low back and leg pain visual analog scales (BP-VAS, LP-VAS). Radiographic analysis included Meyerding grading and sagittal parameters: segmental lordosis (SL), L1-S1 lumbar lordosis (LL), T1-T12 thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were classified according to three main types: 1A: preserved LL and SL; 1B: preserved LL and reduced SL (≤5°); 2A: PI-LL≥10° without pelvic compensation (PT<25°); 2B: PI-LL≥10° with pelvic compensation (PT≥25°); type 3: global sagittal malalignment (SVA≥40mm). Results: 166 patients (119 F: 47 M) suffering from DSLS were included. Mean age was 67.1 ± 11 years. DSLS demographics were respectively: type 1A: 73 patients, type 1B: 3, type 2A: 8, type 2B: 22, type 3: 60. Meyerding grading was: grade 1 (n=124), grade 2 (n=24). Affected levels were: L4-L5 (n=121), L3-L4 (n=34), L2-L3 (n=6), and L5-S1 (n=5). Mean sagittal parameter values were: PI: 59.3° ± 11.9°; PT: 24.3°± 7.6°; SVA: 29.1 ± 42.2 mm; SL: 18.2° ± 8.1°. DSLS types were correlated with age, ODI and SF-12 PCS (rho= 0.34, p<0.05; rho= 0.33, p<0.05; rho= -0.20, p=0.01, respectively). Conclusion: this classification was consistent with age and HRQOLs and could be a preoperative assessment tool. Its therapeutic impact has yet to be validated. Study Design. Inter-observer and Intra-observer reliability study. Object. To assess the reliability of a new classification of degenerative spondylolisthesis of the lumbar spine (DSLS). Summary of background data: DSLS is a common cause of chronic low back and leg pain in adults. To this date, there is no consensus for a comprehensive analysis of DSLS. A new DSLS classification system based on sagittal alignment was proposed and required validation. Methods: 99 patients admitted to our spinal surgery department for surgical treatment of DSLS between January 2012 and December 2015 were included. Three observers measured sagittal alignment parameters with validated software: segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Full body low-dose lateral view X-rays were analyzed and classified according to three main types: type 1a: preserved LL and SL; type 1b: preserved LL and reduced SL (≤5°); type 2a: PI-LL≥10° without pelvic compensation (PT<25°); type 2b: PI-LL≥10° with pelvic compensation (PT≥25°); type 3: global sagittal malalignment (SVA≥40mm). The three observers classified X-rays twice with a 3-weekinterval for intra-observer reproducibility. Inter-observer reproducibility was calculated using Fleiss′s κ and intra-class coefficient. Intra-observer reproducibility was calculated using Cohen′s κ. Results: mean age was 68.8 ± 9.8 years. Mean sagittal alignment parameters values were the following: PI: 60.1 ± 12.7°; PI-LL was 12.2 ° ± 13.9°, PT: 24.7 ± 8.5°; SVA: 44.9 ± 44.6mm; SL: 16.6 ± 8.4°. Intra-observer repeatability showed an almost perfect agreement (ICC > 0.92 and Cohen′s κ > 0.89 for each observer). Fleiss κ value for inter-observer reproducibility was 0.82, with percentage agreement among observers between 88% and 89%. Conclusion: this new classification showed an excellent inter- and intra-observer reliability. This simple method can help surgeons improve their preoperative DSLS analysis taking into account global sagittal parameters.
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Submitted on : Friday, June 16, 2017 - 6:44:00 PM
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Soufiane Ghailane. Le spondylolisthésis dégénératif lombaire, un élément d’instabilité dans un équilibre sagittal précaire : proposition d’une nouvelle classification - Etude de reproductibilité et impact clinique de la nouvelle classification. Médecine humaine et pathologie. 2017. ⟨dumas-01540969⟩

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