Clinical Significance of Lumbosacral Kyphosis in Adolescent Spondylolisthesis

Study Design. A cross-sectional study of 96 patients with lumbosacral adolescent spondylolisthesis. Objective. To evaluate whether lumbosacral kyphosis (LSK) is associated with the quality of life of patients with spondylolisthesis and to identify reference values of LSK associated with significant impairments in quality of life. Summary of Background Data. LSK is considered an important aspect of deformity in adolescent spondylolisthesis, but its clinical impact is not known. Methods. Sixty-seven patients with low-grade and 29 with high-grade adolescent lumbosacral spondylolisthesis were evaluated. Three radiological parameters of LSK were measured: slip angle (SA), Dubousset lumbosacral angle (Dub-LSA), and lumbosacral joint angle (LSJA). All patients completed the Short Form Health Survey-12v2 questionnaire. Pearson correlations were calculated between each radiological parameter and the questionnaire scores. Results. Correlations of the 3 LSK parameters with the physical component summary of the Short Form Health Survey-12v2 were significant (r = -0.55 for SA, 0.52 for Dub-LSA, and -0.55 for LSJA). Correlations were even stronger when calculated for high-grade patients only (r = -0.62 for SA, 0.56 for Dub-LSA, and -0.63 for LSJA). Correlations also remained significant when controlling for slip percentage. Values of 30 degrees, 80 degrees, and 30 degrees for SA, Dub-LSA, and LSJA were associated with an increased proportion of subjects with poor physical component scores. Conclusion. LSK is significantly correlated to the physical aspect of the quality of life of adolescents with spondylolisthesis. The implication of abnormal LSK is particularly evident in patients with high-grade spondylolisthesis. All evaluated LSK parameters seem equivalent to measure this effect. LSK should be routinely measured in adolescents with spondylolisthesis to fully appreciate the severity of the deformity and its clinical association with the quality of life of the patient.