ArticleSpine deformity2024
Lumbar degenerative spondylolisthesis: role of sagittal alignment.
Article in Spine deformity, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 3 citations in OpenAlex.
- The Effect of Thoracolumbar Kyphosis on the Presence and Affected Level of Lumbar Degenerative Spondylolisthesis.Journal of clinical medicine · 2026Article
- Research progress on sagittal balance and minimal clinically important difference after two-level lumbar spondylolisthesis surgery.Frontiers in surgery · 2026Review
- Sex differences in factors affecting spinopelvic sagittal alignment and balance: a cross-sectional observational study in a Japanese community.Scientific reports · 2025Observational
- Correlation and risk factor analysis of multifidus muscle atrophy in degenerative lumbar spondylolisthesis.Frontiers in medicine · 2025Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
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Abstract
purposeTo evaluate the sagittal alignment of the lumbar spine in patients with degenerative spondylolisthesis at the L4-5 level.
methodsPatients with untreated degenerative spondylolisthesis at L4-5 were retrospectively identified from the clinical practice of spine surgeons at an academic medical center. All patients had standing X-rays that were reviewed by the senior surgeon to confirm the presence of degenerative spondylolisthesis at L4-5. Radiographs were analyzed for the following: lumbar lordosis (LL), lower lumbar lordosis (L4-S1; LLL), L5-S1 lordosis, pelvic incidence (PI), and pelvic tilt (PT). From these measurements, lumbar distribution index (LLL/LL × 100; LDI), ideal lumbar lordosis (PI × 0.62 + 29; ILL), PI-LL mismatch, and relative lumbar lordosis (LL-ILL; RLL) were calculated. These parameters were used to evaluate the sagittal alignment of the lumbar spine. Normal alignment was defined based on previous studies and clinical experience.
results117 participants met inclusion criteria, with an average age of 67.2 years. The majority of the cohort demonstrated hypolordotic sagittal alignment of the L5-S1 segment when assessed in relation to ILL, PI, and LL (73.5%, 61.5%, and 50.4% respectively). Evaluation of the lower lumbar spine (L4-S1) demonstrated normal sagittal alignment when evaluated via LDI and LLL (65%, 52.1%, respectively), suggesting the presence of compensatory hyperextension at L4-5 in response to the L5-S1 hypolordosis. Consequently, normal sagittal alignment of the regional lumbar spine was maintained when evaluated using LL, PI-LL mismatch, and RLL (51.3%, 47%, and 62.4% respectively).
conclusionsThis study demonstrates that there is a high incidence of relative hypolordosis at the L5-S1 level among patients who present with degenerative spondylolisthesis at L4-5. The L5-S1 hypolordosis is associated with L4-5 hyperlordosis, such that the lower lumbar lordosis (L4-S1; LLL) and regional lumbar lordosis (LL) are still within normal range. It is probable that L5-S1 hypolordosis was the initial pathologic event that incited compensatory L4-5 hyperlordosis, which in turn may have led to facet degeneration and laxity, and eventually to development of spondylolisthesis.
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