Overpowering posterior lumbar instrumentation and fusion with hyperlordotic anterior lumbar interbody cages followed by posterior revision: a preliminary feasibility study

OBJECTIVEThe authors’ aim in this study was to evaluate whether sagittal plane correction can be obtained from the front by overpowering previous posterior instrumentation and/or fusion with hyperlordotic anterior lumbar interbody fusion (ALIF) cages in patients undergoing revision surgery for degenerative spinal conditions and/or spinal deformities.METHODSThe authors report their experience with the application of hyperlordotic cages at 36 lumbar levels for ALIFs in a series of 20 patients who underwent revision spinal surgery at a single institution. Included patients underwent staged front-back procedures: ALIFs with hyperlordotic cages (12°, 20°, and 30°) followed by removal of posterior instrumentation and reinstrumentation from the back. Patients were divided into the following 2 groups depending on the extent of posterior instrumentation and fusion during the second stage: long constructs (≥ 6 levels with extension into thoracic spine and/or pelvis) and short constructs (< 6 levels). Preoperative and postoperative standing radiographs were evaluated to measure segmental lordosis (SL) along with standard sagittal parameters. Radiographic signs of pseudarthrosis at previously fused levels were also sought in all patients.RESULTSThe average patient age was 54 years (range 30–66 years). The mean follow-up was 11.5 months (range 5–26 months). The mean SL achieved with 12°, 20°, and 30° cages was 13.1°, 19°, and 22.4°, respectively. The increase in postoperative SL at the respective surgically treated levels for 12°, 20°, and 30° cages that were used to overpower posterior instrumentation/fusion averaged 6.1° (p < 0.05), 12.5° (p < 0.05), and 17.7° (p < 0.05), respectively. No statistically significant difference was found in SL correction at levels in patients who had pseudarthrosis (n = 18) versus those who did not (n = 18). The mean overall lumbar lordosis increased from 44.3° to 59.8° (p < 0.05). In the long-construct group, the mean improvement in sagittal vertical axis was 85.5 mm (range 19–249.3 mm, p < 0.05). Endplate impaction/collapse was noted in 3 of 36 levels (8.3%). The anterior complication rate was 13.3%. No neurological complications or vascular injuries were observed.CONCLUSIONSALIF in which hyperlordotic cages are used to overpower posterior spinal instrumentation and fusion can be expected to produce an increase in SL of a magnitude that is roughly half of the in-built cage lordotic angle. This technique may be particularly suited for lordosis correction from the front at lumbar levels that have pseudarthrosis from the previous posterior spinal fusion. Meticulous selection of levels for ALIF is crucial for safely and effectively performing this technique.

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Differences in Demographic and Radiographic Characteristics between Patients with Visible and Invisible T1 Slopes on Lateral Cervical Radiographic Images

Journal of Clinical Medicine ◽

10.3390/jcm11020411 ◽

2022 ◽

Vol 11 (2) ◽

pp. 411

Author(s):

Sadayuki Ito ◽

Hiroaki Nakashima ◽

Akiyuki Matsumoto ◽

Kei Ando ◽

Masaaki Machino ◽

...

Keyword(s):

Pilot Study ◽

Surgical Planning ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Radiographic Images ◽

T1 Slope ◽

Group I ◽

Significant Difference ◽

The Mean ◽

Flexion And Extension

Introduction: The T1 slope is important for cervical surgical planning, and it may be invisible on radiographic images. The prevalence of T1 invisible cases and the differences in demographic and radiographic characteristics between patients whose T1 slopes are visible or invisible remains unexplored. Methods: This pilot study aimed to evaluate the differences in these characteristics between outpatients whose T1 slopes were visible or invisible on radiographic images. Patients (n = 60) who underwent cervical radiography, whose T1 slope was confirmed clearly, were divided into the visible (V) group and invisible (I) group. The following radiographic parameters were measured: (1) C2-7 sagittal vertical axis (SVA), (2) C2-7 angle in neutral, flexion, and extension positions. Results: Based on the T1 slope visibility, 46.7% of patients were included in group I. The I group had significantly larger C2-7 SVA than the V group for males (p < 0.05). The C2-7 SVA tended to be larger in the I group, without significant difference for females (p = 0.362). Discussion: The mean C2-7 angle in neutral and flexion positions was not significantly different between the V and I groups for either sex. The mean C2-7 angle in the extension position was greater in the V group. The T1 slope was invisible in males with high C2-7 SVA.

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Anterior hyperlordotic cages: early experience and radiographic results

Journal of Neurosurgery Spine ◽

10.3171/2016.4.spine151206 ◽

2016 ◽

Vol 25 (6) ◽

pp. 713-719 ◽

Cited By ~ 16

Author(s):

Philip A. Saville ◽

Abhijeet B. Kadam ◽

Harvey E. Smith ◽

Vincent Arlet

Keyword(s):

Blood Loss ◽

Complication Rate ◽

Posterior Instrumentation ◽

Neurological Complication ◽

Case Series ◽

Sagittal Vertical Axis ◽

Radiographic Measurements ◽

The Mean ◽

Segmental Lordosis

OBJECTIVE The aim of this study was to evaluate the segmental correction obtained from 20° and 30° hyperlordotic cages (HLCs) used for anterior lumbar interbody fusion in staged anterior and posterior fusion in adults with degenerative spinal pathology and/or spinal deformities. METHODS The authors report a retrospective case series of 69 HLCs in 41 patients with adult degenerative spine disease and/or deformities who underwent staged anterior, followed by posterior, instrumentation and fusion. There were 29 females and 12 males with a mean age of 55 years (range 23–76 years). The average follow-up was 10 months (range 2–28 months). Radiographic measurements of segmental lordosis and standard sagittal parameters were obtained on pre- and postoperative radiographs. Implant subsidence was measured at the final postoperative follow-up. RESULTS For 30° HLCs, the mean segmental lordosis achieved was 29° (range 26°–34°), but in the presence of spondylolisthesis this was reduced to 19° (range 12°–21°) (p < 0.01). For 20° HLCs, the mean segmental lordosis achieved was 19° (range 16°–22°). The overall mean lumbar lordosis increased from 39° to 59° (p < 0.01). The mean sagittal vertical axis (SVA) reduced from 113 mm (range 38–320 mm) to 43 mm (range −13 to 112 mm). Six cages (9%) displayed a loss of segmental lordosis during follow-up. The mean loss of segmental lordosis was 4.5° (range 3°–10°). A total complication rate of 20% with a 4.1% transient neurological complication rate was observed. The mean blood loss per patient was 240 ml (range 50–900 ml). CONCLUSIONS HLCs provide a reliable and stable degree of segmental lordosis correction. A 30° HLC will produce correction of a similar magnitude to a pedicle subtraction osteotomy, but with a lower complication rate and less blood loss.

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Can we use shorter constructs while maintaining satisfactory sagittal plane alignment for adult spinal deformity?

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20917 ◽

2020 ◽

pp. 1-8

Author(s):

Hiroshi Moridaira ◽

Satoshi Inami ◽

Daisaku Takeuchi ◽

Haruki Ueda ◽

Hiromichi Aoki ◽

...

Keyword(s):

Spinal Deformity ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Factors Associated ◽

Radiographic Parameters ◽

Lumbar Vertebral Fracture ◽

The Mean ◽

Lumbar Kyphosis

OBJECTIVEIssues with spinopelvic fixation for adult spinal deformity (ASD) include loss of the physiological mobility of the entire lumbar spine, perioperative complications, and medical costs. Little is known about the factors associated with successful short fusion for ASD. The authors evaluated radiographic and clinical outcomes after shorter fusion for different subtypes of ASD at 2 years postoperatively and examined factors associated with successful short fusion.METHODSThis was a single-center study of 37 patients who underwent short fusion and a minimum 2 years of follow-up for ASD in which lumbar kyphosis was the main deformity. The exclusion criteria were 1) age < 40 years, 2) previous lumbar vertebral fracture, 3) severe osteoporosis, 4) T10–L2 kyphosis > 20°, 5) scoliotic deformity with an upper end vertebra (UEV) above T12, and 6) concomitant Parkinson’s disease or neurological disease. The surgical procedures, radiographic course, and Oswestry Disability Index (ODI) were assessed, and correlations between radiographic parameters and postoperative ODI at 2 years were analyzed.RESULTSA mean of 3.5 levels were fused. The mean radiographic parameters preoperatively, at 2 weeks, and at 2 years, respectively, were as follows: coronal Cobb angle: 22.9°, 11.5°, and 12.6°; lumbar lordosis (LL): 12.9°, 35.8°, and 32.2°; pelvic incidence (PI) minus LL: 35.5°, 14.7°, and 19.2°; pelvic tilt: 29.4°, 23.1°, and 25.0°; and sagittal vertical axis 85.3, 36.7, and 59.2 mm. Abnormal proximal junctional kyphosis occurred in 8 cases. Revision surgery was performed to extend the length of fusion from a lower thoracic vertebra to the pelvis in 2 cases. The mean ODI scores preoperatively and at 2 years were 50.7% and 24.1%, respectively. Patient age, number of fused intervertebral segments, and radiographic parameters were analyzed by the stepwise method to identify factors contributing to the ODI score at 2 years, preoperative PI, and sagittal vertical axis at 2 years. On receiver operating characteristic curve analysis of the minimal clinically important difference of ODI (15%) and preoperative PI, the cutoff value of the preoperative PI was 47° (area under the curve 0.75).CONCLUSIONSIn terms of subtypes of ASD in which lumbar kyphosis is the main deformity, if the PI is < 47°, then the use of short fusion preserving mobile intervertebral segments can produce adequate LL for the PI, improving both postoperative global spinal alignment and quality of life.

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Long-term results after the one-stage posterior-only surgical correction of thoraco-lumbar kyphoscoliosis in congenital spine deformity caused by two ipsilateral hemi-vertebrae

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04201-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xuhong Xue ◽

Sheng Zhao ◽

Feng Miao ◽

Kai Li ◽

Bin Zhao

Keyword(s):

Sagittal Plane ◽

Vertical Axis ◽

Surgical Correction ◽

Neurological Injury ◽

Long Term Results ◽

Spine Deformity ◽

Sagittal Vertical Axis ◽

The Mean

Abstract Background Two ipsilateral hemivertebrae is less common and presents severe growth imbalance caused by the vertebral anomalies. However, there is a paucity of reports regarding to two ipsilateral thoracolumbar hemivertebrae. The purpose of present study is to evaluate the long-term outcomes of the posterior surgical correction of thoraco-lumbar spine deformity caused by two ipsilateral hemivertebrae. Methods From 2006 to 2014, a total of 14 consecutive pediatric patients with congenital thoraco-lumbar hemivertebrae were treated by posterior excision of hemivertebrae with short segment fusion. The following parameters were measured: coronal major curvature, cranial and caudal compensatory curvature, segmental kyphosis, lumbar lordosis, trunk shift, apical vertebra translation and sagittal vertical axis. These results were compared and evaluated in preoperatively, immediately postoperatively and at the final follow-up. All patients had a minimum of 5 years follow-up. Results The mean age at surgery was 11.1 ± 4.8 years (2yos to 17yos). The mean follow-up period was 80.2 ± 19.4 months (60mons to 117mons). There was a mean improvement of 74.2% in the coronal major curve from a mean angle of 64.1° before surgery to 15.8° at the final follow-up. The cranial and caudal curves improved of 69.8 and 69.0% from 25.6° to 7.7°, 26.9 to 8.2, respectively. The mean thoraco-lumbar kyphosis was 59.9° before and 13.6° after surgery, 20.8° at the final follow-up. Alignment in the coronal and sagittal plane was either maintained or improved within normal values in all patients. Conclusions Good correction and spinal balance can be achieved by posterior-only hemivertebrectomy in patients with thoracolumbar kyphocsoliosis caused by two ipsilateral hemivertebra. The complication of neurological injury is low but a technically demanding procedure. More attention should be paid in residual curve progression after surgery.

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Gender-specific analysis for the association between trunk muscle mass and spinal pathologies

Scientific Reports ◽

10.1038/s41598-021-87334-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yusuke Hori ◽

Masatoshi Hoshino ◽

Kazuhide Inage ◽

Masayuki Miyagi ◽

Shinji Takahashi ◽

...

Keyword(s):

Muscle Mass ◽

Bioelectrical Impedance ◽

Vertical Axis ◽

Impedance Analysis ◽

Poor Quality ◽

Trunk Muscle ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Lower Trunk ◽

Significant Difference

AbstractWe investigated the relationship between trunk muscle mass and spinal pathologies by gender. This multicenter cross-sectional study included patients aged ≥ 30 years who visited a spinal outpatient clinic. Trunk and appendicular muscle mass were measured using bioelectrical impedance analysis. The Oswestry Disability Index (ODI), visual analog scale (VAS) score for low back pain, sagittal vertical axis (SVA), and EuroQol 5 Dimension (EQ5D) score were investigated to evaluate spinal pathology. The association between trunk muscle mass and these parameters was analyzed by gender using a non-linear regression model adjusted for patients’ demographics. We investigated the association between age and trunk muscle mass. We included 781 men and 957 women. Trunk muscle mass differed significantly between men and women, although it decreased with age after age 70 in both genders. Lower trunk muscle mass was significantly associated with ODI, SVA, and EQ5D score deterioration in both genders; its association with VAS was significant only in men. Most parameters deteriorated when trunk muscle mass was < 26 kg in men and < 19 kg in women. Lower trunk muscle mass was associated with lumbar disability, spinal imbalance, and poor quality of life in both genders, with significant difference in muscle mass.

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The utility of supine radiographs in the assessment of thoracic flexibility and risk of proximal junctional kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201565 ◽

2021 ◽

pp. 1-7

Author(s):

Francis Lovecchio ◽

Renaud Lafage ◽

Jonathan Charles Elysee ◽

Alex Huang ◽

Bryan Ang ◽

...

Keyword(s):

Thoracic Spine ◽

Lumbar Lordosis ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Vertical Axis ◽

Control Analysis ◽

Proximal Junctional Kyphosis ◽

Sagittal Vertical Axis ◽

Significant Difference ◽

Junctional Kyphosis

OBJECTIVE Supine radiographs have successfully been used for preoperative planning of lumbar deformity corrections. However, they have not been used to assess thoracic flexibility, which has recently garnered attention as a potential contributor to proximal junctional kyphosis (PJK). The purpose of this study was to compare supine to standing radiographs to assess thoracic flexibility and to determine whether thoracic flexibility is associated with PJK. METHODS A retrospective study was conducted of a single-institution database of patients with adult spinal deformity (ASD). Sagittal alignment parameters were compared between standing and supine and between pre- and postoperative radiographs. Thoracic flexibility was determined as the change between preoperative standing thoracic kyphosis (TK) and preoperative supine TK, and these changes were measured over the overall thoracic spine and the fused portion of the thoracic spine (i.e., TK fused). A case-control analysis was performed to compare thoracic flexibility between patients with PJK and those without (no PJK). The cohort was also stratified into three groups based on thoracic flexibility: kyphotic change (increased TK), lordotic change (decreased TK), and no change. The PJK rate was compared between the cohorts. RESULTS A total of 101 patients (mean 63 years old, 82.2% female, mean BMI 27.4 kg/m2) were included. Preoperative Scoliosis Research Society–Schwab ASD classification showed moderate preoperative deformity (pelvic tilt 27.7% [score ++]; pelvic incidence–lumbar lordosis mismatch 44.6% [score ++]; sagittal vertical axis 42.6% [score ++]). Postoperatively, the average offset from age-adjusted alignment goals demonstrated slight overcorrection in the study sample (−8.5° ± 15.6° pelvic incidence–lumbar lordosis mismatch, −29.2 ± 53.1 mm sagittal vertical axis, −5.4 ± 10.8 pelvic tilt, and −7.6 ± 11.7 T1 pelvic angle). TK decreased between standing and supine radiographs and increased postoperatively (TK fused: −25.3° vs −19.6° vs −29.9°; all p < 0.001). The overall rate of radiographic PJK was 23.8%. Comparisons between PJK and no PJK demonstrated that offsets from age-adjusted alignment goals were similar (p > 0.05 for all). There was a significant difference in the PJK rate when stratified by thoracic flexibility cohorts (kyphotic: 0.0% vs no change: 18.4% vs lordotic: 35.0%; p = 0.049). Logistic regression revealed thoracic flexibility (p = 0.045) as the only independent correlate of PJK. CONCLUSIONS Half of patients with ASD experienced significant changes in TK during supine positioning, a quality that may influence surgical strategy. Increased thoracic flexibility is associated with PJK, possibly secondary to fusing the patient’s spine in a flattened position intraoperatively.

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Comparative Analysis of the Exposure and Surgical Freedom of the Endoscopic Extended Minipterional Craniotomy and the Transorbital Endoscopic Approach to the Anterior and Middle Cranial Fossae

Operative Neurosurgery ◽

10.1093/ons/opy309 ◽

2018 ◽

Vol 17 (2) ◽

pp. 174-181 ◽

Cited By ~ 9

Author(s):

Raywat Noiphithak ◽

Juan C Yanez-Siller ◽

Juan M Revuelta Barbero ◽

Raymond I Cho ◽

Bradley A Otto ◽

...

Keyword(s):

Comparative Analysis ◽

Standard Deviation ◽

Minimally Invasive ◽

Vertical Axis ◽

Endoscopic Approach ◽

Extended Version ◽

Specific Approach ◽

Significant Difference ◽

Surgical Application ◽

The Mean

AbstractBACKGROUNDNumerous minimally invasive approaches to the skull base have been successively developed. Knowledge of the surgical nuances of a specific approach may facilitate approach selection. This study sought to compare the nuances of an extended version of the minipterional craniotomy (EMPT) with those of the transorbital endoscopic approach (TOEA) to the anterior and middle cranial fossae (ACF and MCF, respectively).OBJECTIVETo quantitatively analyze and compare the area of exposure and surgical freedom between EMPT and TOEA to the ACF and MCF.METHODSEMPT and TOEA were carried out in 5 latex-injected cadaveric heads, bilaterally (10 sides). For each approach, the area of exposure, surgical freedom, and angle of attack were obtained with neuronavigation and statistically compared.RESULTSNo significant difference was found between the mean area of exposure of EMPT and TOEA at the ACF and MCF (P = .709 and .317, respectively). The mean exposure area at the ACF was of 13.4 ± 2.6 cm2 (mean ± standard deviation) and 13.0 ± 1.9 cm2 for EMPT and TOEA, respectively. Except for the crista galli, EMPT afforded a larger area of surgical freedom at all targets. EMPT also achieved significantly greater attack angles in vertical axis except to the crista galli. The horizontal attack angles to all targets were similar between approaches.CONCLUSIONEMPT and TOEA offer a comparable area of exposure at the ACF and MCF in the cadaver; however, the instrument maneuverability afforded by EMPT is superior. Further studies are necessary to better define their precise surgical application.

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DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?

Journal of Musculoskeletal Research ◽

10.1142/s0218957713500073 ◽

2013 ◽

Vol 16 (02) ◽

pp. 1350007

Author(s):

P. Motwani ◽

A. Jariwala ◽

N. Valentine

Keyword(s):

Total Knee Replacement ◽

Tibial Component ◽

Sagittal Plane ◽

Computer Navigation ◽

Component Alignment ◽

Tibial Component Alignment ◽

Significant Difference ◽

Total Knee ◽

The Mean

Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.

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Expandable cylindrical cages in the cervical spine: a review of 22 cases

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.4.285 ◽

2006 ◽

Vol 4 (4) ◽

pp. 285-291 ◽

Cited By ~ 27

Author(s):

Kurtis I. Auguste ◽

Cynthia Chin ◽

Frank L. Acosta ◽

Christopher P. Ames

Keyword(s):

Cervical Spine ◽

Perioperative Complications ◽

Posterior Spinal Fusion ◽

Anterior Fusion ◽

Graft Material ◽

Significant Difference ◽

Flexion Extension ◽

Functional Scores ◽

Cage Subsidence ◽

The Mean

Object Expandable cylindrical cages (ECCs) have been utilized successfully to reconstruct the thoracic and lumbar spine. Their advantages include ease of insertion, reduced endplate trauma, direct application/maintenance of interbody distraction force, and one-step kyphosis correction. The authors present their experience with ECCs in the reconstruction of the cervical spine in patients with various pathological conditions. Methods Data obtained in 22 patients were reviewed retrospectively. A standard anterior cervical corpectomy was performed in all cases. Local vertebral body bone was harvested for use as graft material. Patients underwent pre- and postoperative assessment involving the visual analog scale (VAS), Nurick grading system for determining myelopathy disability, and radiographic studies to determine cervical kyphosis/lordosis and cage subsidence. Fusion was defined as the absence of motion on flexion–extension x-ray films. Sixteen patients presented with spondylotic myelopathy, two with osteomyelitis, two with fracture, one with tumor metastasis, and one with severe stenosis. Fourteen patients underwent supplemental posterior spinal fusion, seven underwent single-level corpectomy, and 15 patients underwent multilevel corpectomy. No perioperative complications occurred. The mean follow-up period was 22 months. In 11 patients with preexisting kyphosis (mean deformity +19°), the mean correction was 22°. There was no statistically significant difference in subsidence between single- and multilevel corpectomy or between 360º fusion and anterior fusion alone. The VAS scores improved by 35%, and the Nurick grade improved by 31%. The fusion rate was 100%. Conclusions The preliminary results support the use of ECCs in the cervical spine in the treatment of patients with various disease processes. No significant subsidence was noted, and pain and functional scores improved in all cases. Expandable cylindrical cages appear to be well suited for cervical reconstruction and for correcting sagittal malalignment.

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Effect of sagittal imbalance on functional disability in patients with degenerative spondylolisthesis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195794 ◽

2019 ◽

Vol 6 (1) ◽

pp. 31

Author(s):

Ramdas Maloth

Keyword(s):

Functional Disability ◽

Pelvic Incidence ◽

Sagittal Plane ◽

Degenerative Spondylolisthesis ◽

Vertical Axis ◽

P Value ◽

Sagittal Imbalance ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Digital Radiograph

Background: Deformity of spine in sagittal plane is a major cause of pain and disability among patients presenting with low back pain to spine clinic. We have studied the effect of spinal sagittal imbalance on functional disability in these patients.Methods: Cross sectional observational study in 50 patients with degenerative spondylolisthesis of more than 45 years age group study done in period of1 years. Subjects underwent standing lateral radiographs of the spine in a relaxed position, facing forward, with their knees maximally extended and their arms raised horizontally forward resting on a support. 2 radiographic films are stitched at baseline using digital radiograph operating console (DROC) software.Results: In our study out of 50 patients we observed female preponderance, female:male 3:1, degenerative spondylolisthesis more commonly involves L4-L5 level (46 patients). 58% of patients with severe degenerative spondylolisthesis. There is significant correlation between sagittal vertical axis (SVA) and severity (p=0.015) in both grade 1 and grade 2 DS, there is significant correlation between pi and functional disability (p=0.001 and 0.010 respectively) it is found that pelvic tilt with p=0.02 and sagittal vertical axis with p value 0.036 are the two most significant variables at the end of backward elimination analysis.Conclusions: Sagittal imbalance is seen in degenerative spondylolisthesis which needs further evaluation with spinopelvic parameters. Pelvic incidence and sagittal vertebral axis are important determinants of functional disability in patients with degenerative spondylolisthesis. Individuals with high pelvic incidence and more lumbo pelvic kyphosis showed more functional disability compared to others.

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