Work

Comparative analysis of coronal balance with clinical correlation between degenerative and isthmic lumbar spondylolisthesis: a retrospective study

Year: 2026

Type: article

Abstract: Objective Few studies have examined the relationship between lumbar spondylolisthesis and coronal balance. This study compared coronal radiographic parameters between degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) and investigated their associations with clinical characteristics. Methods We retrospectively reviewed 150 patients with single-level lumbar spondylolisthesis and persistent symptoms after at least 3 months of conservative treatment. Standing whole-spine anteroposterior radiographs were used to measure clavicle angle, T1 tilt, pelvic coronal tilt, segmental wedge angle, spondylolisthesis vertebral tilt angle, lateral vertebral translation, lumbar Cobb angle, lumbar coronal balance, and C7 plumb line deviation from the central sacral vertical line. Demographic, clinical, and radiographic variables were compared between groups. Multivariable logistic regression identified factors distinguishing DS from IS. A decision tree assessed whether segmental wedge angle predicted lower limb pain distribution in DS. Results Patients with DS were older, whereas those with IS were taller and heavier. Segmental wedge angle, spondylolisthesis vertebral tilt angle, and lumbar coronal balance were greater in the DS group than in the IS group (2.7 ± 1.9° vs. 1.8 ± 1.7°, P = 0.005; 4.7 ± 3.6° vs. 3.5 ± 2.4°, P = 0.016; and 10 ± 7 mm vs. 5 ± 3 mm, P < 0.001, respectively). Segmental wedge angle and lumbar coronal balance independently distinguished DS from IS. The DS group had higher leg-pain VAS scores (6.0 ± 1.1 vs. 4.6 ± 1.6, P < 0.001), but back-pain VAS and ODI scores did not differ between groups. In patients with DS and a segmental wedge angle of 1.3° to <5.0°, lower limb pain was associated with wedge orientation and occurred mainly on the concave side. Pain distribution was not predictable from wedge orientation when the angle was <1.3° or ≥5.0°. Conclusion DS is associated with greater lumbar coronal imbalance and segmental wedging than IS. Segmental wedge angle and lumbar coronal balance may help distinguish these conditions. In DS, wedge orientation may also indicate the side of lower limb pain when the segmental wedge angle is between 1.3° and <5.0°.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1902310