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Degenerative Spondylolisthesis Is Related to Multiparity and Hysterectomies in Older Women

Cholewicki, Jacek PhD∗,†; Lee, Angela S. MPH∗,†; Popovich, John M. Jr DPT, PhD∗,†; Mysliwiec, Lawrence W. DO∗,†; Winkelpleck, Michael D. DC, DO∗,†; Flood, John N. DO∗,†; Pathak, Pramod K. PhD∗,‡; Kaaikala, Kiilani H. BS∗,†; Reeves, N. Peter PhD∗,†; Kothe, Ralph MD§,¶

doi: 10.1097/BRS.0000000000002178

Study Design. A case-control study.

Objective. To determine whether parity and abdominal surgeries are associated with degenerative spondylolisthesis (DS).

Summary of Background Data. DS is considered to be a major cause of low back pain (LBP) in the older population, with greater prevalence of DS among women. Because LBP and impaired abdominal muscle function are common during pregnancy and post-partum, parity-related abdominal muscle deficiency, resulting in poor spinal mechanics, could be a factor in the development of DS in women. Indeed a relationship between the number of pregnancies and DS was reported in one study.

Methods. A total of 322 women between the ages of 40 and 80 (149 with DS and 173 controls) filled out a questionnaire providing information about their demographics, the number of full-term pregnancies, the number and types of abdominal surgeries (including cesarean section and hysterectomies), and age at menopause among other items. A binary logistic regression was used as a multivariate model to identify the variables associated with DS.

Results. Along with age and body mass index as covariates, the number of full-term pregnancies and the hysterectomy were significant predictors of DS. Other abdominal surgeries, cesarean section, or the number of years postmenopause were not significant predictors of DS in this regression model after adjusting for all other significant variables.

Conclusion. Each full-term pregnancy seems to be associated with the 22% increase in odds of developing DS. Hysterectomy nearly doubles the odds of DS as compared to women who did not have hysterectomy.

Level of Evidence: 4

MSU Center for Orthopedic Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI

Department of Osteopathic Surgical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI

Department of Statistics and Probability, College of Natural Sciences, Michigan State University, East Lansing, MI

§Department for Spinal Surgery, Schön Klinik, Hamburg, Germany

Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Address correspondence and reprint requests to Jacek Cholewicki, PhD, MSU Center for Orthopedic Research, McLaren Orthopedic Hospital, 2727 S. Pennsylvania Ave, Lansing, MI 48910; E-mail:

Received 29 September, 2016

Revised 21 February, 2017

Accepted 17 March, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

The National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (Award Number R21AR056404) funds were received in support of this work.

Relevant financial activities outside the submitted work: grants, stocks.

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