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The Relationship Between Lumbar Lateral Listhesis and Radiculopathy in Adult Scoliosis

Kleimeyer, John P. MD; Liu, Ning MD, MPH; Hu, Serena S. MD; Cheng, Ivan MD; Alamin, Todd MD; Grottkau, Brian E. MD, MBA; Kukreja, Sunil MD; Wood, Kirkham B. MD

doi: 10.1097/BRS.0000000000002986

Study Design. Retrospective review and prospective validation study.

Objective. To develop a classification system of lumbar lateral listhesis that suggests different likelihoods of having radiculopathy in adult scoliosis.

Summary of Background Data. The association of lumbar lateral listhesis with radiculopathy remains uncertain.

Methods. A retrospective cohort of patients with adult scoliosis enrolled from 2011 to 2015 was studied to develop a classification system of lateral listhesis that can stratify the likelihood of having radiculopathy. Four radiological aspects of lateral listhesis, including Nash and Moe vertebral rotation, L4–L5 lateral listhesis, the number of consecutive listheses, and the presence of a contralateral lateral listhesis at the thoracolumbar junction above a caudal listhesis, were evaluated on radiographs. Their associations with the presence of radicular leg pain were evaluated using multivariable logistic regression. The classification system of lateral listhesis was thus developed using the most influential radiological factors and then validated in a prospective cohort from 2016 to 2017.

Results. The retrospective cohort included 189 patients. Vertebral rotation is more than or equal to grade 2 (odds ratio [OR] = 9.45, 95% confidence interval [CI]: 4.07–25.14) and L4–5 listhesis (OR = 4.56, 95%CI: 1.85–12.35) were the two most influential listhesis factors associated with radiculopathy. The classification system of lateral listhesis was thus built based on the combinations of their respective presence: Type 0, 1, 2, 3 were defined as not having listhesis at all, none of the two factors present, one of the two presents, and both present, respectively. This classification significantly stratified the probability of radiculopathy, in both the retrospective cohort (0%, 6.4%, 33.8%, and 68.4% in Type 0, 1, 2, and 3, respectively; P < 0.001) and a prospective cohort of 105 patients (0%, 16.7%, 46.9%, and 72.7%; P < 0.001).

Conclusion. Lumbar lateral listhesis is associated with the presence of radiculopathy in adult scoliosis. Types 2 and 3 lateral listhesis on radiographs may alert surgeons treating patients with spinal deformity.

Level of Evidence: 2

Lumbar lateral listhesis is associated with the presence of lumbar radiculopathy in adult scoliosis. A classification of lumbar lateral listhesis was developed accordingly, demonstrating a considerable probability of having radicular leg pain in Type 2 or 3 lateral listhesis. This classification was then validated in a prospective cohort.

Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California

Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Kirkham B. Wood, MD, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street MC 6342, Redwood City, CA 94063; E-mail:

Received 9 August, 2018

Revised 5 December, 2018

Accepted 28 December, 2018

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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