Background:

Degenerative lumber spondylolisthesis (DLS) is a common orthopedic condition, described as a condition that compared to lower vertebra, superior vertebra to slide forward or backward in the sagittal plane without accompanying isthmic spondylolisthesis. Information pertaining to different types of double-level DLS is scarce. This study aims to analyse parameters of patients with different types of double-level DLS to provide a reference for guiding surgical treatment and restoring sagittal balance of DLS patients.

Methods:

From January 2014 to January 2020, double-level DLS patients’ records were retrospectively reviewed. Double-level DLS patients were divided into three types: anterior, posterior, and combined; the anterior and combined types were studied. The sagittal spinopelvic parameters included, C7 tilt, maximal thoracic kyphosis (TKmax), maximal lumbar lordosis (LLmax), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Following descriptive analysis, demographic and radiographic data were compared.

Results:

Forty and 18 patients were included in the anterior and combined type groups, respectively. Both groups had different levels of chronic low back pain, but the incidence of radiating leg pain and neurogenic claudication was significantly higher in the anterior type. ODI and VAS low back scores were also higher in the anterior type. In the anterior type, C7 tilt (7.14±2.15 vs. 5.41±2.28, P = 0.007), LLmax (50.02±14.76 vs. 36.96±14.56, P = 0.003), PI (68.28±9.16 vs. 55.53±14.19, P <0.001), PT (28.68±7.31 vs. 19.38±4.70, P <0.001), and PT/PI (42.45±11.22 vs. 36.04±9.87, P = 0.041) were significantly higher. In the anterior type, PI correlated positively with LLmax (r = 0.59) and SS (r = 0.71). LLmax and SS (r = 0.65) had a positive correlation. PT/PI and SS (r = -0.77) had a negative correlation. In the combined type, PI correlated positively with LLmax (r = 0.61) and SS (r = 0.88), and PT/PI correlated negatively with SS (r = -0.81).

Conclusions:

In patients with double-level DLS, the sagittal spinopelvic parameters differed between the anterior and combined types. Overall, spinal surgeons should focus on correcting sagittal deformities, relieving postoperative clinical symptoms, and improving quality of life during fusion surgery.