Spinal-pelvic sagittal parameters and plantar pressure characteristics in elderly patients with degenerative lumbar spondylolisthesis

doi:10.12307/2026.866

Abstract

Abstract: BACKGROUND: Degenerative lumbar spondylolisthesis is a common spinal degenerative disorder among older adults, often accompanied by spinopelvic sagittal imbalance. The characteristics of plantar pressure and balance function in these patients have not been fully elucidated.
OBJECTIVE: To investigate the spinopelvic sagittal parameters and plantar pressure characteristics in older adults with degenerative lumbar spondylolisthesis, to provide a reference for early diagnosis and the development of rehabilitation plans in older adults with degenerative lumbar spondylolisthesis.
METHODS: A total of 33 patients with degenerative lumbar spondylolisthesis (degenerative lumbar spondylolisthesis group) and 35 healthy older adults (control group) were enrolled. Lateral radiographs of the whole spine were obtained to measure spinopelvic sagittal parameters. Plantar pressure distribution, including the pressure ratio, peak pressure in eight regions of interest, and center of pressure trajectory parameters, was collected using a plantar pressure analysis system. The differences in spinal-pelvic sagittal parameters, center of pressure trajectory, and plantar pressure parameters between the two groups were compared and analyzed.
RESULTS AND CONCLUSION: (1) Compared with the control group, the degenerative lumbar spondylolisthesis group showed significant increases in pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis (P < 0.05). (2) Compared with the control group, the degenerative lumbar spondylolisthesis group exhibited a significant increase in the pressure percentage under the left forefoot and the forefoot overall (P < 0.05), while the pressure percentage under the left hindfoot and the hindfoot overall decreased significantly (P < 0.05). (3) Compared with the control group, peak pressure under the left first metatarsal bone was significantly higher in the degenerative lumbar spondylolisthesis group (P < 0.05), whereas peak pressure under the right fifth metatarsal and the left medial arch was significantly lower (P < 0.05). (4) Compared with the control group, under eyes-open and eyes-closed conditions, the degenerative lumbar spondylolisthesis group demonstrated a significant increase in center of pressure trajectory length, 95% confidence ellipse area, and the average center of pressure displacement in the anteroposterior (X) and mediolateral (Y) directions (P < 0.05). (5) It is indicated that older adults with degenerative lumbar spondylolisthesis exhibit characteristic changes in spinopelvic sagittal alignment, notably increased pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis. Their plantar pressure distribution shifts anteriorly, with increased forefoot pressure and decreased hindfoot pressure, indicating an imbalance in foot mechanical symmetry and disruption of the normal tripod support structure. These alterations are accompanied by reduced center of pressure stability, reflecting impaired balance function in degenerative lumbar spondylolisthesis patients.

Key words: degenerative lumbar spondylolisthesis, elderly population, spinal-pelvic sagittal parameters, plantar pressure, balance function, center of pressure

CLC Number:

Han Zijia, He Xiaochen, Wang Jiarong, Tian Yichao, Wang Lixin, Gong Shuhui. Spinal-pelvic sagittal parameters and plantar pressure characteristics in elderly patients with degenerative lumbar spondylolisthesis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(27): 7037-7043.

Figures/Tables 5

References

[1] SAREMI A, GOYAL KK, BENZEL EC, et al. Evolution of lumbar degenerative spondylolisthesis with key radiographic features. Spine J. 2024;24(6):989-1000.
[2] HE LC, WANG YX, GONG JS, et al. Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women. Eur Radiol. 2014;24(2): 441-448.
[3] BYDON M, ALVI MA, GOYAL A. Degenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment. Neurosurg Clin N Am. 2019;30(3):299-304.
[4] CAI T, YANG L, CAI W, et al. Dysplastic spondylolysis is caused by mutations in the diastrophic dysplasia sulfate transporter gene. Proc Natl Acad Sci U S A. 2015;112(26):8064-8069.
[5] AOKI Y, TAKAHASHI H, NAKAJIMA A, et al. Prevalence of lumbar spondylolysis and spondylolisthesis in patients with degenerative spinal disease. Sci Rep. 2020;10(1):6739.
[6] BALTIC SP, LYONS KW, MARIAUX F, et al. Evaluation of the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system as a guide to surgical technique selection. Spine J. 2023;23(11):1641-1651.
[7] FONG AM, DUCULAN R, ENDO Y, et al. Instability Missed by Flexion-Extension Radiographs Subsequently Identified by Alternate Imaging in L4-L5 Lumbar Degenerative Spondylolisthesis. Spine (Phila Pa 1976). 2023;48(3):E33-E39.
[8] 谭蓥滢,曾雪梅. PI-LL对强直性脊柱炎后凸畸形患者截骨矫形术后矢状面平衡的影响[J].徐州医科大学学报,2024,44(11):826-829.
[9] LAFAGE V, SCHWAB F, PATEL A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009;34(17):E599-E606.
[10] CHUANG CY, LIAW MY, WANG LY, et al. Spino-pelvic alignment, balance, and functional disability in patients with low-grade degenerative lumbar spondylolisthesis. J Rehabil Med. 2018;50(10):898-907.
[11] CICI H, AKCALI O, ELVAN A, et al. Balance Control and Plantar Pressure Distribution in Hyperkyphotic Adolescent and Young Adults. Turk Neurosurg. 2023;33(3): 451-457.
[12] GUO C, LIANG Y, XU S, et al. Lasso Analysis of Gait Characteristics and Correlation with Spinopelvic Parameters in Patients with Degenerative Lumbar Scoliosis. J Pers Med. 2023;13(11):1576.
[13] BARREY C, JUND J, NOSEDA O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J. 2007;16(9):1459-1467.
[14] 姜雅文, 刘明威, 肖青霞, 等. 青少年扁平足患者足底压力、下肢平衡与冠状位躯干平衡的相关性研究[J]. 医用生物力学,2024,39(S1):484.
[15] ITO T, SAKAI Y, KAWAI K, et al. Proprioceptive reliance on trunk muscles for maintaining postural stability decreases in older patients with sagittal imbalance. Gait Posture. 2023;105:1-5.
[16] KIM K, MULLINEAUX D, JEON K. A Comparative Study of Spinal Deformity and Plantar Pressure according to the Static Standing Posture of Female Adolescents with or without Idiopathic Scoliosis. Iran J Public Health. 2019;48(2):345-346.
[17] KIRKALDY-WILLIS WH, FARFAN HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982;(165):110-123.
[18] DAHER M, REZK A, BAROUDI M, et al. Lumbar Spondylolisthesis Grading: Current Standards and Important Factors to Consider for Management. World Neurosurg. 2024;190:311-317.
[19] MORITA T, YOSHIMOTO M, TERASHIMA Y, et al. Do We Have Adequate Flexion-extension Radiographs for Evaluating Instability in Patients With Lumbar Spondylolisthesis? Spine (Phila Pa 1976). 2020;45(1):48-54.
[20] DENG L, WANG C, SUN H, et al. Effects of Cage Implantation Depth on Sagittal Parameters and Functional Outcomes in Posterior Lumbar Interbody Fusion for the Treatment of L4-L5 Lumbar Degenerative Spondylolisthesis. Orthop Surg. 2024;16(6): 1327-1335.
[21] SU K, LUAN J, WANG Q, et al. Radiographic Analysis of Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Conventional Open Surgery on Sagittal Lumbar-Pelvic Alignment for Degenerative Spondylolisthesis. World Neurosurg. 2019;124:e733-e739.
[22] RADOVANOVIC I, URQUHART JC, GANAPATHY V, et al. Influence of postoperative sagittal balance and spinopelvic parameters on the outcome of patients surgically treated for degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2017;26(4):448-453.
[23] 陈涛, 黎观保, 梁科友, 等. 脊柱-骨盆矢状面平衡及其在脊柱疾病治疗中的作用[J]. 中国组织工程研究,2013,17(13):2423-2430.
[24] ZHOU L J, YANG M, ZHENG WW, et al. [Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis]. Zhongguo Gu Shang. 2020;33(9):862-866.
[25] 郑召民, 刘辉. 脊柱-骨盆矢状面平衡及其在成人脊柱畸形治疗中的作用[J]. 中国脊柱脊髓杂志,2012,22(3):278-282.
[26] DUBOUSSET J, HADDAD F, ZELLER R, et al. La dysplasie ischio-vertébrale (un dangereux syndrome pour la moëlle épinière) [Ischio-vertebral dysplasia (a dangerous syndrome for the spinal cord)]. Rev Chir Orthop Reparatrice Appar Mot. 1994;80(7):610-619.
[27] 史祎, 许亚民, 马晓丽, 等. 中度Lenke 3CN型女性青少年特发性脊柱侧弯的静态平衡足底压力特征[J]. 医用生物力学,2024,39(5):923-930.
[28] 王欣,罗文,黄文泽,等.单侧膝骨关节炎临床分期与双足足底压力的相关性[J].中国组织工程研究,2021,25(27):4312-4317.
[29] 唐智, 郎蕾, 王任远, 等. 拇外翻足有限元模型构建及其第1跖趾关节生物力学分析[J]. 中国组织工程研究,2023,27(27):4283-4290.
[30] RUSSELL BS, HOIRIIS KT, HOSEK RS. Walking Gait Before and After Chiropractic Care Following Fifth Metatarsal Fractures: A Single Case Kinetic and Kinematic Study. J Chiropr Med. 2018;17(2):106-116.
[31] MATSUMOTO H, TOMOSADA M, NISHI T, et al. Comparing the Ground Reaction Forces, Toe Clearances, and Stride Lengths of Young and Older Adults Using a Novel Shoe Sensor System. Sensors (Basel). 2024;24(21):6871.
[32] GONZALEZ-SANMAMED AG, RUIZ-FERNÁNDEZ ML, DEL-VALLE-SOTO ME. Alterations of the center of pressures in the greater trochanter pain syndrome: Evaluation of pelvitrochanteric injuries through dynamic baropodometry. Gait Posture. 2025;119:246-251.
[33] WANG XW, CHEN X, FU Y, et al. Analysis of lumbar lateral instability on upright left and right bending radiographs in symptomatic patients with degenerative lumbar spondylolisthesis. BMC Musculoskelet Disord. 2022;23(1):59.
[34] PAN W, ZHAO JL, XU J, et al. Lumbar alignment and patient-reported outcomes after single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with and without local coronal imbalance. J Neurosurg Spine. 2020;34(3):464-470.
[35] PERRY SD, RADTKE A. Efficacy and effectiveness of a balance-enhancing insole. J Gerontol A Biol Sci Med Sci. 2008;63(6):595-602.
[36] 朱飞龙, 张明, 吴宇, 等. 青少年特发性脊柱侧弯患者足部姿势和步态特征的3D形态分析及生物力学评价[J]. 中国组织工程研究,2021,25(33): 5294-5300.
[37] BURCAL CJ, WIKSTROM EA. Plantar Cutaneous Sensitivity With and Without Cognitive Loading in People With Chronic Ankle Instability, Copers, and Uninjured Controls. J Orthop Sports Phys Ther. 2016;46(4):270-276.
[38] 侯宗辰, 江东, 胡跃林. 足底压力分析在慢性踝关节不稳诊疗中的研究进展[J]. 中国微创外科杂志,2019,19(2):186-189.
[39] RHEA CK, KIEFER AW, WRIGHT WG, et al. Interpretation of postural control may change due to data processing techniques. Gait Posture. 2015;41(2):731-735.
[40] 段林茹,郑洁皎.脑卒中患者姿势控制的感觉系统特征[J].医用生物力学, 2023,38(4):770-776.
[41] 王耀霆, 姚佳琴, 王红雨, 等. 肌电生物反馈疗法结合镜像疗法对脑卒中患者下肢运动和平衡功能的影响[J]. 中国康复医学杂志,2024,39(3):375-381.
[42] 颜雯婷, 杨倩倩, 任凤, 等. 双侧膝骨关节炎患者足底压力分布及平衡特征研究[J]. 中国康复医学杂志,2023,38(5):696-699.
[43] 王建国, 唐佳, 董继革, 等. 功能性踝关节不稳足底压力分析[J]. 中国康复理论与实践,2022,28(10):1217-1223.
[44] GE L, YU Q, WANG C, et al. How cognitive loads modulate the postural control of older women with low back pain? BMC Geriatr. 2021;21(1):82.
[45] 罗卫, 钟陶, 黄志锐, 等. 慢性非特异性腰痛患者的静态平衡和稳定极限[J]. 中国组织工程研究,2023,27(27):4362-4366.
[46] 葛乐, 余秋华, 郑福明, 等. 腰痛对老年女性动静态平衡功能的影响[J]. 中国康复医学杂志,2022,37(6):760-764.