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Level-Specific Differences in Degenerative Spondylolisthesis: A Comparative Analysis of L3 versus L4 Spinopelvic
Xinghua Zhou1, Jianhua Ren1, Junkai Kou1
1Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, China.
Objective:
To investigate the distinct biomechanical characteristics of L3 versus L4 degenerative spondylolisthesis (DS) by comparing spinopelvic sagittal parameters, facet joint morphology, and paraspinal muscle degeneration patterns.
Methods:
This retrospective comparative cohort study included 112 patients who underwent surgical treatment for single-level DS (48 L3-L4, 64 L4-L5) between 2021 and 2023. Comprehensive radiographic analysis assessed spinopelvic sagittal alignment parameters using full-spine standing radiographs. Facet joint angles and pedicle-facet angles were measured using computed tomography. Paraspinal muscle cross-sectional area and fat infiltration were quantified using magnetic resonance imaging at multiple lumbar levels.
Results:
L4DS patients demonstrated significantly greater global sagittal imbalance compared to L3DS patients (sagittal vertical axis: 3.43 ± 3.99 mm vs. 0.13 ± 3.86 mm, P < 0.01). L3DS patients exhibited larger facet joint angles at L4-L5 and L5-S1 levels, suggesting protective compensatory adaptations. L4DS patients showed more severe vertebral slippage (19.02 ± 7.47% vs. 15.85 ± 7.09%, P < 0.05) and greater multifidus fat infiltration at the L3-L4 level (40.36 ± 14.06% vs. 30.42 ± 13.31%, P < 0.05). Muscle cross-sectional areas remained comparable between groups.
Conclusions:
L3 and L4 DS represent distinct pathological entities with fundamentally different compensatory mechanisms, morphological adaptations, and degenerative patterns. These level-specific differences may have important implications for surgical planning and treatment strategies.
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