Radiographic risk factors for degenerative lumbar spondylolisthesis: A comparison with healthy control subjects (original) (raw)
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Degenerative lumbar spondylolisthesis: Anatomy, biomechanics and risk factors
Journal of Back and Musculoskeletal Rehabilitation, 2008
Degenerative spondylolisthesis (DS) is a major cause of spinal stenosis and is often related to low back and leg pain. We reviewed the anatomical and biomechanical predisposition of lumbar DS and discuss possible predictors and risk factors for this condition. Spinal segment L4-L5 is most vulnerable because of the great forces in this region and the increased mobility of this segment due to the specific anatomy of quadratus lumborum muscle and iliolumbar ligament. A high pelvic incidence and lumbar lordosis increase the forces on the low spinal segments and probably raise the risk for DS. Individuals with relatively more sagittal orientation of the lumbar facets have a higher probability of developing DS because such joints have less ability to resist the shearing forces. Disc degeneration is not an important predisposing factor for DS. Reduced disc space caused by disc degeneration increases the facet joint articulation overlap and together with osteophyte formation and ossification of spinal ligaments, can be seen as a part of the restabilization process. Deep abdominal and paraspinal muscles, most likely, play an important role in dynamic lumbar stability. Factors found to be associated with lumbar DS include age > 50, female gender, pregnancy, African American race, and generalized joint laxity.
Correlation of the Risk Factors in Degenerative Lumbar Spondylolisthesis with MRI Imaging
JULY 2023
Introduction: Degenerative spondylolisthesis burdens the future economy. Elderly individuals with this condition suffer from back pain, limb paralysis, reduced activity, and diminished quality of life. Surgery offers relief but is risky and expensive. As healthcare improves, the aging population grows, and spondylolisthesis incidence rises. Early detection and risk factor management are vital for prevention. Therefore, this study aimed to evaluate the correlation of the risk factors for degenerative lumbar spondylolisthesis. Methods: A retrospective observational study was done in Dr Soetomo General Academic Hospital, Surabaya from January 2018 to December 2019. Forty-five subjects with degenerative spondylolisthesis diagnosed by MR Imaging enrolled in this study. Intervertebral disc, facet joint, multifidus muscle, and ligamentum flavum at level L1 until level L5 were examined using MR imaging. Correlation analysis was measured using the Spearman correlation test and risk factor an...
Degenerative lumbar spondylolisthesis. Cohort of 670 patients, and proposal of a new classification
Orthopaedics & Traumatology: Surgery & Research, 2014
Based on a radiological analysis, the authors propose a new classification with five types of degenerative spondylolisthesis: type 1, SL > 5 • and LL > PI-10 • ; type 2, SL < 5 • and LL > PI-10 • ; type 3, LL < PI-10 • ; type 4, LL < PI-10 • and compensated sagittal balance with PT > 25 • ; and type 5, sagittal imbalance with SVA > 4 cm. Proof level: IV Observational cohort study. Retrospective review of prospectively collected outcome data.
Risk Factors For the Development of a Mobile Degenerative Spondylolisthesis at L4–L5
Spine Deformity, 2015
Objective: The purpose of this study was to identify factors that may be important in determining whether a degenerative spondylolisthesis at L4eL5 is mobile. Summary of background data: Degenerative scoliosis is a common condition among middle-aged and elderly adults. Sacropelvic morphology and orientation modulate the geometry of the lumbar spine and, consequently, the mechanical stresses at the lumbo-sacral junction. To date, no in vivo data exist to describe the relationship between these pelvic parameters and their association with a mobile spondylolisthesis. Method: Sixty consecutive patients with a degenerative spondylolisthesis (DS) at L4eL5 with adequate imaging were identified. Patient groups were defined on the basis of whether the DS was mobile (Group A) or nonmobile (Group B) when comparing the upright plain lumbar radiograph to the supine magnetic resonance imaging (MRI). We assessed the grade of slip, lumbar lordosis, pelvic parameters, and facet characteristics (angles, tropism, presents of effusion, degenerative scoredcartilage and sclerosis values) as well as disc degenerative score (Pfirrmann) at L4eL5. Results: There were 40 patients in Group A and 20 in Group B. No significant differences were found between groups for pelvic incidence (p 5 .409), pelvic tilt (p 5 .476), sacral slope (p 5 .785), lumbar lordosis (p 5 .695), degree of facet tropism (p 5 .38), and magnitude of the facet effusions (p 5 .01). Facet angle differences between groups approached significance (p 5 .058). Significant differences between groups were found in cartilage degenerative score (p 5 .01), facet sclerosis grade (p 5 .01), and disc degenerative score (p ! .0001). In Group A, 10 of 40 (25%) reduced fully and were not apparent on the supine MRI. Conclusions: Sagittal pelvic parameters do not play a significant role in differentiating between mobile and nonmobile DS at L4eL5. However, DS does appear to be associated with more sagittally orientated facets, higher Pfirrmann grade, and higher facet cartilage and sclerosis degenerative scores.
European Spine Journal, 2016
Purpose Most morphometric studies on lumbar degenerative spondylolisthesis (DS) have focused solely on the L4-L5 slipped level, neglecting the shape of the entire lumbar segments. The purpose of this study was to present a morphometric analysis of the entire lumbar IVDs and VBs in DS. Methods Out of 500 lumbar CTs, the first 100 CTs, 50 with DS at L4 and 50 age-and sex-matched control CTs, were randomly selected. All lumbar IVD and VB heights, widths, lengths and sagittal wedging as well as lumbar lordosis (LL) and sacral inclination (SI) were measured and relevant ratios calculated. The prevalence of lumbar vertebral osteophyte was also measured. Results A total of 6700 measurements were taken. Age, height, weight and BMI had no effect on all parameters. Compared with controls, in females with DS, the majority of IVDs were flatter, with increased kyphotic wedging at L1-L2 (D1.3°) and L2-L3 (D1.8°), turning to lordotic wedging at L3-L4 (D5.9°), and decreased lordotic wedging at L4-L5 (D2.7°) and L5-S1 (D5.3°). The posterior IVD/VB ratio of all lumbar levels, middle IVD/ VB ratio of L3-S1 and anterior IVD/VB ratio of L4-S1 were smaller. In males with DS, the L2-L3 IVD manifested more kyphotic wedging (D3.8°), the L4 VB wedging was more lordotic (D2.4°) and all L4-L5 IVD/ VB ratios and L3-L4 middle and posterior IVD/VB ratios were smaller. Conclusions Individuals with DS have a more generalized degenerative disc disease on all lumbar vertebral levels, characterized by decreased disc space heights and kyphotic posture of the upper lumbar segments, occurring more predominantly in females than in males with DS.
Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine
European Spine Journal, 2012
Introduction Little is known about when and how progressive spondylolisthesis occurs. In this report segmental motion related to age and disc degeneration at L4/5 disc was investigated. Materials and methods 637 patients with low back and/or leg pain underwent radiologic and MRI examinations simultaneously. Because 190 patients with conditions which might impede accurate measurement were excluded, 447 patients, comprising 268 men and 179 women, were included; age range, was 10-86 (mean: 53) years. Three radiologic parameters slip in neutral position (mm), sagittal translation (mm), and segmental angulation (degrees) were examined at the L4/5 segment. On T2-weighted MRI, severity of disc degeneration at L4/5 was classified by Pfirrmann's criteria, grade 1-5. Results Results showed stage of disc degeneration that progressed according to aging with significant differences except for between grades 4 and 5. Amount of anterior slip was small among grades 1 to 3; however, it greatly increased between grades 3 and 4 and between grades 4 and 5, suggesting that grade 3 disc degeneration has a potential risk of future progression of anterior slip. This finding may also suggest that once significant slip occurs, it will progress to the final grade. Furthermore, the grade 3 degeneration group exhibited large amounts of motion in both angulation and translation, suggesting it was the most unstable group. Conclusion Our results with radiography and MRI indicate that grade 3 disc degeneration is a critical stage for the progression of lumbar spondylolisthesis at L4/5 segment.
Predisposing factors in degenerative spondylolisthesis
International Orthopaedics, 1997
We report a prospective study analysing whether possible factors predisposing to degenerative spondylolisthesis (DS) must be present concomitantly in order to cause vertebral slipping. Standard and flexion-extension radiographs were obtained from 27 patients with DS and 27 without spondylolisthesis. The level of the intercrestal line, the lumbosacral angle, the presence of sacralization of L5 and vertebral motion at the L4 ± L5 level were assessed. Facet joint orientations were measured on CT scans. Only facet joint orientation and vertebral motion at the spondylolisthetic level were significantly different in patients with DS compared with controls. Facet joints were oriented more sagittally both at the spondylolisthetic level and at the levels above and below. An inverse linear correlation was found between the sagittal orientation of facet joints and the mobility of the slipped vertebra. Abnormal sagittal orientation of facet joints and hypermobility of the spondylolisthetic vertebra appear to play major roles among possible factors predisposing to DS. Both factors should be considered in the planning of surgical treatment.
The spine journal : official journal of the North American Spine Society, 2015
The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis features evidence-based recommendations for diagnosing and treating degenerative lumbar spondylolisthesis. The guideline updates the 2008 guideline on this topic and is intended to reflect contemporary treatment concepts for symptomatic degenerative lumbar spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of May 2013. NASS' guideline on this topic is the only guideline on degenerative lumbar spondylolisthesis included in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse (NGC). The purpose of this guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for patients with degenerative lumbar spondylolisthesis. This article provides a brief summary of the evidence-based guideline reco...
Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment
2021
Introduction There is weak relationship between the presence of lumbar spondylolisthesis [SPL] and low back pain that is not always associated with instability, either at the involved lumbar segment or at different spinal levels. Therefore patients with lumbar symptomatic SPL can be divided into stable and unstable, based on the level of mobility during flexion and extension movements as general classifications for diagnostic and therapeutic purposes. Different opinions persist about best treatment (conservative vs. surgical) and among conservative treatments, on the type, dosage, and progression of physical therapy procedures. Purpose and importance to practice The aim of this Masterclass is to provide clinicians evidence-based indications for assessment and conservative treatment of SPL, taking into consideration some subgroups related to specific clinical presentations. Clinical implications This Masterclass addresses the different phases of the assessment of a patient with SPL, ...
Diagnosis and conservative management of degenerative lumbar spondylolisthesis
European Spine Journal, 2008
Degenerative spondylolisthesis (DS) is a disorder that causes the slip of one vertebral body over the one below due to degenerative changes in the spine. Lumbar DS is a major cause of spinal canal stenosis and is often related to low back and leg pain. We reviewed the symptoms, prognosis and conservative treatments for symptoms associated with DS. PubMed and MEDLINE databases (1950-2007) were searched for