Analysis of lumbar lateral instability on upright left and right bending radiographs in symptomatic patients with degenerative lumbar spondylolisthesis

Abstract

Background To evaluate lumbar mobility in various positions using upright left and right bending radiographs in patients with degenerative lumbar spondylolisthesis (DLS), as well as to assess the impact of lateral instability on patient-reported outcomes. Methods This study retrospectively reviewed a consecutive series of patients with DLS between January 2019 and October 2020. The enrolled patients were divided into two groups: the lateral instability group (group L) and non-lateral instability group (group NL). Translational and angular motion in both sagittal and coronal planes and patient-reported outcomes were compared between the two groups. Results There were 104 (59.8%) patients in group L and 70 (40.2%) patients in group NL, with an average age of 60.6 ± 7.8 years. Patients with a right bending posture in group L had a higher slip percentage (14.2 ± 7.4% vs 9.2 ± 3.2%, p = 0.01) and slip angle (6.3 ± 1.5° vs 2.2 ± 0.8°, p = 0.021). Compared with group NL, group L demonstrated significantly larger angular motion in the coronal plane (2.4 ± 1.3° vs 1.0 ± 0.7°, p = 0.008). Patients with lateral instability had worse preoperative back pain (6.1 ± 1.6 vs 2.7 ± 1.9, p = 0.01) and Oswestry Disability Index (ODI) scores (37.7 ± 5.5 vs 25.6 ± 2.6, p = 0.002). In terms of pain characteristics, group L was characterized by pain when getting out of a car, when rising from a chair, and when climbing stairs (all p values < 0.05). Conclusion Lumbar lateral instability, that is, increased mobility in the coronal plane on lateral bending radiographs, translational and/or angular, correlates to more pronounced patient related symptoms in degenerative L4–5 spondylolisthesis. The existence of lumbar lateral instability leads to worse impacts on patient-reported outcomes when patients change their positions including getting out of a car, rising from a chair, and climbing stairs.

Radiographic analysis of dynamic lumbar motion during the five-repetition sit-to-stand test in degenerative lumbar spondylolisthesis

“…In our previous study, the combination of standing upright radiographs and supine MRI was shown to be superior to traditional standing flexion-extension radiographs in measuring translational motion and identifying instability for DLS patients with low back pain and a kyphotic configuration at the slip level [2]. Another study also suggested that upright left and right bending radiographs are more suitable for evaluating lumbar mobility in DLS patients with local coronal instability [15]. As in the current study, N-sMR is an effective radiographic method for evaluating lumbar instability in a distinct subgroup of patients with positive signs of 5R-STS.…”

“…Spinal movement-triggered pain is one of the characteristics of low back pain [14]. Some patients with low back pain are obviously aggravated when they change body posture [9,15]. In our previous study, we identified a subset of patients with low back pain due to lateral displacement during spinal bending motion.…”

“…In our previous study, we identified a subset of patients with low back pain due to lateral displacement during spinal bending motion. In addition, other patients suffer from low back pain during sit-to-stand movements [9,15,16]. Low back pain triggered by the movement of sitting to standing has a substantial impact on patients' daily lives and results in OFI [7,10,16].…”

Sample Preparation Method for MALDI Mass Spectrometry Imaging of Fresh-Frozen Spines

“…The spine may be imaged in humans for diagnostic purposes, which may be accomplished via several modalities of various sensitivities and resolution . The most common is X-ray radiography, which quickly (seconds to minutes) provides information for m 2 sized areas compared to other related modalities and provides radiographic information about bone structures in a nonstatic context such as mobility or bending radiography. , Computed tomography (CT) involves reconstructing the internal structures of the body from a collection of X-ray data taken from hundreds or more angles. − Both X-ray radiography and CT share the risks of high radiation exposure, especially for higher-resolution images . Another form of imaging is nuclear magnetic resonance imaging (MRI), which defines soft tissues and neural elements and can noninvasively create an image without applying radiation , through the use of dyes .…”

Spatial lipidomics of fresh-frozen spines

“…The spine may be imaged in humans for diagnostic purposes, which may be accomplished via several modalities of various sensitivities and resolution 16 . The most common is x-ray radiography 17 , which quickly (sec-min) provides information for a m 2 sized areas compared to other related modalities 18 and provides radiographic information about bone structures in a nonstatic context such as mobility 19 or bending radiography 20,21 . Computed tomography (CT) involves reconstructing the internal structures of the body from a collection of X-ray data taken from hundreds or more angles 22,[23][24][25] .…”