Clinical Tests to Diagnose Lumbar Segmental Instability: A Systematic Review

Alqarni, Abdullah M.; Schneiders, Anthony G.; Hendrick, Paul

doi:10.2519/jospt.2011.3457

Cited by 71 publications

(60 citation statements)

References 61 publications

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“…Instability was usually determined from the 2D ROMs of the vertebrae using 2D extension-flexion lateral radiographs. Several radiographic diagnostic criteria have been proposed for lumbar spinal instability and the reported criteria had different cutoff value for different author, such as 3, 4 or 5 mm for translational motion [27]. More recently, Hasegewa presented a new intraoperative measurement system, with displacement transducer and load cell fixed to the spinous process to measure the force-displacement behavior during flexionextension.…”

Section: Discussionmentioning

confidence: 99%

Motion characteristics of the vertebral segments with lumbar degenerative spondylolisthesis in elderly patients

et al. 2012

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Objective Although some studies have reported on the kinematics of the lumbar segments with degenerative spondylolisthesis (DS), few data have been reported on the in vivo 6 degree-of-freedom kinematics of different anatomical structures of the diseased levels under physiological loading conditions. This research is to study the in vivo motion characteristics of the lumbar vertebral segments with L4 DS during weight-bearing activities. Methods Nine asymptomatic volunteers (mean age 54.4) and 9 patients with L4 DS (mean age 73.4) were included. Vertebral kinematics was obtained using a combined MRI/ CT and dual fluoroscopic imaging technique. During functional postures (supine, standing upright, flexion, and extension), disc heights, vertebral motion patterns and instability were compared between the two groups.Results Although anterior disc heights were smaller in the DS group than in the normal group, the differences were only significant at standing upright. Posterior disc heights were significantly smaller in DS group than in the normal group under all postures. Different vertebral motion patterns were observed in the DS group, especially in the left-right and cranial-caudal directions during flexion and extension of the body. However, the range of motions of the both groups were much less than the reported criteria of lumbar spinal instability. Conclusion The study showed that lumbar vertebra with DS has disordered motion patterns. DS did not necessary result in vertebral instability. A restabilization process may have occurred and surgical treatment should be planned accordingly.

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Section: Discussionmentioning

confidence: 99%

Motion characteristics of the vertebral segments with lumbar degenerative spondylolisthesis in elderly patients

et al. 2012

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“…8 Two special tests for lumbar spine instability were performed: the prone instability test 37 and the passive lumbar extension test. 1,42 A posterior/anterior lumbar spring test 48 was performed at each spinal level. Two strength tests, the active sit-up and active bilateral straight leg raise tests, were administered.…”

Section: Examination Proceduresmentioning

confidence: 99%

Derivation of a Preliminary Clinical Prediction Rule for Identifying a Subgroup of Patients With Low Back Pain Likely to Benefit From Pilates-Based Exercise

Stolze¹,

Allison²,

Childs³

2012

J Orthop Sports Phys Ther

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“…Biomechanical features of the lumbar spine are difficult to assess on a clinical routine basis and the diagnosis is commonly based on imaging findings [21]. No definite agreement on the optimum approach to evaluate segmental instability has been reached, with standing flexion-extension images being the most widely used [4,5].…”

Section: Discussionmentioning

confidence: 99%

Radiographic evaluation of ventral instability in lumbar spondylolisthesis: do we need extension radiographs in routine exams?

et al. 2013

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Purpose To determine the usefulness of acquiring extension radiographs for the evaluation of the degree of spondylolisthesis. Methods Routine radiographs of the lumbar spine were retrospectively evaluated in 87 patients (mean-age 63, range 32-86) by two independent radiologists. All patients received radiographs in standing neutral, flexion and extension position. Vertebral body depth, sagittal translational displacement and lordosis angle were measured and slip percentage (SP) was calculated on standing neutral, flexion and extension radiographs. Statistical analysis was performed with a two-sided t test. Inter-and intraobserver reliability was assessed using the kappa-coefficient. Results There was no statistically significant SP-difference between neutral standing and extension images. Ventral instability was diagnosed in 25-34 % (cut-off [8 % SP-difference) for neutral versus flexion comparison. The detection rate of flexion-extension radiographs representing the extremes of motion was lower with 15-22 %. Inter-and intraobserver reliability was good to excellent. Conclusion Slip percentage in routine standing extension radiography ultimately does not differ from that obtained in a static neutral standing view. Extension radiography may therefore be omitted in a routine work-up of ventral instability in lumbar spondylolisthesis.

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Clinical Tests to Diagnose Lumbar Segmental Instability: A Systematic Review

Cited by 71 publications

References 61 publications

Motion characteristics of the vertebral segments with lumbar degenerative spondylolisthesis in elderly patients

Motion characteristics of the vertebral segments with lumbar degenerative spondylolisthesis in elderly patients

Derivation of a Preliminary Clinical Prediction Rule for Identifying a Subgroup of Patients With Low Back Pain Likely to Benefit From Pilates-Based Exercise

Radiographic evaluation of ventral instability in lumbar spondylolisthesis: do we need extension radiographs in routine exams?

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