Degenerative lumbar intervertebral instability: what is it and how does imaging contribute?

Leone, Alessandro; Cassar‐Pullicino, Victor N.; Guglielmi, Giuseppe; Bonomo, Lorenzo

doi:10.1007/s00256-009-0646-5

Cited by 29 publications

(19 citation statements)

References 39 publications

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“…Nevertheless, SFE revealed a pathologic ST in 11% of cases that had not been apparent in SRP. The number of comparative studies analysing different positions and movements to reveal maximal slip of the vertebral body is limited, and recent studies are rare [16].…”

Section: Discussionmentioning

confidence: 99%

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The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis

et al. 2011

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Purpose Lumbar flexion-extension radiographs in standing position (SFE) are the most commonly used imaging method to evaluate segmental mobility. Many surgeons use SFE to disclose abnormal vertebral motion and base their decision for surgical fusion on its results. We tested the hypothesis that imaging in standing and recumbent position (SRP) reveals a higher sagittal translation (ST) and sagittal rotation (SR) in symptomatic patients than with SFE. Materials and methods We analysed images of 100 symptomatic patients with a low-grade spondylolisthesis that underwent surgical fusion. To determine the ST and SR in SRP, we compared the images taken in the recumbent position in the CT with images taken in the standing position during the routine plain radiography. Results The measurement of ST revealed an absolute value of 2.3 ± 1.5 mm in SFE and 4.0 ± 2.0 mm in SRP and differed significantly (p = 0.001). The analysis of the relative value showed an ST of 5.9 ± 3.9% in SFE and 7.8 ± 5.4% in SRP (p = 0.008). The assessment of ST in flexion and in a recumbent position (FRP) revealed the highest ST (4.6 ± 2.5 mm or 9.2 ± 5.7%). Comparison of SR showed the highest rotation in SFE (6.1°± 3.8°), however, compared to SRP (5.4°± 3.3°), it missed the level of significance (p = 0.051). ConclusionsFor evaluation of ST in symptomatic patients with spondylolisthesis SRP appears to be more suitable than SFE, while a pathological SR is better revealed in SFE. The analysis of SRP might offer a complementary method to detect or exclude pathological mobility in more cases.

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Section: Discussionmentioning

confidence: 99%

“…There are no recent comparative studies about radiography of low-grade spondylolisthesis [15,16]. The multitude of possible positions for functional radiography and complicated manoeuvres that might cause the maximal ST makes it difficult to choose the proper diagnostic modality.…”

Section: Introductionmentioning

confidence: 99%

The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis

et al. 2011

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“…A review by Leone et al [35] concludes that patients with symptomatic lumbar stenosis and a slip of more than 3 mm should receive concomitant fusion. However, in a study they performed in 2009 [36], they conclude that it is a challenge to determine a relationship between imaging instability and its symptoms. This is partly due to the fact that measurement errors may exist in plain X-rays.…”

Section: Discussionmentioning

confidence: 99%

Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review

et al. 2018

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Purpose The primary objective of this systematic review is to compare the outcome after decompression with and without concomitant instrumented fusion in patients with lumbar stenosis and degenerative spondylolisthesis. Does adding fusion to simple decompression lead to better results? Methods PubMed, Embase, CENTRAL, Cochrane, Web of Science, CINAHL and Academic Search Premier were searched. All studies comparing outcome of decompression alone to decompression with concomitant-instrumented fusion in patients suffering from symptomatic lumbar stenosis with degenerative spondylolisthesis were included. Risk of bias was assessed using an adapted version of the Cowley checklist. Results Eleven studies were included in the analysis involving 3119 patients in total. In the majority of studies, including two RCTs, clinical outcome of both patient groups was comparable regarding most clinical outcome measures. Conclusion Currently there is not enough evidence that adding instrumented fusion to a decompression leads to superior outcomes compared to decompression only in patients with lumbar stenosis and degenerative spondylolisthesis. The most important clinical outcome measures, including the ODI, show comparable results. Therefore, the least invasive and least costly procedure, being decompression alone, is preferred in patients with low-grade spondylolisthesis with predominant leg pain. Take Home Messages 1. Adding fusion to a decompression does not lead to better outcomes regarding the ODI and leg pain. Graphical abstract2. Decompression with concomitant fusion is presumably associated with more complications compared to decompression alone.3. Decompression alone is preferred in patients with low-grade spondylolisthesis with predominant leg pain. Forsth, P., et al. (2013). Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: A two-year follow-up study involving 5390 patients. Bone Joint J 95-B(7): 960-965 Forsth, P., et al. (2016). A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis.

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“…At a given time 23 % of the population suffers from chronic low back pain [1]. In many cases it remains difficult, if not impossible, to determine the exact cause of back pain, but among various other conditions spondylolisthesis with lumbar intervertebral instability can be an important factor [2].…”

Section: Introductionmentioning

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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Degenerative lumbar intervertebral instability: what is it and how does imaging contribute?

Cited by 29 publications

References 39 publications

The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis

The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis

Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review

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

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