Management of symptomatic degenerative low-grade lumbar spondylolisthesis

Evans, Nick; McCarthy, Michael

doi:10.1302/2058-5241.3.180020

Cited by 22 publications

(22 citation statements)

References 108 publications

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“…This may be alleviated by resting or leaning forward -this is in stark contrast to vascular claudication which is associated with pain even at rest. If pulses are not palpable or pain continues even at rest, a vascular work-up should be initiated to rule out underlying vascular etiology [21][22][23][24][25][26][27][28][29][30][31][32][33].…”

Section: Clinical Presentationmentioning

confidence: 99%

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Spondylolisthesis

Mossaad¹

2020

RRHOAJ

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Section: Clinical Presentationmentioning

confidence: 99%

“…At 100% displacement, patients have developed spondyloptosis [20]. Grades 1 and 2 are considered low-grade slips [21]. Grades 3 and 4 are considered high-grade spondylolisthesis [19].…”

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confidence: 99%

Spondylolisthesis

Mossaad¹

2020

RRHOAJ

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“…However, common clinical presentations may include back pain, radiculopathy, and neurologic claudication. 2 5 6…”

Section: Introductionmentioning

confidence: 99%

The Fate of Nonoperative Management in Patients with Lytic Spondylolisthesis

Sinha

George

2022

J Neurol Surg A Cent Eur Neurosurg

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Introduction: There is a lack of consensus within the current literature about the role of nonoperative management in lytic spondylolisthesis. Our objective was to assess the fate that nonoperative management plays in patients diagnosed with lytic spondylolisthesis. Material and Methods: Data was collected from 41 patients between May 2015 to February 2020 who were initially referred specifically for instrumented lumbar fixation but were instead planned for nonoperative management as they opted to avoid surgery. MRI scans were used to determine spondylolisthesis grade, type of deformity and radiological features. Patient notes were reviewed to establish management plans. Furthermore, patients were also contacted via telephone to assess their symptoms and disease progression. Results: 26 of the 41 patients had lytic spondylolisthesis (63.4%). Of these patients the male to female ratio was 10:16. The median age was 60 (range: 22 to 76). A total of 12 patients were managed nonoperatively for 5 years or longer with 2 patients showing progression from grade I to II. Conclusion: Nonoperative management of lytic spondylolisthesis is a reasonable option in a selected cohort of patients. The longer in duration, patients are managed conservatively the less likely they are to require a surgical intervention. Even severe radiological foraminal stenosis without radicular pain does not seem to push patients towards surgery. Management decisions must be made on an individual basis. This data can give some reassurance to patients that wish to consider nonoperative management and help guide clinicians.

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“…The natural history of spondylolisthesis involves contributory factors such as a lower intercristal line, tilting of the intervertebral disc, tropism and sagittal orientation of the facet joints, increased pelvic incidence, increased mechanical loading across the disc space, and generalized joint laxity ( 6 , 7 ). While degenerative spondylolisthesis is seen as a rather stable condition, with slip progression rates of 30% over the years, spondylolysis is associated with slip progression rates of 40% and higher ( 8 , 9 ). An amount of ≥3 mm difference of translation measured on different imaging modalities is defined as instability ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…While patients with mild symptoms might be treated with conservative measures alone, those with more severe pain or neurological deficits benefit from surgical treatment ( 9 , 13 ). Cases with predominant stenosis (with or without the presence of stable spondylolisthesis) could be considered for decompression alone; instability and slip progression tilt the scales toward instrumentation and interbody fusion as treatment of choice ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Intermodal Detection of Lumbar Instability in Degenerative Spondylolisthesis is Superior to Functional Radiographs

et al. 2022

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PurposeIn this study, we compare different imaging modalities to find the most sensitive and efficient way of detecting instability in lumbar spondylolisthesis.MethodsPatients presenting with spondylolisthesis from June 01, 2018 to May 31, 2020 with functional radiographs and either CT scans or MRI images were included in our single-center retrospective cohort study. The amount of translation, in millimeters, was measured on supine MRI images, CT scans, and radiographs of inclination while sitting, standing, or prone and reclination while standing using the Meyerding technique. The amount of translation was compared among the different modalities.ResultsA total of 113 patients with spondylolisthesis on 125 vertebral levels were included in this study. The mean patient age was 73.52 ± 12.59 years; 69 (60.5%) patients were females. The most affected level was L4/5 (62.4%), followed by L3/4 (16%) and L5/S1 (13.6%). The average translations measured on supine CT were 4.13 ± 5.93 mm and 4.42 ± 3.49 mm on MRI (p = 0.3 for the difference between MRI and CT). The difference of inclination while sitting radiograph to slice imaging was 3.37 ± 3.64 mm (p < 0.0001), inclination while standing to slice imaging was 2.67 ± 3.03 mm (p < 0.0001), reclination while standing to slice imaging was 1.6 ± 3.15 mm (p = 0.03), and prone to slice imaging was 2.19 ± 3.02 mm (p = 0.03).ConclusionWe found that a single radiograph in either inclination, reclination, or prone position compared to a CT scan or an MRI image in supine position can detect instability in spondylolisthesis more efficiently than comparison of functional radiographs in any position.

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Management of symptomatic degenerative low-grade lumbar spondylolisthesis

Cited by 22 publications

References 108 publications

Spondylolisthesis

Spondylolisthesis

The Fate of Nonoperative Management in Patients with Lytic Spondylolisthesis

Intermodal Detection of Lumbar Instability in Degenerative Spondylolisthesis is Superior to Functional Radiographs

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