Spondylolysis and spondylolisthesis of the cervical spine

Spondylolysis and spondylolisthesis of the cervical spine are rare entities. The nomenclature and detailed anatomic features of these conditions are discussed. Four new cases are presented and the world literature is reviewed.Picker Scholar, James Picker Foundation     

The imaging of lumbar spondylolisthesis

Lumbar spondylolisthesis is a common finding on plain radiographs. The condition has a variety of causes which can be differentiated on the basis of imaging findings. As the treatment is dependent upon the type of spondylolisthesis, it is important for the radiologist to be aware of these features. We present a pictorial review of the imaging features of lumbar spondylolisthesis and explain the differentiating points between different groups of this disorder. The relative merits of the different imaging techniques in assessing lumbar spondylolisthesis are discussed.     

Geographic variation in the surgical management of lumbar spondylolisthesis: characterizing practice patterns and outcomes

Background Context

The role of arthrodesis in the surgical management of lumbar spondylolisthesis remains controversial. We hypothesized that practice patterns and outcomes for this patient population may vary widely.

极外侧入路腰椎间融合术联合双侧椎弓根螺钉固定治疗腰椎滑脱症

目的:探讨极外侧入路腰椎间融合术(extreme lateral interbody fusion,XLIF)联合双侧椎弓根螺钉固定治疗腰椎滑脱症的临床及影像学疗效。方法:回顾性分析2014年9月~2016年8月广州军区广州总医院采用XLIF联合双侧椎弓根螺钉固定治疗的单节段腰椎滑脱症患者的资料,共21例,其中女性18例,男性3例;年龄57.0±13.3岁(45~77岁),随访时间18.0±5.0个月(12~29个月)。术前及末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)对临床疗效进行评估。术前及术后3d在轴位MRI上测量轴位椎管前后径(anterior-posterior diameter of the canal,APDC);术前及末次随访时在侧位X线片测量椎间孔高度(foraminal height,FH)、椎间隙高度(disc height,DH),并计算滑移百分比(slipping percentage,SP)。末次随访时应用CT评估融合率及融合器塌陷率。结果:术前及末次随访时腰痛VAS评分分别为5.9±1.7分、1.7±0.7分,腿痛VAS评分分别为6.1±2.1分、1.4±0.7分,ODI分别为(42.6±24.8)%、(12.1±4.2)%,术前与末次随访比较差异均有统计学差异(P0.05)。术前及术后3d的APDC分别为11.2±3.8mm、12.7±4.0mm,差异具有统计学意义(P0.05),术前及末次随访手术节段DH分别为7.2±1.2mm、10.2±1.4mm,FH分别为17.3±2.9mm、20.0±1.7mm,SP分别为(16.4±7.0)%、(6.1±6.6)%,术前与末次随访比较差异均有统计学意义(P0.05)。术中无大血管损伤、腹腔脏器损伤、生殖股神经损伤等严重并发症,术后5例患者出现大腿前方麻木,症状均在3个月内缓解。2例患者出现融合器塌陷,无明显不适。所有手术节段均获得植骨融合,无内固定松动、断裂。结论:XLIF联合双侧椎弓根螺钉固定技术治疗腰椎滑脱症,椎体复位及椎管间接减压效果满意,是一种治疗腰椎滑脱症安全、有效的术式。     

Assessment of lumbosacral kyphosis in spondylolisthesis: a computer-assisted reliability study of six measurement techniques

Although recognized as an important aspect in the management of spondylolisthesis, there is no consensus on the most reliable and optimal measure of lumbosacral kyphosis (LSK). Using a custom computer software, four raters evaluated 60 standing lateral radiographs of the lumbosacral spine during two sessions at a 1-week interval. The sample size consisted of 20 normal, 20 low and 20 high grade spondylolisthetic subjects. Six parameters were included for analysis: Boxall’s slip angle, Dubousset’s lumbosacral angle (LSA), the Spinal Deformity Study Group’s (SDSG) LSA, dysplastic SDSG LSA, sagittal rotation (SR), kyphotic Cobb angle (k-Cobb). Intra- and inter-rater reliability for all parameters was assessed using intra-class correlation coefficients (ICC). Correlations between parameters and slip percentage were evaluated with Pearson coefficients. The intra-rater ICC’s for all the parameters ranged between 0.81 and 0.97 and the inter-rater ICC’s were between 0.74 and 0.98. All parameters except sagittal rotation showed a medium to large correlation with slip percentage. Dubousset’s LSA and the k-Cobb showed the largest correlations (r = −0.78 and r = −0.50, respectively). SR was associated with the weakest correlation (r = −0.10). All other parameters had medium correlations with percent slip (r = 0.31–0.43). All measurement techniques provided excellent inter- and intra-rater reliability. Dubousset’s LSA showed the strongest correlation with slip grade. This parameter can be used in the clinical setting with PACS software capabilities to assess LSK. A computer-assisted technique is recommended in order to increase the reliability of the measurement of LSK in spondylolisthesis.     

横突间融合及椎体间融合治疗腰椎滑脱疗效观察

目的：观察横突间融合及椎体间融合在治疗腰椎滑脱中的效果。方法：对52例腰椎滑脱患者进行后路植骨融合加椎弓根钉内固定。其中20例采用横突间融合,32例采用椎体间融合。结果：两种治疗方式的优良率分别为82％和88％,其中采用横突间融合组发生椎弓根钉断裂2例,内固定取出后再次滑脱2例;而采用椎体间融合组无发生椎弓根钉断裂及腰椎滑脱复发。结论：在治疗腰椎滑脱的应用中。横突间融合与椎体间融合疗效差异无显著性,但后者手术时间更短,所需植骨量更少,创伤更小,并发症的发生率更低．是较好的治疗方法。     

单钉-沟槽柱翼钢板联合自行研制的椎间融合器治疗腰椎滑脱症

目的：评价单钉-沟槽柱翼钢板联合自行研制的椎间融合器治疗腰椎滑脱症的效果，并探讨其有关外科技术问题。方法：将2001年2月～2003年11月间收治的111例腰椎滑脱症患者分成两组，行单钉-沟槽柱翼钢板联合椎间融合器后路手术治疗的62例为观察组；行单钉-沟槽柱翼钢板内固定、后外侧植骨融合术治疗的49例为对照组。观察两组患者术前、术后和随访期间Tailard指数、Boxall指数、滑脱角、腰椎生理前凸角、椎间隙高度指数的变化；同时观察两组的临床疗效及融合率。结果：观察组62例平均随访17.3个月（14～35个月），术后与术前所有观察指标均有显著性差异（P〈0．01）；随访时与术后比较无显著性差异；优良率为93．5％，改善率96．8％，融合率100％。对照组49例平均随访16．7个月（13～32个月），术后与术前所有观察指标均有显著性差异（P〈0．01）：随访时与术后比较Tailard指数、Boxall指数、滑脱角有显著性差异（P〈0．05）；优良率为61．2％，改善率77．6％．融合率79.8％。结论：单钉-沟槽柱翼钢板联合自行研制的椎间融合器后路手术治疗腰椎滑脱症可避免取骨区并发症、维持椎间隙高度和节段稳定、融合率高。     

Spondylolisthesis caused by extreme pedicle elongation in osteogenesis imperfecta

Although osteogenesis imperfecta is a well-known skeletal disorder, reports of spondylolisthesis in osteogenesis imperfecta are rare. Only very few cases of spondylolisthesis caused by elongation of lumbar pedicles have been described in the literature. Here we report three patients suffering from osteogenesis imperfecta showing a severe form of hyperlordosis caused by lumbar pedicle elongation and consecutive spondylolisthesis. Radiographs in the course of childhood and adolescence show a rapid progression of pedicle elongation and hyperlordosis with increased mechanical loads. The treatment strategy consists of physiotherapy, medical treatment with bisphosphonates, and orthopedic surgery and is preferably conservative. In the three patients reported here, one patient was treated with laminectomy and postero-lateral fusion, whereas in the other two patients surgery is currently not considered as necessary.     

Relationship between alterations of the lumbar spine,visualized with magnetic resonance imaging,and occupational variables

Although the effect of physical workload on the occurrence of low back pain (LBP) has been extensively investigated, few quantitative studies have examined the morphological changes visualized via magnetic resonance imaging (MRI) in relation to occupational variables. The relationship between the severity of some abnormalities such as lumbar spinal stenosis or spondylolisthesis and physical or psychosocial occupational risk factors has not been investigated previously. In this cross-sectional study patients fulfilled the following inclusion criteria: (1) long-standing (minimum 1-year) LBP radiating down the leg (or not); (2) age more than 40 years; (3) willingness to undergo an MRI of the lumbar spine; and (4) ability to speak Italian. Primary objective of the study was to investigate the association between occupational exposure and morphological MRI findings, while controlling for the individual risk factors for LBP. Secondarily, we looked at the influence of this exposure and the degenerative changes in the lumbar spine on clinical symptoms and the related disability. Lumbar MRI scans from 120 symptomatic patients were supplemented by the results of structured interviews, which provided personal, medical, and occupational histories. All occupational factors were arranged on scales of increasing exposure, whereas pain and disability were assessed using ad hoc validated questionnaires. Evidence of intervertebral disc narrowing or herniation and the occurrence and severity of spinal stenosis and spondylolisthesis was obtained from the MRI scans and a summative degenerative score was then calculated. We detected a direct association between increasing age and the global amount of degenerative change, the severity of intervertebral disc height loss, the number of narrowed discs, stenosis, the number of stenotic levels, and spondylolisthesis. Physical occupational exposure was not associated with the presence of lumbar disc degeneration and narrowing per se, but a higher degree of such an exposure was directly associated with a higher degree of degeneration (P=0.017). Spondylolistesis and stenosis were positively related to heavy workload (P=0.014) and the manual handling of materials (P=0.023), respectively. Psychosocial occupational discomfort was directly associated to stenosis (P=0.041) and number of stenotic levels (P=0.019). A heavier job workload was the only occupational factor positively related to the degree of disability at the multivariate analysis (P=0.002). Total amount of degeneration in the lumbar spine directly influenced pain duration (P=0.011) and degree of disability (P=0.050). These results suggest that caution should be exercised when symptomatic subjects with evidence of degenerative changes on MRI scans engage in strenuous physical labor.