Chaput Christopher, Padon Derek, Rush Jeremy, Lenehan Eric, Rahm Mark
Department of Orthopedic Surgery, Scott and White Clinic and Memorial Hospital, Temple, TX 76508, USA.
Spine (Phila Pa 1976). 2007 Aug 1;32(17):1883-7. doi: 10.1097/BRS.0b013e318113271a.
Retrospective radiographic review of consecutive patients with universally applied standard.
To define MRI findings at the facet joints that may suggest abnormal sagittal plane translation seen on standing lateral flexion-extension (SLFE) radiographs.
MRI findings, including facet joint orientation, facet joint osteoarthritis, and the presence of synovial cysts, have all been linked with degenerative spondylolisthesis (DS). MRI can also detect facet joint effusion; however, there has not been a study specifically addressing the association of facet fluid signal to degenerative spondylolisthesis (DS).
MRI and SLFE films of all patients seen at a single institution for an orthopedic spine consultation over a 2-year period were analyzed. The presence of facet effusions, synovial cysts, increased intensity within the interspinous ligament, degenerative changes at the facets, and anterior sagittal plane translation were all recorded. The data were analyzed to determine if there was a significant association between the presence of DS and the following: facet effusion, degenerative changes of the facets, synovial cysts, increased signal in the interspinous ligament, age, and gender.
There were 139 patients without DS at (NegDS) and 54 with DS (PosDS) on SLFE films at L4-L5 (n = 193). PosDS patients were more likely to be older (P < 0.0001), female (P = 0.0042), have synovial cysts (P < 0.0001), have higher osteoarthritis grade (P < 0.0001), and have larger facet effusion size (P < 0.0001). For both groups, facet joint effusions were also found to be significantly larger in patients with Grade 2 or less osteoarthritis, than in patients with Grade 3 osteoarthritis. Twenty-two percent of the listheses were not detectable on supine MRI.
Large (> 1.5 mm) facet effusions are highly predictive of degenerative spondylolisthesis at L4-L5 in the absence of measurable anterolisthesis on supine MRI. A clinically measurable facet effusion (> or = 1 mm) suggests the need for SLFE films to diagnose degenerative spondylolisthesis that can be missed with supine positioning on MRI.
对连续患者进行回顾性影像学检查，采用通用标准。
明确小关节的MRI表现，这些表现可能提示在站立位侧屈 - 后伸（SLFE）X线片上观察到的矢状面异常平移。
MRI表现，包括小关节方向、小关节骨关节炎以及滑膜囊肿的存在，均与退行性椎体滑脱（DS）相关。MRI还可检测到小关节积液；然而，尚未有研究专门探讨小关节液信号与退行性椎体滑脱（DS）的关联。
分析了在两年期间于单一机构接受脊柱骨科会诊的所有患者的MRI和SLFE片。记录小关节积液、滑膜囊肿、棘间韧带内信号增强、小关节退变改变以及矢状面前方平移的情况。对数据进行分析，以确定DS的存在与以下因素之间是否存在显著关联：小关节积液、小关节退变改变、滑膜囊肿、棘间韧带信号增强、年龄和性别。
在L4 - L5水平的SLFE片上，有139例患者无DS（NegDS），54例有DS（PosDS）（n = 193）。PosDS患者更可能年龄较大（P < 0.0001）、为女性（P = 0.0042）、有滑膜囊肿（P < 0.0001）、骨关节炎分级较高（P < 0.0001）且小关节积液尺寸较大（P < 0.0001）。对于两组患者，骨关节炎2级或以下的患者小关节积液也显著大于骨关节炎3级的患者。22%的椎体滑脱在仰卧位MRI上无法检测到。
在仰卧位MRI上无可测量的椎体前移的情况下，大的（> 1.5 mm）小关节积液高度提示L4 - L5水平的退行性椎体滑脱。临床上可测量的小关节积液（>或 = 1 mm）提示需要进行SLFE片检查以诊断仰卧位MRI可能漏诊的退行性椎体滑脱。
