Pieper Claus Christian, Groetz Simon Frederik, Nadal Jennifer, Schild Hans Heinz, Niggemann Pascal Dominique
Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany,
Eur Spine J. 2014 Jan;23(1):96-101. doi: 10.1007/s00586-013-2932-0. Epub 2013 Aug 4.
To determine the usefulness of acquiring extension radiographs for the evaluation of the degree of spondylolisthesis.
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.
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.
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.
确定获取伸展位X线片对评估腰椎滑脱程度的作用。
两名独立的放射科医生对87例患者（平均年龄63岁，范围32 - 86岁）的腰椎常规X线片进行回顾性评估。所有患者均接受了站立中立位、屈曲位和伸展位的X线片检查。测量椎体深度、矢状位平移位移和前凸角，并计算站立中立位、屈曲位和伸展位X线片上的滑脱百分比（SP）。采用双侧t检验进行统计学分析。使用kappa系数评估观察者间和观察者内的可靠性。
中立位站立和伸展位图像之间的SP差异无统计学意义。中立位与屈曲位比较时，25% - 34%（临界值>8%的SP差异）诊断为腹侧不稳定。代表运动极限的屈伸位X线片的检出率较低，为15% - 22%。观察者间和观察者内的可靠性良好至优秀。
常规站立伸展位X线摄影中的滑脱百分比最终与静态中立位站立视图中获得的滑脱百分比无差异。因此，在腰椎滑脱症腹侧不稳定的常规检查中，伸展位X线摄影可能可以省略。
