Liu Ning, Wood Kirkham B, Schwab Joseph H, Cha Thomas D, Pedlow Frank X, Puhkan Rishabh D, Hyzog Tylor L
From the Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, Boston, MA.
Spine (Phila Pa 1976). 2015 Aug 15;40(16):E929-35. doi: 10.1097/BRS.0000000000000941.
Prospective cohort study in consecutive patients.
To investigate and compare the use of 2 diagnostic modalities in the evaluation of stability in lumbar spondylolisthesis.
Evaluating potential instability in lumbar spondylolisthesis is significant to its management. Lateral lumbar flexion-extension (FE) radiograph is frequently obtained on the basis of a thought that this forward-backward movement can actually describe hypermobility at the listhetic segment. However, simply comparing standard upright lumbar lateral radiograph (U) with a supine sagittal magnetic resonance image (S) (combined, US), something typically conducted for patients with lumbar spondylolisthesis, may also be used.
This prospective study included a cohort of 68 consecutive patients with lumbar spondylolisthesis seen in the outpatient clinic of a single hospital. The mobility observed in US was compared with that observed in FE. The ability to identify "instability" using US was compared with that using FE. In addition, the relationships between mobility determined using FE or US and sex, age, height, weight, body mass index, primary symptom (with or without back pain), nature of spondylolisthesis (degenerative or isthmic), listhetic segment, slippage grade, and focal disc height were examined.
Overall, the mobility in US was significantly higher than that in FE (7.68 ± 5.34% vs. 4.90 ± 3.82%, t =-3.545, P = 0.001). The ability to identify "instability" on the basis of US was improved compared with that obtained using FE. Female patients demonstrated higher mobility in FE than male patients to a significant degree. Back pain, isthmic spondylolisthesis, and slippage grade also showed some relevance with mobility but without statistical significance.
US may offer an easily available, alternative diagnostic modality in lumbar spondylolisthesis, with the potential of reducing both radiation exposure and costs. Further studies should focus on its influence in clinical decision making.
对连续患者进行前瞻性队列研究。
调查并比较两种诊断方法在评估腰椎滑脱稳定性中的应用。
评估腰椎滑脱的潜在不稳定性对其治疗具有重要意义。腰椎侧位屈伸（FE）X线片常基于这样一种观点而获取，即这种前后运动实际上可以描述滑脱节段的活动过度。然而，对于腰椎滑脱患者，通常进行的简单比较标准直立腰椎侧位X线片（U）与仰卧位矢状面磁共振成像（S）（联合，US）也可使用。
这项前瞻性研究纳入了在一家医院门诊就诊的68例连续腰椎滑脱患者队列。比较US中观察到的活动度与FE中观察到的活动度。比较使用US和FE识别“不稳定性”的能力。此外，还研究了使用FE或US确定的活动度与性别、年龄、身高、体重、体重指数、主要症状（有无背痛）、滑脱性质（退行性或峡部性）、滑脱节段、滑脱程度和椎间盘局部高度之间的关系。
总体而言，US中的活动度显著高于FE（7.68±5.34%对4.90±3.82%，t=-3.545，P=0.001）。与使用FE相比，基于US识别“不稳定性”的能力有所提高。女性患者在FE中的活动度比男性患者高得多。背痛、峡部裂性腰椎滑脱和滑脱程度也与活动度有一定相关性，但无统计学意义。
US可能为腰椎滑脱提供一种易于获得的替代诊断方法，具有减少辐射暴露和成本的潜力。进一步的研究应关注其对临床决策的影响。
2级。
