Aoyama Ryoma, Shiraishi Tateru, Kato Masahiro, Yamane Junichi, Ninomiya Ken, Kitamura Kazuya, Nori Satoshi, Iga Takahito
Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Tokyo, Japan.
Shiraishi Spine Clinic, Tokyo, Japan.
Spine Surg Relat Res. 2018 Jan 27;2(1):30-36. doi: 10.22603/ssrr.2017-0017. eCollection 2018.
The characteristics of cervical spondylolisthesis are not currently fully understood, because of the shortage of reports covering the large population of patients with cervical spondylolisthesis. The purpose of this study was to elucidate the characteristics of cervical spondylolisthesis by examining a relatively large number of cases.
We analyzed 101 cases with more than 2 mm of vertebral listhesis as determined from X-ray or computed tomography (CT) images among 731 patients who underwent surgery at a single institute. We considered the C2-7 angle, range of motion, and C2-7 sagittal vertical axis on lateral X-ray images. From sagittal CT images, classifications into five grades based on the slipped disc and adjacent caudal levels were made. We examined the orientation of facet joints at the slipped level using axial CT images.
Spondylolisthesis was recognized in 101 cases at 124 levels. Anterior and posterior spondylolisthesis were detected in 68 and 40 cases, respectively. Anterior spondylolisthesis developed predominantly at C3 or C4, usually at the level adjacent to the narrowed disc, or at C7, adjacent to the stiffened thoracic spine. The disc height was relatively preserved at the anterior slipped level. Posterior spondylolisthesis developed predominantly at the level of the significantly narrowed disc associated with advanced intervertebral osteoarthritis. At the segment with listhesis in the lower cervical spine, the direction of the facet joint in the axial plane tended to be posteromedial.
Cervical degenerative spondylolisthesis was classified into two types. The first and more common listhesis occurred adjacent to stiffened levels, and anterior slippage was common in this type. The second and less common listhesis occurred within progressively degenerated segments, and posterior slippage was prominent. We have uniquely described the morphological changes in orientation of the cervical facet joints at the slipped level in the transverse plane.
由于涵盖大量颈椎滑脱患者的报告不足，目前对颈椎滑脱的特征尚未完全了解。本研究的目的是通过检查相对大量的病例来阐明颈椎滑脱的特征。
我们分析了在单一机构接受手术的731例患者中，根据X线或计算机断层扫描（CT）图像确定椎体滑脱超过2mm的101例病例。我们在侧位X线图像上考虑了C2 - 7角、活动范围和C2 - 7矢状垂直轴。从矢状面CT图像上，根据椎间盘和相邻尾侧节段进行了五级分类。我们使用轴向CT图像检查了滑脱节段小关节的方向。
在101例患者的124个节段发现了椎体滑脱。分别在68例和40例中检测到前滑脱和后滑脱。前滑脱主要发生在C3或C4，通常在与狭窄椎间盘相邻的节段，或在与僵硬胸椎相邻的C7。在前滑脱节段椎间盘高度相对保留。后滑脱主要发生在与晚期椎间骨关节炎相关的明显狭窄椎间盘节段。在下颈椎滑脱节段，轴向平面上小关节的方向倾向于后内侧。
颈椎退行性椎体滑脱分为两种类型。第一种也是更常见的滑脱发生在僵硬节段附近，这种类型中前滑脱常见。第二种也是较不常见的滑脱发生在逐渐退变的节段内，后滑脱突出。我们独特地描述了颈椎滑脱节段在横平面上小关节方向的形态学变化。
