A morphological characterization of the lumbar neural arch in females and males with degenerative spondylolisthesis.

BACKGROUND

Although Degenerative Spondylolisthesis (DS) is a common osseous dysfunction, very few studies have examined the bony morphology of lumbar the neural arch in the population afflicted with DS. Therefore, this study aimed to characterize the neural arch (NA) morphology along the entire lumbar spine in individuals with degenerative spondylolisthesis (DS) and compare them to healthy controls.

METHODS

One hundred CTs from a database of 500 lumbar CTs of spondylolisthesis were selected. We excluded vertebral fractures, non-L4-L5 slips, previous surgeries, vertebral spondyloarthropathies, and scoliosis. Scans were divided into a study group of 50 individuals with single-level DS (grades 1-2) at L4-5 (25 males and 25 females), and an age-sex matched control group of 50 individuals. Linear and angular measurements from all lumbar segments included: vertebral canals, intervertebral foramens, pedicles, and articular facets.

RESULTS

Compared with the controls, all individuals with DS had greater pedicle dimensions in the lower lumbar segments (∆ = 1 mm-2.14 mm) and shorter intervertebral foramens in all the lumbar segments (∆range:1.85 mm-3.94 mm). In DS females, the lower lumbar facets were mostly wider (∆ = 1.73-2.86 mm) and more sagittally-oriented (∆10°) than the controls. Greater prevalence of grade-3 facet arthrosis was found only in the DS population (DS = 40-90%,controls = 16.7-66.7%). In DS males, degenerated facets were observed along the entire lumbar spine (L1-S1), whereas, in DS females, the facets were observed mainly in the lower lumbar segments (L4-S1). Individuals with DS have shorter intervertebral foramens and greater pedicle dimensions compared with controls.

CONCLUSIONS

Females with DS have wider articular facets, more sagittally-oriented facets, and excessively degenerated facets than the controls. This unique NA shape may further clarify DS's pathophysiology and explain its greater prevalence in females compared to males.