Forbech Elmose Signe, Oesterheden Andersen Mikkel, Sigmundsson Freyr G, Yacat Carreon Leah
Center for Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej, Middelfart, Denmark.
Department of Orthopaedic surgery, Örebro University Hospital, Södra Grev Rosengatan, Örebro, Sweden.
Spine (Phila Pa 1976). 2022 Nov 1;47(21):1473-1482. doi: 10.1097/BRS.0000000000004437. Epub 2022 Jul 20.
Retrospective cohort study.
The aim was to investigate whether findings on magnetic resonance imaging (MRI) can be proxies (MRIPs) for segmental instability in patients with degenerative lumbar spinal stenosis (LSS) and/or degenerative spondylolisthesis (LDS) L4/L5.
LDS has a heterogeneous nature. Some patients have a dynamic component of segmental instability associated with LDS. Studies have shown that MRI can show signs of instability.
Patients with LSS or LDS at L4/L5 undergoing decompressive surgery±fusion from 2010 to 2017, with preoperative standing lateral spine radiographs and supine lumbar MRI and enrolled in Danish national spine surgical database, DaneSpine. Instability defined as slip of >3 mm on radiographs. Patients divided into two groups based upon presence of instability. Outcome measures: radiograph: sagittal slip (mm). MRIPs for instability: sagittal slip >3 mm, facet joint angle (°), facet joint effusion (mm), disk height index (%), and presence of vacuum phenomena. Optimal thresholds for MRIPs was determined by receiver operating characteristic (ROC) curves and area under the curve (AUC). Logistic regression to investigate association between instability and MRIPs.
Two hundred thirty-two patients: 47 stable group and 185 unstable group. The two groups were comparable with regard to baseline patient-reported outcome measures. Thresholds for MRIPs: bilateral facet joint angle ≥46°; bilateral facet effusion ≥1.5 mm and disk height index ≥13%. Logistic regression showed statistically significant association with MRIPs except vacuum phenomena, ROC curve AUC of 0.951. By absence of slip on MRI logistic regression showed statistically significant association between instability on radiograph and the remaining MRIPs, ROC curve AUC 0.757.
Presence of MRIPs for instability showed statistically significant association with instability and excellent ability to predict instability on standing radiograph in LSS and LDS patients. Even in the absence of slip on MRI the MRIPs had a good ability to discriminate presence of instability.
回顾性队列研究。
旨在调查磁共振成像（MRI）检查结果是否可作为退行性腰椎管狭窄症（LSS）和/或L4/L5退行性腰椎滑脱症（LDS）患者节段性不稳定的替代指标（MRIPs）。
LDS具有异质性。一些患者存在与LDS相关的节段性不稳定动态成分。研究表明，MRI可显示不稳定迹象。
2010年至2017年期间，L4/L5节段患有LSS或LDS且接受减压手术±融合术的患者，术前有站立位脊柱侧位X线片和仰卧位腰椎MRI，并纳入丹麦国家脊柱手术数据库DaneSpine。不稳定定义为X线片上滑移>3 mm。根据是否存在不稳定将患者分为两组。结局指标：X线片：矢状位滑移（mm）。不稳定的MRIPs：矢状位滑移>3 mm、小关节角度（°）、小关节积液（mm）、椎间盘高度指数（%）以及真空现象的存在情况。通过受试者工作特征（ROC）曲线和曲线下面积（AUC）确定MRIPs的最佳阈值。采用逻辑回归分析来研究不稳定与MRIPs之间的关联。
232例患者：47例为稳定组，185例为不稳定组。两组在基线患者报告的结局指标方面具有可比性。MRIPs的阈值：双侧小关节角度≥46°；双侧小关节积液≥1.5 mm且椎间盘高度指数≥13%。逻辑回归分析显示，除真空现象外，与MRIPs存在统计学显著关联，ROC曲线AUC为0.951。根据MRI上无滑移情况，逻辑回归分析显示，X线片上的不稳定与其余MRIPs之间存在统计学显著关联，ROC曲线AUC为0.757。
不稳定的MRIPs的存在与不稳定存在统计学显著关联，并且在预测LSS和LDS患者站立位X线片上的不稳定方面具有出色能力。即使在MRI上无滑移的情况下，MRIPs也具有很好的鉴别不稳定存在的能力。
