Issa Tariq Z, Lee Yunsoo, Berthiaume Emily, Lambrechts Mark J, Zaworski Caroline, Qadiri Qudratallah S, Spracklen Henley, Padovano Richard, Weber Jackson, Mangan John J, Canseco Jose A, Woods Barrett I, Kaye I David, Hilibrand Alan S, Kepler Christopher K, Vaccaro Alexander R, Schroeder Gregory D, Lee Joseph K
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Asian Spine J. 2023 Aug;17(4):721-728. doi: 10.31616/asj.2022.0443. Epub 2023 Jul 6.
Retrospective cohort study.
Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection.
The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography.
We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of >10° or >8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities.
A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p <0.001). Standing flexion and lateral radiographs when seated produced more kyphosis (4.66° and 4.97°, respectively) than neutral upright and MRI (7.19° and 7.20°, p <0.001). Seated lateral performed similarly to standing flexion in detecting all measurement parameters and categorizing DS (all p >0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p =0.041; and 28.1% vs. 14.6%, p =0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p >0.20).
Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph.
回顾性队列研究。
我们的目标是确定哪些影像学图像对于退行性椎体滑脱（DS）的分类和不稳定检测最为关键。
DS的异质性需要多个影像学视角来评估椎体移位、椎间隙、滑脱角和不稳定情况。然而，常用的影像学视角，如屈伸位和站立位X线摄影，存在一些限制。
我们对2021年1月至2022年5月期间由一位脊柱外科医生确诊为椎体滑脱的患者的基线中立位站立、站立位屈曲、坐位侧位X线片以及磁共振成像（MRI）进行了评估。DS采用迈耶丁分类法以及临床和影像学退行性椎体滑脱分类法进行分类。分别以不同视角间相差>10°或>8%来界定角度和移位不稳定。采用方差分析和配对卡方检验来比较不同检查方式。
共纳入136例患者。坐位侧位和站立位屈曲X线片显示的最大滑脱百分比（分别为16.0%和16.7%），而MRI显示的最低（12.2%，p<0.001）。坐位时的站立位屈曲和侧位X线片产生的后凸比中立位站立和MRI更多（分别为4.66°和4.97°）（中立位站立和MRI为7.19°和7.20°，p<0.001）。坐位侧位在检测所有测量参数和对DS进行分类方面与站立位屈曲表现相似（所有p>0.05）。与中立位站立相比，坐位侧位或站立位屈曲时移位不稳定更为常见（分别为31.5%对20.2%，p =0.041；以及28.1%对14.6%，p =0.014）。坐位侧位和站立位屈曲在不稳定检测方面无差异（所有p>0.20）。
坐位侧位X线片是站立位屈曲X线片的合适替代方法。直立位拍摄的片子在DS检测方面并未提供更多信息。检测不稳定可使用术前常进行的MRI并结合一张坐位侧位X线片，而非站立位屈伸位X线片。
