Spine Labs, St George and Sutherland Clinical School, University of New South Wales, 10 South Street, Kogarah, New South Wales, Australia.
Spine Labs, St George and Sutherland Clinical School, University of New South Wales, 10 South Street, Kogarah, New South Wales, Australia; Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Xicheng District, Beijing, China.
Spine J. 2024 Aug;24(8):1431-1442. doi: 10.1016/j.spinee.2024.03.010. Epub 2024 Mar 16.
Isthmic spondylolisthesis (IS) is defined as the anterior translation of one lumbar vertebra relative to the next caudal segment as a result of a unilateral or bilateral fracture of the pars interarticularis. These fractures are interchangeably known as "pars defects" or "spondylolysis." Many risk factors have been proposed to explain the progression of a spondylolytic defect to IS, however, none are validated.
This systematic review provides an overview of various radiological and imaging parameters that can help predict the risk of progression of a spondylolytic defect into IS.
Systematic review.
Medline, Embase and Cochrane online database were searched. The various correlations between imaging features with observed spondylolisthesis prevalence or severity or spondylolysis rates of spondylolisthesis were evaluated to provide a list of imaging risk factors to predict IS. Significance of the correlations in the original article was recorded to enable comparison of the collected evidence of separate image features.
All searches combined generated a total of 431 results of which 26 articles were included into this study. Of the 22 potential risk factors identified, 5 were found to be statistically insignificant, 8 were found to be significant and 9 had mixed results. The following features were found to be significant risk factors in at least on study: disc degeneration, transverse process width, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lumbar index, thoracic kyphosis, facet joint angle above the level of defect, facet joint degeneration, facet tropism, multifidus size, lateral erector spinae size, mesenteric fat thickness, subcutaneous fat thickness and soft tissue calcification.
Our research suggests that only disc degeneration had moderately strong evidence with consistent significant associations with development of IS in patients with spondylolysis. Transverse process width, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lumbar index, thoracic kyphosis, facet joint angle above the level of defect, facet joint degeneration, facet tropism, multifidus size, lateral erector spinae size, mesenteric fat thickness, subcutaneous fat thickness and soft tissue calcification had some evidence. All other radiological factors had weak evidence. The results of this study can be used to improve early clinical decision making for patients with spondylolysis.
峡部裂性脊柱滑脱（IS）定义为由于单侧或双侧关节突间部骨折，一个腰椎相对于下位腰椎向前移位。这些骨折也被称为“关节突部缺损”或“脊柱裂”。已经提出了许多危险因素来解释脊柱裂缺损进展为 IS，但没有一个是经过验证的。
本系统评价综述了各种影像学参数，这些参数可以帮助预测脊柱裂缺损进展为 IS 的风险。
系统评价。
检索了 Medline、Embase 和 Cochrane 在线数据库。评估了影像学特征与观察到的脊柱滑脱患病率或严重程度或脊柱滑脱率之间的各种相关性，以提供一组预测 IS 的影像学危险因素列表。记录了原始文章中相关性的显著性，以便比较单独影像学特征的证据收集。
所有搜索合并共产生了 431 项结果，其中 26 项研究被纳入本研究。在确定的 22 个潜在危险因素中，有 5 个被认为无统计学意义，8 个被认为有统计学意义，9 个结果不一致。以下特征在至少一项研究中被认为是显著的危险因素：椎间盘退变、横突宽度、骨盆入射角、骨盆倾斜度、骶骨倾斜度、腰椎前凸角、腰椎指数、胸椎后凸角、缺陷上方关节突关节角度、关节突关节退变、关节突关节倾斜、多裂肌大小、竖脊肌外侧大小、肠系膜脂肪厚度、皮下脂肪厚度和软组织钙化。
我们的研究表明，只有椎间盘退变具有中度强证据，与脊柱裂患者发生 IS 有一致的显著相关性。横突宽度、骨盆入射角、骨盆倾斜度、骶骨倾斜度、腰椎前凸角、腰椎指数、胸椎后凸角、缺陷上方关节突关节角度、关节突关节退变、关节突关节倾斜、多裂肌大小、竖脊肌外侧大小、肠系膜脂肪厚度、皮下脂肪厚度和软组织钙化有一定的证据。所有其他影像学因素的证据较弱。本研究的结果可用于改善脊柱裂患者的早期临床决策。
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