Lutschounig Marie-Christine, Sigmund Irene Katharina, Steiner Irene, Rienmüller Anna, Stihsen Christoph, Windhager Reinhard, Grohs Josef Georg
Department of Orthopedics, Medical University of Vienna, Vienna, Austria.
CeDAS, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria.
Global Spine J. 2025 Jun;15(5):2634-2644. doi: 10.1177/21925682241306025. Epub 2024 Dec 9.
Study DesignRetrospective radiological database analysis.ObjectiveThe aim of this study was to assess the value of functional radiography (FRF = flexion; FRE = extension) compared to MRI and standing sagittal plane full spine radiography (SP) with low-grade spondylolisthesis.MethodsSagittal translation (ST) and rotation (SR) were measured between all lumbar levels to assess instability. The differences for ST and SR of SP and FRE as well as MRI and FRF were calculated. In addition, the lumbar lordosis, the sacral slope, the pelvic tilt and the pelvic incidence were measured.ResultsRadiological datasets of 55 patients with 165 lumbar segments fulfilled inclusion criteria. Instability was diagnosed in 20 segments (12.1%) with SP/MRI compared to 14 segments (8.5%) using FRF/FRE with ST. SR functional radiographs showed instability in 41 segments (25%) and 23 segments (14%) using SP/MRI. The intraclass correlation coefficients (ICC) of ST between SP and FRE for L3/L4, L4/L5, and L5/S1 were 0.74, 0.84 and 0.97, respectively, indicating moderate to excellent agreement between imaging methods. For SP/FRE, the ICCs of the SR were 0.72, 0.61 and 0.64, respectively with moderate agreement. The ICCs of the ST for L3/4, L4/5, and L5/S1 showed moderate to good agreement between MRI and FRF with values of 0.52, 0.77, and 0.80, respectively. Regarding SR, poor agreement between MRI and FRF was observed. The ICCs for L3/4, L4/5, L5/S1 were 0.16, 0.23 and 0.23.ConclusionBased on our results, instability may also be diagnosed by calculating the difference in the ST in SP and MRI without additional functional radiographs. However, FRF showed translational instability more clearly than MRI in some patients and might still be an asset in borderline cases.
研究设计
回顾性放射学数据库分析。
目的
本研究的目的是评估与MRI和站立位矢状面全脊柱X线摄影（SP）相比，功能X线摄影（FRF = 前屈；FRE = 后伸）在低度腰椎滑脱中的价值。
方法
测量所有腰椎节段之间的矢状面平移（ST）和旋转（SR）以评估不稳定性。计算SP和FRE以及MRI和FRF的ST和SR差异。此外，测量腰椎前凸、骶骨倾斜度、骨盆倾斜度和骨盆入射角。
结果
55例患者的165个腰椎节段的放射学数据集符合纳入标准。使用SP/MRI诊断出20个节段（12.1%）存在不稳定，而使用FRF/FRE结合ST诊断出14个节段（8.5%）存在不稳定。对于SR，功能X线摄影显示41个节段（25%）存在不稳定，而使用SP/MRI显示23个节段（14%）存在不稳定。L3/L4、L4/L5和L5/S1节段SP与FRE之间ST的组内相关系数（ICC）分别为0.74、0.84和0.97，表明成像方法之间具有中度至高度一致性。对于SP/FRE，SR的ICC分别为0.72、0.61和0.64，一致性为中度。L3/4、L4/5和L5/S1节段MRI与FRF之间ST的ICC分别为0.52、0.77和0.80，显示出中度至良好的一致性。关于SR，MRI与FRF之间一致性较差。L3/4、L4/5、L5/S1的ICC分别为0.16, 0.23和0.23。
结论
基于我们的结果，无需额外的功能X线摄影，通过计算SP和MRI中ST的差异也可诊断不稳定性。然而，在一些患者中，FRF比MRI更清楚地显示平移性不稳定，在临界病例中可能仍然是一项有用的检查。
