12. Lumbar spine instability in degenerative spondylolisthesis: The role of magnetic resonance imaging
Main Article Content
Abstract
The purpose of this study was to identify the factors suggesting segmental instability in patients with lumbar degenerative spondylolisthesis (LDS) on conventional magnetic resonance imaging (MRI). 101 patients (68 patients of the stable group (SG) and 33 patients of the unstable group (UG)) diagnosed with DS on X-ray and MRI from 01/2021 to 02/2022 were included in the study. The results showed that the most common level of LDS is at L4/L5 (60.39%). The mean value of facet joints fluid of the UG (2.15 ± 1.23mm) was greater than the SG (0.89 ± 1.11mm) with p < 0.01. The facet degeneration of UG (2.01 ± 0.43) was less than the SG (2.57 ± 0.76) with p < 0,05 (p = 0.047). There is no statistically significant difference in the mean disc height and disc degeneration between the two groups. Facet joint fluid on MRI may represent a useful predictor suggestiveof spinal instability in patients with LDS. Therefore, when there is identification of fluid signal in the facet joints on MRI, standing lateral flexion-extension radiographs should be performed. Patients with spondylolisthesis on X-ray should be performed lateral flexion-extension radiographs to assess spinal instability.
Article Details
Keywords
Degenerative spondylolisthesis, segmental instability, facet joint fluid, facet degeneration, standing lateral and flexion-extension films
References
2. Farfan HF and Gracovetsky S. The nature of instability. Spine 1984; 9(7): 714-719.
3. Kuhns Benjamin D, Kouk S, Buchanan C, et al. Sensitivity of magnetic resonance imaging in the diagnosis of mobile and nonmobile L4-L5 degenerative spondylolisthesis. Spine J. Sep 1 2015; 15(9): 1956-62.
4. Youp Cho, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). May-Aug 2017; 25(2): 1-5.
5. Boden SD and Wiesel SW. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine (Phila Pa 1976). 1990; 15(6): 571-576.
6. Hayes MA HT, Gruel CR, et al. Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine. 1989; 14(3): 327-331.
7. Knutsson F. The instability associated with disk degeneration in the lumbar spine. Acta Radiologica. 1944; 25(5-6): 593-609.
8. Farfan HF. The pathological anatomy of degenerative spondylolisthesis. A cadaver study. Spine (Phila Pa 1976). Sep-Oct 1980; 5(5): 412-8.
9. Pfirrmann CW MA, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001; 26: 1873-8.
10. Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol. Apr 1999; 28(4): 215-9.
11. Even JL, Chen, A. F., & Lee, J. Y. Imaging characteristics of “dynamic” versus “static” spondylolisthesis: analysis using magnetic resonance imaging and flexion/extension films. The Spine Journal, 2014, 14(9), 1965-1969.
12. Fujiwara A, Lim TH, An HS, et al. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine (Phila Pa 1976). Dec 1 2000; 25(23): 3036-44.
13. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clinical Orthop Relat Res 1982; 110-23.
14. Chaput C, Padon D, Rush J, Lenehan E, Rahm M. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine (Phila Pa 1976). Aug 1 2007; 32(17): 1883-7.