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KMID : 1189320230170040721
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Asian Spine Journal
2023 Volume.17 No. 4 p.721 ~ p.728
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Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis
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Tariq Z. Issa
Lee Yun-Soo
Emily Berthiaume
Mark J. Lambrechts
Caroline Zaworski
Qudratallah S. Qadiri
Henley Spracklen
Richard Padovano
Jackson Weber
John J. Mangan
Jose A. Canseco
Barrett I. Woods
I. David Kaye
Alan S. Hilibrand
Christopher K. Kepler
Alexander R. Vaccaro
Gregory D. Schroeder
Joseph K. Lee
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Abstract
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Study Design : Retrospective cohort study.
Purpose : Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection.
Overview of Literature : 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.
Methods : 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.
Results : 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).
Conclusions : 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.
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KEYWORD
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Lumbar spine, Spondylolisthesis, Radiography, Seated lateral, Flexion-extension
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FullTexts / Linksout information
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Listed journal information
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