Lumbar degenerative spondylolisthesis (LDS) is common and has generally been characterized as a homogeneous disease entity in the literature and in clinical practice. Because disease variability has not been carefully characterized, stratification of treatment recommendations based on scientific evidence is currently lacking. In this study, the authors analyzed radiographic parameters of patients with LDS at the L4–5 level to better characterize this entity.
Demographic data were collected from 304 patients (200 women and 104 men) with LDS at the L4–5 level. Plain radiographs including anteroposterior, lateral, and flexion-extension lateral radiographs were analyzed for disc height, segmental angulation, segmental translation, and osteophyte formation. Correlations were sought between the variables of age, sex, disc height, segmental angulation, segmental translation, and osteophyte formation.
The mean patient age was 63.8 years (range 40–86 years). The mean mid-disc height was 7 mm (range 0–14 mm) on the neutral lateral view. The mean angulation between the superior endplate of L-5 and the inferior endplate of L-4 was 6° of lordosis (range 13° of kyphosis to 23° lordosis) on the neutral lateral view. The mean angular change between flexion and extension lateral radiographs was 5° (range 0°–17°). The mean translation on the neutral lateral view was 6 mm (range 0–15 mm). The mean change in translational between flexion and extension was 2 mm (range 0–11 mm). Twenty patients (7%) exhibited spondylolisthesis only on the flexion view. A significant positive correlation was found between the change in angulation and the change in translation on flexion and extension views (ρ = 0.18, p = 0.001). No significant correlation was found between anterior osteophyte size and mobility with flexion-extension radiographs.
The wide range in all radiographic parameters for LDS confirms the heterogeneous nature of this condition and suggests that a grading system to subclassify LDS may be clinically useful. On flexion and extension radiographs, increased translational motion correlated with increased angular motion. Anterior osteophyte size was not found to be predictive of segmental stability. This data set should prove beneficial to those seeking to subcategorize LDS in the future.
Abbreviations used in this paper: LDS = lumbar degenerative spondylolisthesis; PACS = Picture Archiving and Communications System.
Address correspondence to: D. Greg Anderson, M.D., Department of Orthopaedic Surgery, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, Pennsylvania 19107. email: email@example.com.
Please include this information when citing this paper: published online November 25, 2011; DOI: 10.3171/2011.10.SPINE11140.
de SchepperEIDamenJvan MeursJBGinaiAZPophamMHofmanA: The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine (Phila Pa 1976)35:531–5362010
HerkowitzHNKurzLT: Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am73:802–8081991
KalichmanLKimDHLiLGuermaziABerkinVHunterDJ: Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976)34:199–2052009
KawakamiMTamakiTAndoMYamadaHHashizumeHYoshidaM: Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976)27:59–642002
LeeSHLeeJHHongSWChungSEYooSHLeeHY: Spinopelvic alignment after interspinous soft stabilization with a tension band system in grade 1 degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976)35:E691–E7012010
WilkeHJRohlmannFNeidlinger-WilkeCWernerKClaesLKettlerA: Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine. Eur Spine J15:720–7302006