The pedicle isthmus angle: a new imaging parameter for lumbar spondylolysis in young male patients
10.3760/cma.j.cn121113-20240512-00287
- VernacularTitle:青年男性腰椎峡部裂患者椎弓根-峡部角的影像学测量及意义
- Author:
Fuxin WANG
1
;
Kun WANG
;
Zheng ZHANG
;
Zhaohu MAO
;
Ruoxian SONG
Author Information
1. 解放军联勤保障部队第九六〇医院骨科，济南 250031
- Keywords:
Lumbar vertebrae;
Spondylolisthesis;
Anatomy;
Risk factors
- From:
Chinese Journal of Orthopaedics
2024;44(18):1207-1214
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To introduce a novel risk factor for lumbar spondylolysis, the pedicle isthmus angle (PIA), and to explore its underlying mechanism and clinical relevance.Methods:A retrospective analysis of CT imaging data from young male patients with lumbar spondylolysis, admitted to the 960th Hospital of the Joint Logistic Support Force of the PLA between January 2018 and August 2023, was conducted. The study included 119 cases of unilateral spondylolysis and 339 cases of bilateral spondylolysis, with a mean age of 22.8±3.4 years (range 18-30 years). A control group of 458 patients with normal lumbar CT scans, presenting with low back pain, was also analyzed. Their mean age was 22.9±3.5 years (range 18-30 years). The PIA of the left and right sides of the L 3, L 4, and L 5 vertebrae in both the spondylolysis and control groups were measured using CT imaging. Differences in PIA measurements between the left and right sides, as well as between groups, were compared. Binary logistic regression analysis identified risk factors for lumbar spondylolysis. The receiver operating characteristic (ROC) curve and Youden index were used to determine the critical risk threshold for lumbar spondylolysis. Results:No significant differences were found between the spondylolysis and control groups in terms of gender, age, height, weight, or body mass index (BMI) ( P>0.05). Similarly, there was no significant difference in the left and right PIA measurements for the L 3, L 4, and L 5 vertebrae in either group ( P>0.05). The PIA of the L 3 and L 4 vertebrae was not significantly different between the groups (107.2°±3.5° vs. 107.1°±3.5°, t=0.270, P=0.787; 110.6°±3.5° vs. 110.5°±4.0°, t=0.441, P=0.659). However, the PIA of the L 5 vertebra was significantly larger in the spondylolysis group (117.7°±4.7°) compared to the control group (114.0°±4.9°) ( t=11.654, P<0.001). Logistic regression analysis identified an increased PIA at L 5 ( β=0.159, OR=1.172, P<0.001) as a risk factor for lumbar spondylolysis. According to the ROC curve and Youden index, the risk of lumbar spondylolysis increased substantially when the L 5 PIA exceeded 115.8°. The area under the curve (AUC) was 0.709, with a sensitivity of 0.670 and a specificity of 0.644. Conclusion:PIA is an objective and effective imaging parameter for predicting lumbar spondylolysis. It aids in understanding the pathophysiology of spondylolysis, identifying high-risk individuals, and informing prevention and treatment strategies for lumbar spondylolysis.
