Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis
- Author:
Tariq Z. ISSA
1
;
Yunsoo LEE
;
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
Author Information
- Publication Type:Clinical Study
- From:Asian Spine Journal 2023;17(4):721-728
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
