OBJECTIVESTo investigate clinical appearance and radiological characteristics of high grade developmental spondylolisthesis and their significance.

METHODSIn a retrospective study, a group of 6 female patients, who were diagnosed as high grade developmental spondylolisthesis and treated in Peking University third hospital from March 2007 to December 2008 were included. Clinical and radiological characteristics of the 6 patients were investigated and the following parameters were measured on standing lateral X-ray: PI (pelvic incidence), SK (sacral kyphosis) and LL (Lumbar lordosis). A series of 44 patients who came to out-patient department due to LBP and had no positive findings on lateral lumbar X-ray were selected as the control group. The four parameters were compared between study group and control group. Clinical meanings of significant difference were discussed.

RESULTSClinical findings of high grade developmental spondylolisthesis included bending of knees, deformity of trunk and sciatica. Radiological appearances were characterized with kyphosis of lumbo-sacral joint, retroverted pelvis and domed sacrum. Spondylolisthesis patients has an average PI of (52 +/- 7) degrees which was significant higher than the control group [(43 +/- 8) degrees ] (P < 0.01). LL of study group [(51 +/- 10) degrees ] was higher than that of the control group [(18 +/- 9) degrees ] (P < 0.01) and SK of the study group [(12 +/- 11) degrees ] were lower than that of the control group [(21 +/- 10) degrees ] (P < 0.05).

CONCLUSIONSCharacteristics of clinical findings of spondylolisthesis patients have obvious cosmetic appearance, significant pain and lower neurological deficits. Radiological characteristics display deformity of lumbo-sacral joint. PI, LL and SK are significant parameters for high grade spondylolisthesis.

Bone Diseases, Developmental ; complications ; diagnostic imaging ; Child ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; Radiography ; Retrospective Studies ; Spondylolisthesis ; diagnostic imaging ; etiology

OBJECTIVE: To explore the relationship between lumbar degenerative spondylolisthesis and T2WI high signal in the interspinous ligament in MRI in order to improve the understanding of the signal changes of the interspinous ligament. METHODS: The clinical data of 43 patients with clinically diagnosed lumbar degenerative spondylolisthesis were collected from March 2018 to March 2020, there were 19 males and 24 females, aged 50 to 92 years with an average of 69 years old. Using picture archiving and communication systems (PACS) to access images and record the distribution and incidence of T2WI high signal in the interspinous ligament between the slipped and non-slipped segments. Using Spearman correlation analysis to explore the relationshipbetween the T2WI high signal of the interspinous ligament and the degree of lumbar spondylolisthesis. RESULTS: Except for 8 ligaments that were not included in the statistical results due to poor image quality, 43 patients with a total of 207 lumbar vertebrae and interspinous ligaments were included in the study. According to the Meyerding classification method, 43 patients had a total of 48 segments with spondylolisthesis, 41 segments in grade Ⅰ and 7 segments in grade Ⅱ. There were 30 cases of MRI T2WI high signal in the interspinous ligament corresponding to spondylolisthesis segment, including 3 cases on L CONCLUSION In patients with degenerative lumbar spondylolisthesis, the MRI T2WI hyperintensity is more common in the interspinous ligament. The occurrence of T2WI high signal is positively correlated with the degree of spondylolisthesis, which should be payed enough attention in imaging diagnosis.
Aged ; Aged, 80 and over ; Female ; Humans ; Ligaments, Articular ; Lumbar Vertebrae/diagnostic imaging* ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spondylolisthesis/diagnostic imaging*

OBJECTIVETo investigate the relationship between lumbosacral transitional vertebra and the lumbar disc herniation (LDH).

METHODSThe X-ray photographs of lumbar vertebra were retrospectively studied of patients with and without LDH confirmed by surgery, furthermore, the differential incidence of LDH between the two groups and the relationship between transitional vertebra and the position of disc herniation were statistically analyzed.

RESULTSThe incidence of lumbosacral transitional vertebra was 18.3% in the control group, 52.7% in the LDH group, the difference was statistically significant. In the group with single lumbosacral transitional vertebra, there was 75.9% of LDH occurred on the same side of the transitional vertebra, 81.8% of which occurred at the upper one disc of the transitional vertebra; whereas 17.2% of LDH on the opposite side of the transitional vertebra, 80.0% of which occurred at the lower one disc of the transitional vertebra.

CONCLUSIONSThere is a closer relationship between lumbosacral transitional vertebra and the LDH, and the lumbosacral transitional vertebra is one of the important factors in the emergence of LDH.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Humans ; Intervertebral Disc Displacement ; etiology ; Lumbar Vertebrae ; diagnostic imaging ; Male ; Middle Aged ; Radiography ; Sacrum ; diagnostic imaging ; Spondylolisthesis ; complications

Humans ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Postoperative Complications ; etiology ; Soft Tissue Injuries ; etiology ; Spondylolisthesis ; complications ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the value of pedicle parameter obtained by the reformation images on multi-slice spiral CT (MSCT) in the surgical treatment of lumbar spondylolisthesis.

METHODSFrom January 2009 to March 2010, 60 patients with lumbar spondylolisthesis failing in conservative treatment were enrolled into the study and divided into experimental and control group randomly (each group with 30 patients). There were 26 males and 34 females ranging in age from 18 to 59 years with an average of (42.60 +/- 9.36) years. The experimental group was examined with volumetric scanning on MSCT before operation. Reformation such as multiplanar reconstruction (MPR) and volume rendering (VR) were carried out at the work station. Transverse section angle (TSA), sagittal section angle (SSA), pedicle length (PL), pedicle width (PW) and pedicle height (PH) were measured on different images and pedicle screws were implanted according pedicle parameter. In control group, the pedicle screws were implanted according to conventional anatomic landmark. Preparative time of screw canal and accuracy of screw were compared between two groups.

RESULTSA hundred fifty-six screws were inserted in experiment group,143 screws were excellent, 11 good, and 2 poor. A hundred fifty screws were inserted in control group, 101 screws were excellent, 26 good, and 23 poor. There was significant difference in accuracy of screw between two groups (P < 0.001). The preparative time of screw canal in experiment group was (66.20 +/- 7.31) s, and was shorter than that of control group [(104.11 +/- 9.51) s, P < 0.001)].

CONCLUSIONAbundant information and parameter could be obtained with the MSCT reconstruction images. The images and parameters could make a perfect operative strategy before operation, adjust the direction of pedicle screws during operation, avoid and decrease operative complications effectively.

Adolescent ; Adult ; Bone Screws ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Spondylolisthesis ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; methods

High-grade spondylolisthesis is very rare. We came across a case of high-grade spondylolisthesis at the L5-S1 level in a 32-year-old manual labourer who was hit by a heavy object on his flexed back. The patient presented to us with persistent deformity in the back. He complained of back pain on prolonged standing and after moderate work. Because of that he was unable to return to his work. On clinical examination there was a large step in the lower lumbar region. Detailed neurological evaluation of the lower limbs did not reveal any sensory or motor deficit, neither did bowel or bladder involvement. Radiographic examination showed L5 over S1 traumatic spondyloptosis. CT scan revealed that neural canal was in normal width. MRI confirmed spondyloptosis of L5 over S1 without any compromise of the spinal canal and with normal-looking cauda. Concerning the delayed presentation and no neurological deficit, the patient was managed conservatively after thorough counsel. At 6 months, the patient returned to his work and at the latest follow-up (15 months) he was free from back pain. Conservative means of treatment can lead to satisfactory outcome, especially when the patient has delayed presentation.
Accidents, Occupational ; Adult ; Back Pain ; etiology ; Braces ; Humans ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Sacrum ; Spondylolisthesis ; complications ; diagnostic imaging ; etiology ; therapy ; Tomography, X-Ray Computed

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Recovery of Function ; Spondylolisthesis ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo investigate the relationship between radiographic parameters and the 4th lumbar(L4) degenerative spondylolisthesis.

METHODSFrom April 2010 to April 2012, 60 patients with the L 4 degenerative spondylolisthesis (DLS) were enrolled in DLS group, 56 healthy volunteers were recruited in control group. A series of radiographic parameters were measured in the two groups, including disc height (DH), disc degeneration index(DDI), L4 vertebral inclination angle(L4-VA), pelvic incidence (PI), L4 vertebral size (L4-VS), lumbar lordosis angle (LLA), facet joint angulation (FJA) of cephalad and caudad portions, delta FJA of cephlad and caudad portions, asymmetry variation of FJA, bone mineral density(BMD). Student's test was used to compare difference of parameters between two groups. Multivariate logistic regression analysis was used to reveal risk factors of the development of DLS.

RESULTSFifty-three cases of L4 spondylolisthesis in DLS group were classified into grade I, 7 cases of L4 spondylolisthesis were classified into grade II. The average Boxall index was 0.17 ± 0.05. There were significant difference of DH, DDI, L4-VS, L4-VA, LLA, PI, FJA, BMD between DLS group and control group (t = 2.28-9.33, P = 0.021-0.043) . There were significant differences of delta FJA of cephlad and caudad portions in L3-4, L4-5 between DLS group and control group (t = 3.398 and 28.122, P = 0.000 and 0.039). There was no significant difference of asymmetry variation of FJA in L3-4, L4-5 between DLS group and control group (t = 0.209-0.465, P = 0.295-0.858). Multivariate logistic regression analysis showed that LDS was more frequent among patients with smaller L4-VS(OR = 1.01, 95%CI = 1.000-1.024, P = 0.048), larger L4-VA (OR = 1.88, 95%CI = 14.000-14.600, P = 0.037), larger LLA (OR = 1.90, 95%CI = 1.600-15.800, P = 0.040), larger PI (OR = 2.58, 95%CI = 18.000-19.600, P = 0.029) and the more sagittal FJA (OR = 2.46, 95%CI = 1.400-16.400, P = 0.035) than those in control group.

CONCLUSIONSDLS is signifantly correlated with L4-VS, L4-VA, LLA, PI, FJA . They may be risk factors of the development of DLS.

Aged ; Bone Density ; Case-Control Studies ; Female ; Humans ; Intervertebral Disc Degeneration ; diagnosis ; Lumbar Vertebrae ; diagnostic imaging ; Male ; Middle Aged ; Radiography ; Risk Factors ; Spondylolisthesis ; diagnosis

BACKGROUNDThe treatment of high-grade developmental spondylolisthesis (HGDS) is still challenging and controversial. In this study, we investigated the efficacy of the posterior reduction and monosegmental fusion assisted by intraoperative three-dimensional (3D) navigation system in managing the HGDS.

METHODSThirteen consecutive HGDS patients were treated with posterior decompression, reduction and monosegmental fusion of L5/S1, assisted by intraoperative 3D navigation system. The clinical and radiographic outcomes were evaluated, with a minimum follow-up of 2 years. The differences between the pre- and post-operative measures were statistically analyzed using a two-tailed, paired t-test.

RESULTSAt most recent follow-up, 12 patients were pain-free. Only 1 patient had moderate pain. There were no permanent neurological complications or pseudarthrosis. The magnetic resonance imaging showed that there was no obvious disc degeneration in the adjacent segment. All radiographic parameters were improved. Mean slippage improved from 63.2% before surgery to 12.2% after surgery and 11.0% at latest follow-up. Lumbar lordosis changed from preoperative 34.9 ± 13.3° to postoperative 50.4 ± 9.9°, and 49.3 ± 7.8° at last follow-up. L5 incidence improved from 71.0 ± 11.3° to 54.0 ± 11.9° and did not change significantly at the last follow-up 53.1 ± 15.4°. While pelvic incidence remained unchanged, sacral slip significantly decreased from preoperative 32.7 ± 12.5° to postoperative 42.6 ± 9.8°and remained constant to the last follow-up 44.4 ± 6.9°. Pelvic tilt significantly decreased from 38.4 ± 12.5° to 30.9 ± 8.1° and remained unchanged at the last follow-up 28.1 ± 11.2°.

CONCLUSIONSPosterior reduction and monosegmental fusion of L5/S1 assisted by intraoperative 3D navigation are an effective technique for managing high-grade dysplastic spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal balance can be achieved.

Adolescent ; Adult ; Child ; Child, Preschool ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Radiography ; Spinal Fusion ; methods ; Spondylolisthesis ; diagnostic imaging ; surgery ; Young Adult

OBJECTIVESTo find out the radiologic factors predicting the outcomes of reduction of lumbar spondylolisthesis.

METHODSForty two patients were treated with pedicle screw fixation with posterolateral fusion because of lumbar spondylolisthesis, with the average age of 56.0 years. There were 11 males and 31 females; 20 degenerative spondylolisthesis cases, and 22 isthmic spondylolisthesis cases; 1 L(3,4) case, 26 L(4,5) cases and 25 L(5)S(1) cases; 23 grade I patients and 19 grade II ones. All patients were taken the X-ray examination before operation and one week after operation. Measurements of slip ratio, percentage disc height, slip angle, lumbar lordosis angle and sacral slope angle were based on pre-operation X-rays. Measurements of the post-operation slip ratio were based on post-operation X-rays. Multivariate regression analysis was used to analysis the correlation between reduction ratio and pre-operation slip ratio, slip angle, percentage of disc height, lumbar lordosis angle and sacral slope angle.

RESULTSThe average pre-operation slip ratio was (22.5 +/- 10.6)%. The pre-operation percentage disc height was 0.23 +/- 0.10, the slip angle was 4.4 degrees +/- 5.4 degrees , the lumbar lordosis angle was 43 degrees +/- 13 degrees and the sacral slope angle was 34 degrees +/- 10 degrees . The reduction ratio was (63.2 +/- 27.9)%. No correlation was found among reduction ratio with pre-operation slip ratio, slip angle and sacral slope angle, but a positive correlation between reduction ratio and the pre-operation percentage of disc height (P < 0.05), a positive correlation between reduction ratio and the pre-operation lumbar lordosis angle (P < 0.05) was found.

CONCLUSIONThe percentage disc height and the lumbar lordosis angle can predict the outcomes of reduction of lumbar spondylolisthesis.

Adult ; Aged ; Bone Screws ; Female ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; Male ; Middle Aged ; Multivariate Analysis ; Radiography ; Regression Analysis ; Spinal Fusion ; Spondylolisthesis ; diagnostic imaging ; surgery ; Treatment Outcome