Abstract
Objective
Although some studies have reported on the kinematics of the lumbar segments with degenerative spondylolisthesis (DS), few data have been reported on the in vivo 6 degree-of-freedom kinematics of different anatomical structures of the diseased levels under physiological loading conditions. This research is to study the in vivo motion characteristics of the lumbar vertebral segments with L4 DS during weight-bearing activities.
Methods
Nine asymptomatic volunteers (mean age 54.4) and 9 patients with L4 DS (mean age 73.4) were included. Vertebral kinematics was obtained using a combined MRI/CT and dual fluoroscopic imaging technique. During functional postures (supine, standing upright, flexion, and extension), disc heights, vertebral motion patterns and instability were compared between the two groups.
Results
Although anterior disc heights were smaller in the DS group than in the normal group, the differences were only significant at standing upright. Posterior disc heights were significantly smaller in DS group than in the normal group under all postures. Different vertebral motion patterns were observed in the DS group, especially in the left–right and cranial–caudal directions during flexion and extension of the body. However, the range of motions of the both groups were much less than the reported criteria of lumbar spinal instability.
Conclusion
The study showed that lumbar vertebra with DS has disordered motion patterns. DS did not necessary result in vertebral instability. A restabilization process may have occurred and surgical treatment should be planned accordingly.
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References
Iguchi T, Wakami T, Kurihara A et al (2002) Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech 15:93–99
Sengupta DK, Herkowitz HN (2005) Degenerative spondylolisthesis: review of current trends and controversies. Spine 15:S71–S81
Berlemann U, Jeszenszky DJ, Bühler DW et al (1999) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord 12:68–73
Nagaosa Y, Kikuchi S, Hasue M et al (1998) Pathoanatomic mechanisms of degenerative spondylolisthesis. A radiographic study. Spine 23:1447–1451
Kalichman L, Hunter DJ, Kim DH et al (2009) Association between disc degeneration and degenerative spondylolisthesis? Pilot study. J Back Musculoskelet Rehabil 22:21–25
Varlotta GP, Lefkowitz TR, Schweitzer M et al (2011) The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol 40:13–23
Chen IR, Wei TS (2009) Disc height and lumbar index as independent predictors of degenerative spondylolisthesis in middle-aged women with low back pain. Spine 34:1402–1409
Luk KD, Chow DH, Holmes A (2003) Vertical instability in spondylolisthesis: a traction radiographic assessment technique and the principle of management. Spine 28:819–827
Hong SW, Lee HY, Kim KH et al (2010) Interspinous ligamentoplasty in the treatment of degenerative spondylolisthesis: midterm clinical results. J Neurosurg Spine 13:27–35
Cho BY, Murovic JA, Park J (2009) Imaging correlation of the degree of degenerative L4–5 spondylolisthesis with the corresponding amount of facet fluid. J Neurosurg Spine 11:614–619
Pearcy M, Shepherd J (1985) Is there instability in spondylolisthesis? Spine 10:175–177
Takayanagi K, Takahashi K, Yamagata M et al (2001) Using cineradiography for continuous dynamic-motion analysis of the lumbar spine. Spine 26:1858–1865
Okawa A, Shinomiya K, Komori H et al (1998) Dynamic motion study of the whole lumbar spine by videofluoroscopy. Spine 23:1743–1749
McGregor AH, Anderton L, Gedroyc WM et al (2002) The use of interventional open MRI to assess the kinematics of the lumbar spine in patients with spondylolisthesis. Spine 27:1582–1586
Huang KY, Lin RM, Lee YL et al (2009) Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4–5: evaluation with axially loaded MRI. Eur Spine J 18:1851–1857
Li G, Wang S, Passias P et al (2009) Segmental in vivo vertebral motion during functional human lumbar spine activities. Eur Spine J 18:1013–1021
Xia Q, Wang S, Kozanek M et al (2010) In vivo motion characteristics of lumbar vertebrae in sagittal and transverse planes. J Biomech 43:1905–1909
Wang S, Passias P, Li G, Wood K (2008) Measurement of vertebral kinematics using noninvasive image matching method-validation and application. Spine 33:E355–E361
Pfirrmann CW, Metzdorf A, Elfering A et al (2006) Effect of aging and degeneration on disc volume and shape: a quantitative study in asymptomatic volunteers. J Orthop Res 24:1086–1094
Vogt MT, Rubin DA, Palermo L et al (2003) Lumbar spine listhesis in older African American women. Spine J 3:255–261
Bolesta MJ, Bohlman HH (1989) Degenerative spondylolisthesis. Instr Course Lect 38:157–165
Fujiwara A, Tamai K, An HS et al (2000) The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord 13:444–450
Chagnon A, Aubin CE, Villemure I (2010) Biomechanical influence of disk properties on the load transfer of healthy and degenerated disks using a poroelastic finite element model. J Biomech Eng 132:111006
Dai L, Jia L (1996) Role of facet asymmetry in lumbar spine disorders. Acta Orthop Belg 62:90–93
Toyone T, Ozawa T, Kamikawa K et al (2009) Facet joint orientation difference between cephalad and caudad portions: a possible cause of degenerative spondylolisthesis. Spine 34:2259–2262
Ramsbacher J, Theallier-Janko A, Stoltenburg-Didinger G et al (2001) Ultrastructural changes in paravertebral muscles associated with degenerative spondylolisthesis. Spine 26:2180–2185
Alqarni AM, Schneiders AG, Hendrick PA (2011) Clinical tests to diagnose lumbar segmental instability: a systematic review. J Orthop Sports Phys Ther 41:130–140
Hasegewa K, Kitahara K, Hara T, Takano K, Shimoda H (2009) Biomechanical evaluation of segmental instability in degenerative lumbar spondylolisthesis. Eur Spine J 18(4):465–470
Kirkaldy-Willis WH, Farfan HF (1982) Instability of the lumbar spine. Clin Orthop Relat Res 165:110–123
Nizard RS, Wybier M, Laredo JD (2001) Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am 39:55–71 (v–vi)
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This study was supported by NIH (R21AR057989) and China scholarship council.
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Miao, J., Wang, S., Wan, Z. et al. Motion characteristics of the vertebral segments with lumbar degenerative spondylolisthesis in elderly patients. Eur Spine J 22, 425–431 (2013). https://doi.org/10.1007/s00586-012-2428-3
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DOI: https://doi.org/10.1007/s00586-012-2428-3