Abstract
BackgroundTo evaluate lumbar mobility in various positions using upright left and right bending radiographs in patients with degenerative lumbar spondylolisthesis (DLS), as well as to assess the impact of lateral instability on patient-reported outcomes.MethodsThis study retrospectively reviewed a consecutive series of patients with DLS between January 2019 and October 2020. The enrolled patients were divided into two groups: the lateral instability group (group L) and non-lateral instability group (group NL). Translational and angular motion in both sagittal and coronal planes and patient-reported outcomes were compared between the two groups.ResultsThere were 104 (59.8%) patients in group L and 70 (40.2%) patients in group NL, with an average age of 60.6 ± 7.8 years. Patients with a right bending posture in group L had a higher slip percentage (14.2 ± 7.4% vs 9.2 ± 3.2%, p = 0.01) and slip angle (6.3 ± 1.5° vs 2.2 ± 0.8°, p = 0.021). Compared with group NL, group L demonstrated significantly larger angular motion in the coronal plane (2.4 ± 1.3° vs 1.0 ± 0.7°, p = 0.008). Patients with lateral instability had worse preoperative back pain (6.1 ± 1.6 vs 2.7 ± 1.9, p = 0.01) and Oswestry Disability Index (ODI) scores (37.7 ± 5.5 vs 25.6 ± 2.6, p = 0.002). In terms of pain characteristics, group L was characterized by pain when getting out of a car, when rising from a chair, and when climbing stairs (all p values < 0.05).ConclusionLumbar lateral instability, that is, increased mobility in the coronal plane on lateral bending radiographs, translational and/or angular, correlates to more pronounced patient related symptoms in degenerative L4–5 spondylolisthesis. The existence of lumbar lateral instability leads to worse impacts on patient-reported outcomes when patients change their positions including getting out of a car, rising from a chair, and climbing stairs.
Highlights
To evaluate lumbar mobility in various positions using upright left and right bending radiographs in patients with degenerative lumbar spondylolisthesis (DLS), as well as to assess the impact of lateral instability on patient-reported outcomes
Degenerative lumbar spondylolisthesis (DLS) is a common pathological condition defined by anterior slippage of the upper vertebra in relation to lower vertebra occurring in the involved segment with intact neural arch, that appears frequently in the aging population at the Lumbar 4 (L4)/5 level [1, 2]
Patients enrolled in this study had to meet the following criteria, including above 50 years of age, with low back pain, one segment Lumbar 4/5 (L4/5) DLS only, and a complete set of radiological data with upright left and right bending (LRB) radiographs and flexion and extension (FE) radiographs
Summary
To evaluate lumbar mobility in various positions using upright left and right bending radiographs in patients with degenerative lumbar spondylolisthesis (DLS), as well as to assess the impact of lateral instability on patient-reported outcomes. Surgical methods are diverse, Wang et al BMC Musculoskeletal Disorders (2022) 23:59 including decompression alone or spinal decompression and fusion surgery, with or without interbody fusion [5]. Lumbar stability is the most important consideration when evaluating DLS. There are many methods to assess lumbar stability, including flexion-extension radiographs; computed tomography (CT), assessing facet joint effusion; and magnetic resonance imaging (MRI), evaluating disc degeneration [6,7,8]. It is worth noting that these theoretical foundations and evaluation methods concerning lumbar instability are absolutely based on the sagittal plane. The definition of lumbar instability was determined as sagittal translation > 3 mm and/or angulation > 8° [9]
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