Abstract
BackgroundThis study was conducted to compare differences in imaging features and clinical symptoms between patients with single-level isthmic spondylolisthesis (IS) at L4 and at L5 and to investigate the correlation between imaging and clinical parameters.MethodsThis cross-sectional study evaluated patients with single-level IS who were enrolled between June 2011 and June 2018. A total of 139 patients, 44 in the L4 IS group and 95 in the L5 IS group, met the study criteria and were included. Imaging and clinical parameters obtained from the two groups were compared and analyzed.ResultsPatients in the L4 IS group had smaller lower lumbar lordosis (LLL) (27.1 ± 8.2 vs. 30.9 ± 9.3, P = 0.021) and were of older age (58.5 ± 8.7 vs. 52.8 ± 10.1, P < 0.01) than those in the L5 IS group. As per the Roussouly classification system, most patients with L4 IS were classified as Type 2 (43.2%), whereas most patients with L5 IS fell under Type 3 (44.2%). In the L5 IS group, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and L5 incidence (L5I) were positively associated with slippage rate (SR), but the lumbosacral angle (LSA) was negatively associated with SR (P < 0.01). In the L4 IS group, only L5I showed a positive association with SR (P < 0.01). More significant associations were found among sagittal lumbo-pelvic parameters in the L5 IS group, but none were found between SR and Oswestry Disability Index (ODI) in either group.ConclusionsWhen compared with patients with L5 IS, patients with L4 IS were of older age and had straighter low lumbar curvature when they were obviously symptomatic. PI was an important parameter for patients with L5 IS while for those with L4 IS, L5I deserved more attention for its significantly positive correlation with the degree of slippage.
Highlights
This study was conducted to compare differences in imaging features and clinical symptoms between patients with single-level isthmic spondylolisthesis (IS) at L4 and at L5 and to investigate the correlation between imaging and clinical parameters
Patients This study was retrospectively conducted on patients who were hospitalized for L4 or L5 IS between June 2011 and June 2018
There was no difference between the two groups in terms of pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), L5 incidence (L5I), LSK, slippage rate (SR), and disc degeneration grade (DDG)
Summary
This study was conducted to compare differences in imaging features and clinical symptoms between patients with single-level isthmic spondylolisthesis (IS) at L4 and at L5 and to investigate the correlation between imaging and clinical parameters. Isthmic spondylolisthesis (IS), a complication of spondylolysis, is defined by the anterior slippage of one vertebra with a defect in bilateral pars interarticularis over the caudal one [2]. Most patients with spondylolysis progressed to IS when they had obvious clinical symptoms [7]. The differences between single level IS at L4 and L5 have been poorly characterized in clinical studies. A number of researchers have reported that sagittal lumbo-pelvic alignment has a significant influence on the clinical symptoms and progression of IS [8,9,10], but most of these studies only focus on IS at L5 or ignored the differences between IS at L4 and L5
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