Abstract
The purpose of this study was to investigate and determine whether there are differences in L5 pedicles morphology between isthmic and degenerative L5-S1 spondylolisthesis. One hundred and nineteen patients with isthmic spondylolisthesis and 45 patients with degenerative spondylolisthesis at L5-S1 were enrolled in the IS group and DS group, respectively, and 164 lumbar disc herniation patients without spondylolysis or spondylolisthesis were classified into the normal (NL) group. A series of pedicle parameters of the fifth lumbar vertebra, including pedicle length (PL), pedicle width (PW), pedicle screw trajectory length (PSTL), pedicle height (PH), and the pedicle camber angle (PCA), were measured using multi-slice spiral computed tomography (MSCT). The slip distance of the L5 vertebra was measured on radiography, and the percentage of slip was also recorded. The pedicles of the fifth lumbar vertebra were shorter and wider, and the PCA was larger in the IS group compared to the DS group and NL group. On the contrary, the pedicles in the DS group were elongated and thinner, and the PCA was smaller. The pedicle parameters of PL were significantly positively correlated with the percentage of slip in the DS group, but PW and PCA were negatively correlated with the percentage of slip. There was no correlation between the percentage of slip and L5 pedicle parameters in the IS group. The L5 pedicles morphology in L5-S1 isthmic spondylolisthesis shows abduction, shortness, and width, while that in the degenerative spondylolisthesis shows adduction, lengthening, and thinning compared with the normal populations. The morphology changes may be the result of pedicle stress remodelling in the development of spondylolisthesis, which should be taken into consideration when placing at the insertion of pedicle screws.
Highlights
Spondylolisthesis can be divided into the following five types according to the Wiltse-Newman classification system in 1976: dysplastic, isthmic, degenerative, traumatic, and pathologic [1]
The pedicle parameters of pedicle length (PL) were significantly positively correlated with the percentage of slip in the DS group, but pedicle width (PW) and pedicle camber angle (PCA) were negatively correlated with the percentage of slip
The L5 pedicles morphology in L5-S1 isthmic spondylolisthesis shows abduction, shortness, and width, while that in the degenerative spondylolisthesis shows adduction, lengthening, and thinning compared with the normal populations
Summary
Spondylolisthesis can be divided into the following five types according to the Wiltse-Newman classification system in 1976: dysplastic, isthmic, degenerative, traumatic, and pathologic [1]. When patients become symptomatic and conservative management fails, surgical correction with posterior decompression and fusion using pedicle screw fixation is performed [2]. The pedicle anatomy in patients with spondylolisthesis varies greatly from those without spondylolysis or spondylolisthesis, and care must be taken when inserting pedicle screws [3, 4]. To the best of our knowledge, no study has discussed the anatomic changes and difference in the slip vertebra and its pedicle between isthmic and degenerative spondylolisthesis to date. The purpose of this study was to 1) measure the L5 pedicle parameters in patients between isthmic and degenerative spondylolisthesis at L5-S1 on multi-slice spiral computed tomography (MSCT), 2) analyze the morphological features and differences in the pedicle between isthmic and degenerative spondylolisthesis, and 3) clarify the relationship between the forward percentage of slip and the pedicle parameters in spondylolisthesis
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Schedule a callMore From: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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