Isthmic Spondylolisthesis Group Research Articles

What are the differences in paraspinal muscle morphometry among degenerative spondylolisthesis patients, isthmic spondylolisthesis patients, and healthy individuals? A propensity score matching analysis

PurposeTo compare the morphometry of paraspinal muscles in patients with degenerative spondylolisthesis (DS), isthmic spondylolisthesis (IS), and healthy individuals.MethodsThirty-seven pairs of DS patients were selected using propensity score matching with IS patients, while 37 healthy individuals matched for age, sex, and BMI were selected as controls. The relative cross-sectional area (rCSA), and relative functional cross-sectional area (rfCSA) of paraspinal muscles were measured, and the degree of fatty infiltration (FI) was calculated. Based on occupational differences, the patients were also divided into worker and farmer groups, and the same measurements were taken on them.ResultsAt the L3/L4 level, the multifidus (MF) FI was greater in the DS and IS groups than in the control group, the erector spinae (ES) rfCSA was higher in the IS group than in the DS and control groups. At the L4/L5 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS and control groups. At the L5/S1 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS group. At the L3/L4, L4/L5 level, MF rfCSA were higher in the worker group than in the farmer group (p < 0.05).ConclusionThe morphological changes in paraspinal muscles in patients with DS were dominated by selective atrophy of the MF, while in patients with IS, the morphological changes in paraspinal muscle showed selective atrophy of the MF accompanied by compensatory hypertrophy of the ES. The surgeon should consider the morphological differences in paraspinal muscle between different types of lumbar spondylolisthesis when establishing the appropriate surgical program.

Reconsideration and Reflection on Spinal Disorders Through the Study of Intervertebral Discs in Patients with Lumbar Spondylolisthesis

This study analyzed and explored the relationship between isthmic spondylolisthesis and disc degeneration by comparing the degree of disc degeneration in patients with isthmic spondylolisthesis, lumbar disc herniation, and asymptomatic healthy individuals. This study included a total of 138 cases, consisting of L5-S1 single segment lesion patients and a normal lumbar spine population. The cases were divided into 3 groups based on the type of disease: fifty eight cases in the isthmic spondylolisthesis (IS) group, 50 cases in the lumbar disc herniation (LDH) group, and 30 cases in the normal lumbar vertebrae (NLV) group. The research findings indicate that the proportion of intervertebral disc degeneration in the LDH group is significantly higher than that in the IS group and NLV group (65.3% vs. 33.3% vs. 25.8%, P < 0.05). The Pfirrmann grades of lumbar intervertebral discs (L1-L4) in the LDH group are significantly higher than those in the IS group and NLV group (P < 0.05), and the intervertebral height index (IHI) (L1-L4) of lumbar vertebrae in the LDH group is significantly lower than that in the IS group and NLV group (P < 0.05). The results showed that the degree of intervertebral disc degeneration in patients with isthmic spondylolisthesis was lighter than that in patients with LDH, and even similar to that in healthy individuals. The occurrence of IS may have slowed down the degeneration of nonaffected segment intervertebral discs through certain factors.

Radiological Changes of Paraspinal Muscles: A Comparative Study of Patients with Isthmic Spondylolisthesis, Patients with Degenerative Lumbar Spondylolisthesis, and Healthy Subjects

To investigate the differences, correlations, and clinical significance of the paraspinal muscles among patients with isthmic spondylolisthesis (IS), degenerative lumbar spondylolisthesis (DLS), and age-matched healthy subjects. This study involved 159 age-matched patients with L4 anterior spondylolisthesis. The patients were divided into the IS group (n = 81) and DLS group (n = 78). Eighty-four age-matched healthy adults were enrolled as the control group. The cross-sectional area (CSA) of paraspinal muscles (multifidus [MF], erector spinae [ES], and psoas [PS]) and the relative CSA of the paraspinal muscles (paraspinal muscle CSA/vertebral CSA) were measured in the IS group, DLS group, and control group. The degree of fat infiltration was simultaneously observed. There was no significant difference in age or sex among the three groups. The relative CSA of the MF and PS was higher in control group than in IS and DLS groups (p < 0.05). The relative CSA of ES was higher in IS and control groups than in DLS group (p < 0.05). The relative CSA of total paraspinal muscles decreased in the order of control group > IS group > DLS group (p < 0.05). Logistic regression analysis showed that the relative CSA of MF, and the degree of fat infiltration of ES were independent protective factors for IS (odds ratio < 1, p < 0.05). The relative CSA of MF was an independent protective factor for DLS (odds ratio < 1, p < 0.05), whereas BMI and the degree of fat infiltration of MF were independent risk factor for DLS (odds ratio > 1, p < 0.05). Compared with the control group, patients with IS and DLS showed varying degrees of degeneration, and the degree of degeneration in patients with DLS was more severe at the same age. Lower fat infiltration and higher paraspinal muscle CSA are protective factors for IS and DLS, whereas the higher BMI is risk factor for DLS.

Radiographic Analysis of Pedicle Screw Retractor-Assisted Transforaminal Lumbar Interbody Fusion for Single-Segment Spondylolisthesis in Adults: A Retrospective Study and Technical Note.

ObjectivesThe objective of this study was to introduce a retractor that can be temporarily installed on unilateral pedicle screws to achieve distraction‐reduction and nerve root protection, and to analyze the efficacy and safety of retractor‐assisted transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis.MethodsThis was a retrospective study of 125 patients who underwent retractor‐assisted TLIF for single‐segment spondylolisthesis from November 2017 to February 2021. Based on morphology, patients were divided into degenerative (N = 66) and isthmic groups (N = 59). Differences in demographics and preoperative characteristics between the groups were analyzed using the independent samples t‐test and χ 2 test. Changes in radiographic parameters (disc height, foramen height, spondylolisthesis degree, slippage length, and segmental lordosis) before and after surgery were compared using the paired samples t‐test. Logistic regression analysis was performed to analyze the relationship between facet joint angle (FJA) and degenerative lumbar spondylolisthesis (DLS).ResultsUnilateral screw retractor‐assisted TLIF significantly corrected spondylolisthesis and improved disc height and segmental lordosis (p < 0.05). There was no significant difference in foramen height between the two sides before and after operation (pre: 15.81 ± 3.58 mm vs 15.69 ± 3.68 mm, p = 0.599; post: 18.65 ± 2.31 mm vs 18.74 ± 2.26 mm, p = 0.516). The degree of spondylolisthesis in the DLS group before surgery was significantly lower than that in the isthmic spondylolisthesis group (17.70 ± 5.62% vs 25.18 ± 9.73%, p < 0.001), whereas a similar degree of correction could be achieved after surgery (5.91 ± 3.12% vs 7.16 ± 5.69%, p = 0.135). FJAs from L3/4 to L5/S1 were significantly smaller in patients with DLS than those in with isthmic spondylolisthesis (p < 0.05). Patients with facet sagittalization were more likely to have DLS (β: −0.101, odds ratio [OR]:0.904, 95% confidence interval [CI]: 0.874–0.934, p < 0.001), while the cut‐off FJA of L4/5 for predicting L4 spondylolisthesis was 53.19.ConclusionsPedicle screw retractor‐assisted TLIF is effective and safe in treating both degenerative and isthmic lumbar spondylolisthesis. The unilateral retractor has the capacity to maintain the disc height achieved by paddle distractors, which optimizes the nerve protection and distractor placement. Patients with an FJA on L4/5 <53.19 were more likely to have DLS.

Posterior Fixation with Transforaminal Lumbar Interbody Fusion for Single Level Isthmic and Degenerative Lumbar Spondylolisthesis in Adults Causes Less Complication

BACKGROUND&#x0D; Lumbar interbody fusion has long been considered the "gold standard" technique for surgical treatment of adult spondylolisthesis. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. The objectives of the study were to determine the functional outcome after one year following surgery and evaluate the fusion rate.&#x0D; METHODS&#x0D; In this prospective, non-randomised study, 26 patients (average age 37.1 yrs) with isthmic spondylolisthesis (IS), who suffered for an average of 12.08 months and 14 patients with degenerative spondylolisthesis (DS) (average age 58.6 yrs), who suffered for 13.2 months on average were collected in out-patient department basis. They underwent an interbody fusion with cages with posterior instrumentation (TLIF or PLIF). Clinical outcome was measured using VAS and Oswestry Disability Index. Foraminal dimensions and disc heights were measured in standard digital radiographs. Radiographic fusion was confirmed with CT scans at 1 year.&#x0D; RESULTS&#x0D; In the IS group, a mean spondylolisthesis slip of 33.3 % was reduced to 6.7 % at 1 year. Vertical foraminal distance(C) was improved from 11.2 mm to 12.0 mm. The fusion rate was 78.2 % with TLIF and 66.7 % with PLIF. In the DS group, a mean spondylolisthesis slip of 32.7 % was reduced to 7.4 % at 1 year. C distance was improved from 11.8 mm to 13.2 mm. The fusion rate was 66.7 % with TLIF and 100 % with PLIF. The mean ODI scores at baseline and 1 year, were improved from 48 to 9.8 and from 49.5 to 18.4 in the IS and DS groups respectively. VAS score was improved from 6.4 to 0.8 and from 6.6 to 2.5 in IS and DS groups respectively.&#x0D; CONCLUSIONS&#x0D; Interbody fusion for low-grade spondylolisthesis requiring reduction results in excellent to good functional outcomes in 90 % of patients with a good fusion rate. TLIF procedure of spinal fusion requires less time, causes less bleeding, and has less chance of damage to the neural structures than PLIF.

Correlation between the pre-and post-operative sagittal parameters and the quality of life in patients with degenerative and isthmic spondylolisthesis

Objective: To assess the relationship between health-related quality of life (HRQOL) and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery, and to provide a biomechanical basis for improving the clinical prognosis of such patients. Methods: A retrospective analysis of 63 patients with lumbar spondylolisthesis who received lumbar fusion surgery in the Department of Spine Surgery, Tianjin Union Medical Center from December 2017 to June 2020 was carried out. There were 16 males and 47 females with a mean age of (59±8) years. Subgroup analyses were conducted based on disease type (degenerative lumbar spondylolisthesis (DS) and the isthmic spondylolisthesis (IS)) and HRQOL scores. Patients were evaluated post-operatively to observe the improvement of symptoms and quality of life. The relationship between operative related factors, HRQOL scores before and after surgery, and spino-pelvic sagittal parameters (including sagittal axis of the spine, lumbar lordosis angle, pelvic incidence angle, pelvic tilt angle (PT), sacral tilt angle, matching degree of pelvic incidence angle (PI) and lumbar lordosis angle (LL), lumbar 1 vertebra plumb line, upper lumbar curve, lower lumbar curve) in the two groups were analyzed. The correlation between the improvement of HRQOL scores and spino-pelvic sagittal parameters in the DS group and the IS group was analyzed and compared. Results: There were significant differences between postoperative HRQOL scores compared with those before the operation in both the DS and IS groups at three times of follow-up after the operation (all P<0.05). There was no difference in the last HRQOL score, the number of surgical segments, operation time and intraoperative blood loss between the two groups (all P>0.05). The parameters of PT and PI-LL in DS patients with VAS back pain score>3 and ≤3 were statistically different (13.7°±6.4° vs 26.6°±7.4°, 5.1°±8.2° vs 18.2°±13.1°, respectively, both P<0.05), similar results were obtained in IS patients (14.1°±6.9° vs 16.4°±8.7°, 2.9°±9.7° vs 6.8°±9.8°, respectively, both P<0.05). In addition, the parameters of PT and PI-LL between patients with ODI>20 and ≤20 were all statistically different in the two groups at the last follow-up after surgery (all P<0.05). The improvement of VAS back pain score in DS and IS groups was significantly related to the improvement of PT value, respectively (r=0.76, 0.78, both P<0.05). The PT, LL and PI-LL were significantly correlated with the ODI in the DS group (r=0.60, 0.62, 0.50, all P<0.05). There was also a correlation between the improvement of ODI and PT, LL and PI-LL in the IS group, respectively (r=0.22, 0.41, 0.76, all P<0.05). Conclusions: Certain correlation exists between the HRQOL and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery. For the treatment of lumbar spondylolisthesis and improvement of quality of life, the primary goal is to reconstruct the matching degree of the lumbar lordosis angle and PI, and to reduce the PT value to the normal range by tilting the pelvis forward.

Comparison of degenerative lumbar spondylolisthesis and isthmic lumbar spondylolisthesis: effect of pedicle screw placement on proximal facet invasion in surgical treatment

BackgroundPedicle screw invasion of the proximal articular process will cause local articular process degeneration and acceleration, which is an important factor affecting adjacent segment degeneration. Although lumbar spondylolisthesis is a risk factor for screw invasion of the proximal joint, there is no clear conclusion regarding the two different types of spondylolisthesis. Therefore, the purpose of this study was to explore the influence of pedicle screw placement on proximal facet invasion in the treatment of degenerative spondylolisthesis and isthmic spondylolisthesis.MethodsIn total, 468 cases of lumbar spondylolisthesis treated by decompression and fusion in our hospital from January 2017 to January 2020 were included in this retrospective study. Among them, 238 cases were degenerative spondylolisthesis (group A), and 230 cases were isthmic spondylolisthesis (group B). Sex, age, body mass index, bone mineral density, preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, postoperative VAS and ODI scores at 1 month and 3 months, and angle of the proximal facet joint at the last follow-up were recorded and compared between the two groups. The degree of pedicle screw invasion of the proximal facet joint was graded and compared by the SEO grading method.ResultsThere were no significant differences in sex, age, body mass index, bone mineral density, preoperative VAS and ODI scores, or proximal facet joint angle between the two groups (P > 0.05). There was no significant difference in VAS and ODI scores between the two groups at 1 month and 3 months after the operation (P > 0.05). The VAS score of group A at the last follow-up was 1 (1,2). The VAS score of group B at the last follow-up was 3 (1,3). The ODI score of group A at the last follow-up was 6(4,26). The ODI score of group B at the last follow-up was 15(8,36). The VAS and ODI scores of the two groups at the last follow-up were significantly different (P < 0.05). According to the SEO grading method, the invasion of the proximal articular process by pedicle screw placement in group A involved 320 cases in grade 0, 128 cases in grade I and 28 cases in grade II. In group B, there were 116 cases in grade 0, 248 cases in grade I and 96 cases in grade II, with a significant difference (P < 0.01).ConclusionIn summary, a certain number of cases involving screws invading the proximal facet joint occurred in the two different types of lumbar spondylolisthesis, but the number in the isthmic spondylolisthesis group was significantly higher than that in the degenerative spondylolisthesis group, which caused more trauma to the proximal facet joint and significantly affected the patient prognosis.

Correlation of Pelvic Parameters with Isthmic Spondylolisthesis

Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it.&#x0D; Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis.&#x0D; Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group.&#x0D; Result In control group, the pelvic incidence was 50.44±4.78°, the sacral slope was 34.38±6.79°, the pelvic tilt was 15.97±5.31°, and the lumbar lordosis was 46.76±6.78°. In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79°, the sacral slope was 40.40±6.91°, the pelvic tilt was 20.63±7.51°, and the lumbar lordosis was 57.31±7.11°. The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p &lt; 0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52°, II =62° and III 72.5°).&#x0D; Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip.

Increased sagittal diameter of the vertebral arch aids in diagnosis of lumbar spondylolysis

ObjectiveTo identify a diagnostic indicator of lumbar spondylolysis visible in plain X-ray films.MethodsOne hundred and seventy-two patients with low back pain who received X-ray and computerized tomography (CT) examinations were identified and studied. They were divided into three groups: the spondylosis without spondylolisthesis (SWS) group, comprising 67 patients with bilateral pars interarticularis defects at L5 and without spondylolisthesis, the isthmic spondylolisthesis (IS) group, comprising 74 patients with L5/S1 spondylolisthesis and bilateral L5 pars interarticularis defects, and the control group, comprising 31 patients with low back pain but without spondylolysis. The sagittal diameters of the vertebral arch (SDVAs) of L4 and L5 were measured in lateral X-ray image, and the differences in SDVA between L4 and L5 (DSL4-5) in each case were calculated and analyzed.ResultsThere were no significant differences in demographic characteristics among the three groups. In the SWS and IS groups, the SDVA of L5 was significantly longer than the SDVA of L4 (p < 0.001), whereas no significant difference found in the control group (p > 0.05). DSL4-5, in which the SDVA of L4 was subtracted from the SDVA of L5, significantly differed among the three groups (p < 0.001), and the normal threshold was provisionally determined to be 1.55 mm.ConclusionsIn bilateral L5 spondylolysis, the SDVA of L5 is wider than the SDVA of L4, and this difference is greater in isthmic spondylolisthesis. This sign in lateral X-rays may provide a simple and convenient aid for the diagnosis of spondylolysis.

Straighter low lumbar curvature in isthmic spondylolisthesis at L4

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.

Association of MRI-defined lumbar paraspinal muscle mass and slip percentage in degenerative and isthmic spondylolisthesis: A multicenter, retrospective, observational study.

The objective of this study is to investigate the role of paraspinal muscles in the progression of different types of spondylolisthesis by examining the correlation between cross-sectional area (CSA) of lumbar paraspinal muscle and slip percentage (SP) in degenerative spondylolisthesis and isthmic spondylolisthesis.A multicenter retrospective analysis was carried out including 219 subjects diagnosed with lumbar spondylolisthesis. Using T2-weighted axial magnetic resonance imgaging, CSAs of the psoas major (PM), multifidus (MU), and erector spinae were measured and divided by L5 vertebral body (VB) CSA. SP was measured using sagittal T2-weighted images. Correlations between muscle CSA ratio and SP were calculated in each group. Regression analysis was performed to predict the influence of each muscle CSA/VB CSA ratio on SP.No significant correlation was found in the degenerative spondylolisthesis group between any of the muscle CSA ratios and SP. Both PM/VB ratio (r = −0.24, P = .021) and MU/VB ratio (r = −0.26, P = .012) were negatively correlated with SP in the isthmic spondylolisthesis group. MU had more influence on SP than PM in the isthmic spondylolisthesis group (regression coefficient MU/VB: −8.08, PM/VB: −4.34).Both PM and MU muscle CSA ratios were negatively correlated with SP in the isthmic group. MU had more influence on SP than PM. No muscles had any correlations with SP in the degenerative group. This discrepancy between the two groups suggests that exercise programs or interventions regarding the segmental stability of isthmic spondylolisthesis and degenerative spondylolisthesis should be distinguished in clinical practice.Clinical Research Information Service of Korea Centers for Disease control and Prevention, KCT0002588. Registered on 12 December 2017, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=10702

Instrumented Minimally Invasive Spinal-Transforaminal Lumbar Interbody Fusion (MIS-TLIF)

A retrospective study. To determine the clinical and radiologic outcomes of the long-term results of instrumented minimally invasive spinal-transforaminal lumbar interbody fusion (MIS-TLIF) in unstable, single-level, low-grade, isthmic spondylolisthesis (IS) or degenerative spondylosis (DS) including degenerative spondylolisthesis, foraminal stenosis with central stenosis, degenerative disk disease, and recurrent disk herniation. MIS-TLIF is a common surgical procedure to treat lumbar spondylolisthesis. However, there are no studies that have documented the long-term results of MIS-TLIF. Forty-four patients who had undergone instrumented MIS-TLIF between July 2003 and January 2005 were retrospectively reviewed. The visual analog scale, Oswestry Disability Index, patient satisfaction rate, and the patient's return-to-work status were used to assess clinical and functional outcomes. Radiologic follow-up were carried out in patients to check for adjacent segmental degeneration (ASD). The plain radiographs, computed tomography and magnetic resonance imaging, were used in all patients in last follow-up period. The mean visual analog scale scores for back and leg pain decreased from 5.8 and 7 to 3.5 and 3.7, respectively, in the DS group (n=19) and from 6.8 and 6.9 to 1.8 and 2.0, respectively, in the IS group (n=25) (P<0.001). The mean Oswestry Disability Index scores improved from 61.7% to 21.5% in the DS group and from 53.9% to 16% in the IS group (P<0.001). Patient satisfaction rate was 80% and 81% in the DS and IS groups, respectively. Evidence of fusion was observed radiologically in 24 (96%) and 19 (100%) of the patients in the IS and the DS group, respectively, giving an overall fusion rate of 97.7% (43/44). The final ASD rate, observed using radiography, was 68.4% (13/19) in the DS and 40% (10/25) in the IS group. However, 15.8% (3/19) in the DS and 4% (1/25) in the IS group had symptoms associated with ASD. The long-term clinical and radiologic outcomes after instrumented MIS-TLIF in patients with unstable single-level spine are favorable.

Changes in health utility, disability, and health-related quality of life in patients after spinal fusion: a 2-year follow-up study.

Prospective longitudinal database study. To evaluate changes in health utility, disability, and health-related quality of life (HRQOL) in patients undergoing spinal fusion. Recently, measuring disability, HRQOL, and health utility has become important when defining the value of surgical interventions. Data of spinal fusion patients from a prospective longitudinal database were analyzed. Health utility was captured by SF-6D (six dimensional health state classification from the 36-dimensional Short Form Health Survey) score, disability by Oswestry Disability Index, and HRQOL by the 36-Item Short Form Health Survey. The changes in these scores were compared between the groups during the 2-year follow-up. Altogether 242 patients were stratified into 5 groups according to the surgical indication: degenerative spondylolisthesis (n = 140), isthmic spondylolisthesis (n = 39), spinal stenosis (n = 23), disc pathology (n = 15), and postoperative conditions (n = 25). The mean age varied from 48 years in isthmic spondylolisthesis group to 66 years in the groups with degenerative spondylolisthesis or spinal stenosis. Preoperatively, the surgical indication subgroups differed significantly from each other according to utility, disability, and the physical component summary score of the HRQOL. Isthmic spondylolisthesis group had the best and the group of postoperative conditions the worst preoperative values. Nevertheless, the SF-6D, the Oswestry Disability Index, and the physical component summary in all diagnostic groups had improved significantly already by 3 months of follow-up, and the improvement remained stable until 2 years of follow-up. Interestingly, the biggest improvement in Oswestry Disability Index (-27), physical component summary (13) and SF-6D (0.19) was found in a group with disc pathology. The mental component summary score values were similar preoperatively (P = 85), and the improvement in the mental component summary was significant in the groups with degenerative olisthesis, spinal stenosis, and postoperative conditions. The 5 surgical indication groups showed significantly different scores preoperatively in health utility, disability, and the physical aspect of HRQOL. At 2 years, however, all groups benefitted from the fusion surgery significantly. 3.

Difference of Sagittal Spinopelvic Alignments between Degenerative Spondylolisthesis and Isthmic Spondylolisthesis

ObjectiveThe purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients.MethodsThirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults.ResultsThere were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL (42±13°) was significantly lower than that of the control group (48±11°; p=0.029), but that of ISPL (55±6°) was significantly greater than a control group (p=0.004). The SVA of DSPL (55±49 mm) was greater than that of a control group (<40 mm), but that of ISPL (21±22 mm) was within 40 mm as that of a control group. The PT of DSPL (24±7°) and ISPL (21±7°) was significantly greater than that of a control group (11±6°; p=0.000).ConclusionBoth symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups.

Posterior Epidural Fat on Sagittal MR Images: Can it Help in Distinguishing Between Isthmic and Degenerative Lumbar Spondylolisthesis?

Materials and Methods: The midline sagittal MR images of the lumbar spines were retrospectively studied for 50 patients without spondylolisthesis, for 78 patients with isthmic spondylolisthesis and for 43 patients with degenerative spondylolisthesis. The anteroposterior diameter of the posterior epidural fat (ADEF) was measured at each intervertebral disc level by two radiologists and these values were then compared between each group. To normalize for difference of body size, the posterior epidural fat ratio (PEFR) at each level of spondylolisthesis and at L1-2 were also determined for each level of spondylolisthesis, and the PERF was compared between each group. Statistical analysis was performed by the chi-square method. Results: For the patients with isthmic spondylolisthesis, the ADEFs at the spinal levels with spondylolisthesis were significantly greater than those ADEFs in the control group that were measured at the corresponding disc levels (p<0.05). For the patients with degenerative spondylolisthesis, the ADEFs at the spinal level with spondylolisthesis were significantly less than the ADEFs in the control group that were measured at the corresponding disc levels (p<0.05). The PEFRs obtained at L4-5 were 1.37±0.12 for the control group, 2.61±1.31 for the patients with isthmic spondylolisthesis, and 0.60±0.05 for the patients with degenerative spondylolisthesis. The PEFRs obtained at L5-S1 were 2.25±1.32 for the control group, 3.47±1.69 for the patients with isthmic spondylolisthesis and 1.65±0.18 for the patients with degenerative spondylolisthesis. At both levels, the PEFRs were greatest for the isthmic spondylolisthesis group and smallest for the degenerative spondylolisthesis group, and all the differences were statistically significant. Conclusion: The posterior epidural fat, which is easily seen structure on the midline sagittal MR image, is significantly increased in isthmic spondylolisthesis, but it is decreased in degenerative spondylolisthesis, and this could be useful in distinguishing isthmic spondylolisthesis from degenerative spondylolisthesis.