Lumbar Retrolisthesis Research Articles

Effectiveness of <i>Varmam</i> Therapy and <i>Kombarakku Ottradam</i> in the Management of <i>Thandagavatham (Lumbar Retrolistihesis)</i> - A Case Report

The Siddha system of medicine is one of the classical Tamil systems of medicine. According to this system of medicine, Thandagavatham is one of the Vaatha diseases with the clinical features of pain in the lumbar region and para-spinal region. This condition may be correlated to lumbar retrolisthesis. A case report of Thandaga vatham (lumbar retrolisthesis) was documented for publication. A male patient of 19 years had suffered pain in the lower back and right sacroiliac region radiating to the right thigh. He could not walk for long distances, sit for a prolonged time and lie on his right lateral position for more than 6 months. He came for Siddha treatment in Varma Maruthuvam OPD of Ayothidoss Pandithar Hospital (APH), National Institute of Siddha. He had a history of allopathic treatment for this condition. Modern medicine management available for lumbar retrolisthesis is physiotherapy and the severe cases need surgery. In this clinical study, the patient was managed with Varmam therapy and Kombarakku Ottradamin at the Varmam Department of the National Institute of Siddha, Chennai. The patient was treated for 48 days and had decreased pain and a limited range of motion was evaluated clinically by using the Oswestry low back pain scale.

Radiographic and Clinical Outcomes After Stand-Alone Anterior Lumbar Interbody Fusion for Symptomatic L5-S1 Retrolisthesis.

Degenerative lumbar spondylolisthesis is associated with significant pain and disability. The literature on the treatment options and clinical outcomes for lumbar anterolisthesis is robust, but very few reports specifically evaluate lumbar retrolisthesis. This study investigated surgical outcomes for symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 anterior lumbar interbody fusion (ALIF). All patients with symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 ALIF at a single institution over a 7-year period were identified. Exhaustive nonoperative management had failed for all patients. Patients with previous lumbar fusion were excluded. Preoperative and postoperative radiographic images and patient-reported outcome measures for 20 patients (14 males and 6 females; mean [SD] age, 50.3 [13.7] years) were analyzed. The mean (SD) follow-up was 43.0 (23.7) months (range, 12.1-102.5 months). Patients experienced postoperative improvements in L5-S1 retrolisthesis (P = .048), L5-S1 disk height and angle (P < .001), L5 foraminal height (P < .001), L5-S1 lordosis (P < .001), and lumbar lordosis (P = .01). There were no significant changes in spinopelvic parameters. At the most recent follow-up, minimal clinically important differences in Oswestry Disability Index score, 36-Item Short-Form Survey (SF-36), and numerical rating scale score for leg pain were achieved in 11 of 20 (55%), 7 of 14 (50%), and 7 of 13 (54%) patients, respectively. All patients demonstrated fusion with no graft subsidence at up to 32 months. No patient experienced intraoperative complications, was readmitted, or required a subsequent posterior decompression or fusion because of refractory symptoms. In our cohort, stand-alone L5-S1 ALIF was associated with radiographic and clinical improvement in patients with symptomatic L5-S1 retrolisthesis.

Synovial facet joint cysts after lumbar posterior decompression surgery.

Numerous studies have reported on synovial facet joint cysts of the spine as a primary lesion. The exact pathogenesis of those cysts is still controversial, but degeneration and destabilization seem to be underlying mechanisms. However, only a few reports have thus far investigated synovial cysts of the spine as postoperative complications of decompression surgery. In this retrospective clinical study, the authors focused on synovial cysts of the lumbar facet joints as complications after lumbar decompression surgery, with the aim of elucidating their pathophysiology. A total of 326 patients with 384 segments treated with posterior decompression surgery without fusion were included in the study. Of these segments, 107 were surgically decompressed unilaterally and 277 were decompressed bilaterally. After surgery, 18 of the 384 segments developed a complication of symptomatic facet synovial cyst. The anatomical and morphological evaluations of these segments were performed using functional plain radiographs, CT scans, and MR images. All of the 18 segments with postoperative lumbar facet synovial cyst were treated with bilateral lumbar posterior decompression. There was no significant radiological lumbar spinal instability in any segments, although 17 of 18 segments demonstrated facet articular spondylotic changes. Moreover, 12 of 18 patients demonstrated lumbar retrolisthesis in the neutral position. Based on the authors' results, they propose that patients with lumbar degenerative disease who have a potential biomechanical lumbar instability such as disruption of the facet articular surface and hydrarthrosis or lumbar facet tropism might have a high risk for formation of lumbar facet synovial cyst after bilateral posterior decompression surgery.

Degenerative changes of sagittal alignment in patients with Roussouly type 1.

A cross-sectionalradiologicalstudy. We aimed to examine the degenerative changes of sagittal alignment in patients with Roussouly type 1. Roussouly type 1 is unique in shape, characterized by short lumbar lordosis (LL) with the apex at L5 and thoracolumbar kyphosis (TLK). Because of the unique shape of sagittal alignment and the small pelvic incidence (PI) in Roussouly type 1, the degenerative changes of sagittal alignment may differ. A total of 145 patients with Roussouly type 1 were recruited and distributed into three age groups; Group I (N = 40) were young patients (20-40years of age), Group II (N = 47) were middle-aged patients (45-60years of age), and Group III (N = 48) were elderly patients (>65years of age). Sagittal parameters including sagittal vertical axis (SVA), PI, pelvic tilt (PT), L1S1 LL, L4S1 LL, thoracic kyphosis (TK), and TLK were measured using Surgimap® software. The occurrence of lumbar retrolisthesis was also examined. The SVA, PI, PT, L1S1 LL, L4S1 LL, TK, and TLK in group I were - 25.9° ± 23.4mm, 37.1° ± 5.3°, 10.3° ± 5.5°, 42.7° ± 8.8°, 35.5° ± 6.9°, 29.5° ± 23.5°, and 9.7° ± 5.9°, respectively. Among the Groups I, II, and III, there was a stepwise increase in the SVA, PT, TLK, and lumbar retrolisthesis (all P < 0.001). The PI, L4S1 LL, and TK were identical among the three groups. Degenerative changes of Roussouly type 1 include increase in the SVA, PT, TLK, and lumbar retrolisthesis, while the PI, L4S1 LL, and TK remain unchanged. Level IV.

The radiographic characteristics and developmental mechanism of the lumbar degenerative retrolisthesis under a high-grade PI

BackgroundWhen talking about backward displacement of the vertebra, it generally refers to the retrolisthesis under low pelvic incidence (PI). It is worth to mention that lumbar retrolisthesis could also occur under a high-grade PI. Little knowledge was known about the radiographic characteristics and developmental mechanism of the retrolisthesis under high PI. This study was designed to describe the radiographic features and to explore the developmental mechanism of this type of backward vertebral displacement. MethodsA total of 887 consecutive subjects from our database were retrospectively reviewed. Degenerative lumbar retrolisthesis was found in 78 patients, including 54 patients with a relative low-grade PI (Group L) and 24 patients with a relative high-grade PI (Group H). 60 subjects without lumbar spondylolisthesis were randomly selected as the control group. Clinical and radiologic data were collected and compared between different groups. Results91.4% of patients in Group H had the type 4 sagittal construction in terms of Roussouly classification, while 92.6% of patients in Group L had the type 1 sagittal construction. The distribution of retrolisthesis was found about two vertebrae higher with larger backward slope in Group H than Group L. Compared with the control, patients with retrolisthesis under high PI had significantly greater thoracolumbar kyphosis (TLK), PI, sacral slope, sagittal vertical axis, T1 pelvic angle and severer disc degeneration and facet arthritis. Logistic regression analysis showed TLK was the independent factor predicting the development of retrolisthesis under a high-grade PI. ConclusionsRetrolisthesis under a high-grade PI and type 4 sagittal construction had higher location and larger backward slope than retrolisthesis under a low-grade PI. Retrolisthesis under high PI might be primarily associated with the increased backward sliding forces at the hypertilted vertebra in large TLK segment and lumbar instability caused by disc degeneration and facet arthritis.

Lumbar Retrolisthesis Compensates Spinal Kyphosis

Study DesignLarge cohort study. ObjectiveTo investigate the role of lumbar retrolisthesis in spinopelvic alignment and health-related quality of life (HRQOL) among volunteers aged >50 years. Summary of Background DataLumbar retrolisthesis pathology has not been sufficiently elucidated. MethodsWe included 639 volunteers (257 men, average age 73 [50-92] years). Sagittal vertical axis (SVA), maximum thoracic kyphosis (maxTK), lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were measured using whole-spine and pelvic radiographs taken in standing position. MaxTK was measured from the upper to the lower end vertebrae of spinal kyphosis in the sagittal plane using Cobb's method. HRQOL was evaluated using the Oswestry Disability Index (ODI). Subjects with ≥3 mm posterior lumbar vertebral slip and those with multiple retrolisthesis were included in R(+) and multiple groups, respectively. In single lumbar retrolisthesis subjects, those above L3–L4 were defined as the superior group and below L4–L5 as the inferior group. ResultsThe R(+) group had 259 (41%) subjects. Of the posterior slipped vertebrae, 235 (91%) were consistent with the lower end vertebra of the maxTK or its adjacent one. The R(+) group had significantly more males; subjects were older than those in the R(–) group. They also had significantly greater SVA, TK, maxTK, and PI-LL and smaller LL and PI. Multivariate analysis revealed that sex, maxTK, and LL were independent predictors of lumbar retrolisthesis. The inferior group had a significantly greater SVA, PT and PI-LL, and smaller LL and PI than the R(–), superior, and multiple groups. The inferior group also had significantly worse ODI than the R(–) group. ConclusionsSubjects with lumbar retrolisthesis showed greater spinal kyphosis and worse spinopelvic alignments. Subjects with lower-generated lumbar retrolisthesis showed worse spinopelvic alignment and HRQOL than subjects with upper-generated lumbar retrolisthesis and multiple ones and those without it. Level of EvidenceLevel IV.

Lumbar Retrolisthesis in Aging Spine: What are the Associated Factors?

A retrospective radiographic study. The aim of this study is to demonstrate that lumbar retrolisthesis serves as an important compensatory mechanism and to identify the possible factor related to lumbar retrolisthesis. Lumbar instability is one of the common degenerative changes, which presents as 2 radiologic features: anterolisthesis and retrolisthesis. Compared with the extensive studies on anterolisthesis, limit data are available on the characteristics and clinical relevance of lumbar retrolisthesis. In this study, 105 adult patients with low back pain were prospectively recruited, of which 60 patients had retrolisthesis (group 1) and 45 patients had anterolisthesis (group 2). Another 40 healthy age-matched adults (group 3) were also included to serve as the control group. Sagittal spinopelvic parameters were measured from the standing lateral radiograph, including thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), spinosacral angle (SSA), and C7 tilt (C7T). In addition, disk degeneration was quantitatively evaluated by Pfirrmann score on T2-weighted magnetic resonance images in patients with retrolisthesis. For all the sagittal parameters, SVA, PI, SS, and LL in retrolisthesis group were found to be significantly lower than those in the anterolisthesis group and in the control group, respectively (P<0.05), whereas TLK in retrolisthesis group was significantly larger than other 2 groups (P<0.01). In addition, the average Pfirrmann disk score was 2.11 at levels with retrolisthesis indicating that the disks were not severely degenerated. Lumbar retrolisthesis, together with thoracolumbar kyphosis, appears to be associated with mechanisms associated with regulation of sagittal balance. Low PI and disk instability due to degeneration may contribute to the development and progression of retrolisthesis.

Treatment of degenerative lumbar retrolisthesis

Treatment of degenerative lumbar retrolisthesis

Exploratory Evaluation of the Effect of Axial Rotation, Focal Film Distance and Measurement Methods on the Magnitude of Projected Lumbar Retrolisthesis on Plain Film Radiographs

ObjectiveThe purpose of this exploratory study was to evaluate the amount of error in retrolisthesis measurement due to measurement methods or projection factors inherent in spinal radiography. In addition, this study compared how accurately these methods determine positions of the lumbar vertebrae being studied and the expected projected size of the retrolisthesis. MethodsVertebral models were situated in a retrolisthesis position. Radiographs of the models were obtained in positive and negative y-axis rotations at 40- and 84-in focal film distances. The projected retrolisthesis was measured using the Gohl, Iguchi, and Lopes methods. ResultsAt the 40-in focal film distance, the Iguchi method and Lopes methods were significantly more accurate than the Gohl method. At the 84-in focal film distance, the Lopes method was significantly more accurate than the Gohl method. Almost all measurements overestimated both the actual amount of retrolisthesis as well as the amount of trigonometrically calculated retrolisthesis that should have been present on the radiographs. Findings suggest that measurements were less accurate with vertebrae rotated more than 10°. ConclusionsThis study demonstrated that lumbar vertebral rotation, focal film distance, and measurement methods are potential sources of error in retrolisthesis measurement.

Radiological and Clinical Analysis of Degenerative Lumbar Retrolisthesis -Comparative Study of Degenerative Spondylolisthesis-

Radiological and Clinical Analysis of Degenerative Lumbar Retrolisthesis -Comparative Study of Degenerative Spondylolisthesis-