Evaluating the characteristics of spondylolisthesis in low back pain by radiography

Authors

Keywords:

Low back pain, Spondylolisthesis, Spondylosis

Abstract

Background/Aim: In physical therapy and rehabilitation practices, it is important to diagnose radiographic spondylolisthesis for correct choice of exercise in patients with low back pain. There are different results about the rates and the characteristics of spondylolisthesis. The aims of this study were to compare the radiographical findings, and evaluate the frequency and the radiographic characteristics of spondylolisthesis according to gender. Methods: Nine hundred and four patients with low back pain, who were over 18 years of age with records of age, gender, and lumbar spine radiographs (both anterior and lateral) were included in this retrospective cross sectional study. Three hundred and forty-eight patients (245 females, 103 males) who met our criteria were included in the study and reviewed for age, gender, and anterior/lateral-lumbar spine radiographies. Spine radiographies were assessed for the presence of spondylosis, scoliosis, fracture, flattening of the lordosis, hyperlordosis, sacralization, lumbarization and spondylolisthesis. The spondylolisthesis measurements were made according to the Meyerding Grading Scale. The levels and the pattern of anterior or posterior listhesis, and co-existing radiological findings such as osteophyte, sclerosis, intervertebral disk space narrowing and scoliosis, were noted. Results: The rate of hyperlordosis (P=0.003) and spondylolisthesis (P=0.012) were significantly higher in females compared to males. The rate of spondylolisthesis among all patients was 11.4% (female/male ratio:2.95/1). All male patients and 91.5% of female patients with spondylolisthesis had it at the L5-S1 level only. Among all, 90.6% of spondylolisthesis patients had anterolisthesis and 79.1% had grade 1 spondylolisthesis according to Meyerding. The most common radiological findings were sclerosis (95%), osteophytes (62.5%), intervertebral disk narrowing (62.5%), scoliosis (37.5%) in spondylolisthesis patients. Conclusion: The results of our study showed that hyperlordosis and spondylolisthesis were more common in females. The characteristics of spondylolisthesis include occurring mostly at one level only, being Meyerding grade 1 and showing anterolisthesis pattern. The most frequent coexisting radiological findings were sclerosis, osteophytes, and intervertebral disk narrowing. These result support the idea that the pathogenesis of spondylolisthesis is associated with spondylosis. The rate of spondylolisthesis was higher compared to many previous studies. Before deciding on an exercise, it is important to see the direct radiography of the patient with low back pain.

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References

Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res. 1976;117:23-9.

Vibert BT, Sliva CD, Herkowitz HN. Treatment of instability and spondylolisthesis: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:222-7.

Wiltse LL, Winter RB. Terminology and measurement of spondylolisthesis. J Bone Joint Surg Am. 1983;65:768–72.

Şenel K. Spondilolistezis. İçinde: Göksoy T, Şenel K, editörler. Ortopedik Rehabilitasyon, 2. baskı. İstanbul: Bilmedya; 2016;209–12.

Virta L, Rönnemaa T, Osterman K, Aalto T, Laakso M. Prevalence of isthmic lumbar spondylolisthesis in middle aged subjects from eastern and western Finland. J Clin Epidemiol. 1992;45:917–22.

Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine. 2007;32(1):120-5.

He LC, Wang YXJ, Gong JS, Griffith JF, Zeng XJ, Kwok AW, et al. Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women. European radiology. 2014;24(2):441-8.

Horikawa K, Kasai Y, Yamakawa T, Sudo A, Uchida A, et al. Prevalence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis among the elderly in a Japanese village. Journal of orthopaedic surgery. 2006;14(1):9-12.

Denard PJ, Holton KF, Miller J, Fink HA, Kado DM, Yoo JU, et al. Lumbar spondylolisthesis among elderly men: prevalence, correlates and progression. Spine. 2010;35(10):1072.

Kirkaldy Willis WH. Managing Low Back Pain. Churchill Livingstone, New York 1988.

Chanchairujira K, Chung CB, Kim Young J, Papakonstantinou O, Lee MH, Clopton P, et al. Intervertebral disk calcification of the spine in an elderly population: Radiographic prevalence, location, and distribution and correlation with spinal degeneration. Radiol. 2004;230:499-503.

Wang G, Karki SB, Xu S, Hu Z, Chen J, Zhou Z. et al. Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis. Journal of Back and Musculoskeletal Rehabilitation. 2015;28(2):277-85.

Halvorsen TM, Nilsson S, Nakstad PH. Stress fractures. Spondylolysis and spondylolisthesis of the lumbar vertebrae among young athletes with back pain. Tidsskrift for den Norske Laegeforening : Tidsskrift for Praktisk Medicin, ny Raekke. 1996;116(17):1999-2001.

McPhee IB, O’Brien JP. Scoliosis in symptomatic spondylolisthesis. The Journal of Bone and Joint Surgery. 1980;62B(2):155-7.

Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine. 2009;34(2):199.

Lee SY, Cho NH, Jung YO, Seo YI, Kim HA. Prevalence and risk factors for lumbar spondylosis and its association with low back pain among rural Korean residents. Journal of Korean Neurosurgical Society. 2017;60(1):67.

Mammadov T, Senlikci HB, Ayas S. A public health concern: Chronic low back pain and the relationship between pain, quality of life, depression, anxiety, and sleep quality. J Surg Med. 2020;4(9):808-11.

Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371–9.

Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8:1137–48.

Weiner DK, Distell B, Studenski S, Martinez S, Lomasney L, Bongiorni D. Does radiographic osteoarthritis correlate with flexibility of the lumbar spine? J Am Geriatr Soc. 1994;42:257–63.

Le Huec JC, Saddiki R, Franke J, Rigal J, Aunoble S. Equilibrium of the human body and the gravity line the basics. Eur Spine J. 2011;20(5):558–63.

Schwab F, el-Fegoun AB, Gamez L, Goodman H, Farcy JP. A lumbar classification of scoliosis in the adult patient: preliminary approach. Spine. 2005;30(14):1670–3.

Magora A, Schwartz A. Relation between the low back pain syndrome and X-ray findings. Transitional vertebra (mainly sacralization) Scan J Rehabil Med. 1978;10:135-45.

Mahato NK. Morphological traits in sacra associated with complete and partial lumbarization of first sacral segment. The Spine Journal. 2010;10:910-5.

Tekeoğlu İ, Göksoy T, Gürbüzoğlu N. Bel ağrılı 100 olgunun klinik ve radyolojik yönden değerlendirilmesi. Van Tıp Dergisi. 1998;5(2):72-5.

Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. Journal of children's orthopaedics. 2013;7(1):3-9.

Stagnara P, De Mauroy JC, Dran G, Gonon GP, Costanzo G, Dimnet J et al. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 1982;7(4):335-42.

Been E, Kalichman L. Lumbar lordosis. The Spine Journal. 2014;14(1), 87-97.

Sanderson PL, Fraser RD. The influence of pregnancy on the development of degenerative spondylolisthesis. J Bone Joint Surg Br. 1996;78:951–4.

Imada K, Matsui H, Tsuji H. Oophorectomy predisposes to degenerative spondylolisthesis. J Bone Joint Surg Br. 1995;77:126–30.

Wang YX, Griffith JF, Ma HT, Kwok AWL, Leung JCS, Yeung DKW, et al. Relationship between gender, bone mineral density, and disc degeneration in the lumbar spine: a study in elderly subjects using an eight-level MRI-based disc degeneration grading system. Osteoporos Int. 2011;22:91–6.

Denard PJ, Holton KF, Miller J, Fink HA, Kado DM, Yoo JU, et al. Lumbar spondylolisthesis among elderly men: prevalence, correlates and progression. Spine. 2010;35(10):1072.

Rick JR, Winter RB, Moe JH. The lumbosacral articulation and its relationship to scoliosis. J Bone Joint Surg [Am]. 1974;56-A:445.

Altas H, Yilmaz A. Magnetic resonance imaging of the lumbar spine in adult: Evaluation of spinal incidental findings in patients with low back pain. Annals of Medical Research. 2019;26(4):748-52.

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Published

2021-05-01

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Research Article

How to Cite

1.
Bakılan F, Ortanca B, Şahin M. Evaluating the characteristics of spondylolisthesis in low back pain by radiography. J Surg Med [Internet]. 2021 May 1 [cited 2022 Dec. 1];5(5):486-90. Available from: https://jsurgmed.com/article/view/815372