AUTHOR=Krenzlin Harald , Keric Naureen , Ringel Florian , Kantelhardt Sven Rainer 

TITLE=Intermodal Detection of Lumbar Instability in Degenerative Spondylolisthesis is Superior to Functional Radiographs

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.860865

DOI=10.3389/fsurg.2022.860865

ISSN=2296-875X

ABSTRACT=Purpose: In this study, we compare different imaging modalities to find the most sensitive and efficient way of detecting instability in lumbar spondylolisthesis. Methods: Patients presenting with spondylolisthesis from June 1st, 2018, to May 31th, 2020 with functional radiographs and either CT or MRI were included in our single-center retrospective cohort study. The amount of translation, in millimeters, was measured on supine MRI, CT and radiographs of inclination while sitting, -standing or -prone and reclination while standing using the Meyerding technique. The amount of translation was compared among the different modalities.
Results: 113 patients with spondylolisthesis on 125 vertebral levels were included in this study. The mean patient age was 73.52±12.59 years; 69 (60.5%) patients were female. The most affected level was L4/5 (62.4%), followed by L3/4 (16%) and L5/S1 (13.6%). The average translations measured on supine CT were 4.13±5.93 mm and 4.42±3.49 mm on MRI (p=0.3 for the difference between MRI and CT). The difference of inclination while sitting radiograph to slice imaging was 3.37±3.64 mm (p<0.0001), inclination while standing to slice imaging was 2.67±3.03 mm (p<0.0001), reclination while standing to slice imaging was 1.6±3.15 mm (p=0.03) and prone to slice imaging was 2.19±3.02 mm (p=0.03). Conclusion: We found that a single radiograph in either inclination, reclination or prone position compared to CT or MRI in supine position can detect instability in spondylolisthesis more efficiently than comparison of functional radiographs in any position.