Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis
Study Design Retrospective cohort study. Purpose Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection. Overview of Literature The heterogeneity in DS requires multiple imaging views to evaluate vertebr...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Spine Society
2023-08-01
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| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://www.asianspinejournal.org/upload/pdf/asj-2022-0443.pdf |
| _version_ | 1827861449410609152 |
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| author | Tariq Z. Issa Yunsoo Lee Emily Berthiaume Mark J. Lambrechts Caroline Zaworski Qudratallah S. Qadiri Henley Spracklen Richard Padovano Jackson Weber John J. Mangan Jose A. Canseco Barrett I. Woods I. David Kaye Alan S. Hilibrand Christopher K. Kepler Alexander R. Vaccaro Gregory D. Schroeder Joseph K. Lee |
| author_facet | Tariq Z. Issa Yunsoo Lee Emily Berthiaume Mark J. Lambrechts Caroline Zaworski Qudratallah S. Qadiri Henley Spracklen Richard Padovano Jackson Weber John J. Mangan Jose A. Canseco Barrett I. Woods I. David Kaye Alan S. Hilibrand Christopher K. Kepler Alexander R. Vaccaro Gregory D. Schroeder Joseph K. Lee |
| author_sort | Tariq Z. Issa |
| collection | DOAJ |
| description | Study Design Retrospective cohort study. Purpose Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection. Overview of Literature The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography. Methods We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of >10° or >8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities. Results A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p<0.001). Standing flexion and lateral radiographs when seated produced more kyphosis (4.66° and 4.97°, respectively) than neutral upright and MRI (7.19° and 7.20°, p<0.001). Seated lateral performed similarly to standing flexion in detecting all measurement parameters and categorizing DS (all p>0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p=0.041; and 28.1% vs. 14.6%, p=0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p>0.20). Conclusions Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph. |
| first_indexed | 2024-03-12T13:39:07Z |
| format | Article |
| id | doaj.art-137cf6be75e24bf2b2a3eb1a14ca8d37 |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-03-12T13:39:07Z |
| publishDate | 2023-08-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-137cf6be75e24bf2b2a3eb1a14ca8d372023-08-23T23:49:26ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462023-08-0117472172810.31616/asj.2022.04431545Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative SpondylolisthesisTariq Z. Issa0Yunsoo Lee1Emily Berthiaume2Mark J. Lambrechts3Caroline Zaworski4Qudratallah S. Qadiri5Henley Spracklen6Richard Padovano7Jackson Weber8John J. Mangan9Jose A. Canseco10Barrett I. Woods11I. David Kaye12Alan S. Hilibrand13Christopher K. Kepler14Alexander R. Vaccaro15Gregory D. Schroeder16Joseph K. Lee17Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USAStudy Design Retrospective cohort study. Purpose Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection. Overview of Literature The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography. Methods We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of >10° or >8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities. Results A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p<0.001). Standing flexion and lateral radiographs when seated produced more kyphosis (4.66° and 4.97°, respectively) than neutral upright and MRI (7.19° and 7.20°, p<0.001). Seated lateral performed similarly to standing flexion in detecting all measurement parameters and categorizing DS (all p>0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p=0.041; and 28.1% vs. 14.6%, p=0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p>0.20). Conclusions Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph.http://www.asianspinejournal.org/upload/pdf/asj-2022-0443.pdflumbar spinespondylolisthesisradiographyseated lateralflexion-extension |
| spellingShingle | Tariq Z. Issa Yunsoo Lee Emily Berthiaume Mark J. Lambrechts Caroline Zaworski Qudratallah S. Qadiri Henley Spracklen Richard Padovano Jackson Weber John J. Mangan Jose A. Canseco Barrett I. Woods I. David Kaye Alan S. Hilibrand Christopher K. Kepler Alexander R. Vaccaro Gregory D. Schroeder Joseph K. Lee Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis Asian Spine Journal lumbar spine spondylolisthesis radiography seated lateral flexion-extension |
| title | Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis |
| title_full | Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis |
| title_fullStr | Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis |
| title_full_unstemmed | Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis |
| title_short | Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis |
| title_sort | utility of seated lateral radiographs in the diagnosis and classification of lumbar degenerative spondylolisthesis |
| topic | lumbar spine spondylolisthesis radiography seated lateral flexion-extension |
| url | http://www.asianspinejournal.org/upload/pdf/asj-2022-0443.pdf |
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