Lomber spondilolistezis saptanan hastaların radyolojik ve klinik verilerinin karşılaştırılması

Giriş ve Amaç: Spondilolistezis, omurgada üst segmentin alt segmente göre öne veya arkaya yer değiştirdiği deformitedir. Çoğunlukla instabilite eşlik eden bu durumda cerrahi tedavi gerekebilmektedir ve radyolojik olarak iyi değerlendirilmelidir. Yöntem: 2019-2020 yılları arasında nöroşirürji polikliniğine bel ağrısı şikayeti ile başvuran 6593 hasta retrospektif olarak incelendi. Spondilolistezis saptanan hastalardan direk grafi ile birlikte lomber MRG ve lomber BT’si uygun şekilde temin edilenlerin radyolojik bulguları detaylı bir şekilde değerlendirildi. Bu hastalarda yaş, cinsiyet, listezis seviyesi ve derecesi, cobb açısı, pelvik insidans, pelvik tilt, sakral slop açısı, modic dejenerasyonu, vakum fenomeni, anüler yırtık, schmorl nodülü varlığı, faset hipertrofisi, osteofit, maksimum A-P santral kanal çapı ve eklem lizisi incelendi. Bu verilerin birbiri ile ilişkileri istatistiksel olarak değerlendirildi. Bulgular: 58 kadın, 5 erkek hastanın çalışmaya uygun olduğu saptandı. Minimum 22, maksimum 81 ve ortalama yaş 59’du. Hastaların 52’sinde grade 1 listezis saptandı. Sırasıyla 31 hastada L5-S1, 24 hastada L4-L5 ve 8 hastada L3-L4 seviyesinde listezis saptandı. Yaşla beraber vakum fenomeni, osteofit birlikteliği, L5-S1 listezis ve lizis varlığı arasında; sakral slop açısı ile pelvik insidans, faset hipertrofisi, modic tip 2 dejenerasyonu; pelvik tilt ile pelvik insidans; faset hipertrofisi ile vakum fenomeni ve lizis varlığı, ligamentum hipertrofisi ile vakum fenomeni arasında ve faset eklem açısı ile alt seviye listezis arasında doğru orantı saptandı (p 0.05). Tartışma ve Sonuç: Omurga cerrahisinde spondilolistezis çoğunlukla tedavi gerektiren önemli bir sorundur. Radyolojik olarak saptanan parametreler bu patolojinin ciddiyeti ile ilgili önemli bulgular verebilir.

Anahtar Kelimeler:

Spondilolistezis, Radyolojik parametre, Spinal deformite, İnstabilite, Spinopelvik açılar

Correlation between spinopelvic angles and radiological findings of lumbar spondylolisthesis patients

Background: Spondylolisthesis is a deformity in which the upper segment is displaced anteriorly or posteriorly in the spine relative to the lower segment. In this pathology, which often causes instability, surgical treatment may be required. Also, patient’s radiological images should be evaluated carefully before treatment. We aimed to analyze clinical and radiological data with spinopelvic angles of the lumbar spondylolisthesis patients in our research. Material Method: 6593 patients who applied to the neurosurgery outpatient clinic with complaints of low back pain between January 2020 - December 2023 were retrospectively analyzed. The radiological findings of patients with spondylolisthesis, whose lumbar MRI and lumbar CT were obtained appropriately along with X-ray were evaluated in detail. Age, gender, listhesis level and degree, Cobb angle, pelvic incidence, pelvic tilt, sacral slope angle, Modic degeneration, vacuum phenomenon, annulus rupture, schmorl nodule, facet hypertrophy, osteophyte, maximum AP central canal diameter and joint lysis has been examined in these patient tests. The relationships of these data with each other were evaluated statistically. Results: 58 female and 5 male patients were found to be eligible for the study. Mean age was 59 (min 22, max 81). Grade 1 listhesis was detected in 52 of the patients. Listhesis was observed at the level of L5-S1 in 31 patients, L4-L5 in 24 patients and L3-L4 in 8 patients. A direct correlation was found between age with vacuum phenomenon, osteophyte, presence of L5-S1 listesis and lysis. Similar correlation was between pelvic incidence with sacral slop angle, facet hypertrophy and modic type 2 degeneration. Also, there was a direct correlation between pelvic incidence with pelvic tilt; between facet hypertrophy with vacuum phenomenon and lysis; ligamentum hypertrophy with vacuum phenomenon; and facet hypertrophy with lower level listesis (p 0.05). Discussion and Conclusion: Spondylolisthesis is an important problem that requires treatment in spine surgery. Radiologically determined parameters can give important findings about the severity of this pathology. These findings should be taken into consideration in the treatment of spondylolisthesis.

Keywords:

Spondylolisthesis, Radiological parameter, Spinal deformity, Instability, Spinopelvic angles,

PDF

___

Wiltse LL. The etiology of spondylolisthesis. J Bone Joint Surg Am. 1962;44-A:539-560.
Liu X, Wang L, Yuan S, et al. Multiple-level lumbar spondylolysis and spondylolisthesis. J Neurosurg Spine. 2015;22(3):283-287. doi: 10.3171/2014.10.SPINE14415
Marnach ML, Ramin KD, Ramsey PS, Song SW, Stensland JJ, An KN. Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstet Gynecol. 2003;101(2):331-335. doi: 10.1016/s0029-7844(02)02447-x
Kazemi S, Emami Razavi S Z, Azadvari M, et al. Frequency evaluation of early pregnancy in spondylolisthesis: a cross sectional study on ıranian females. Arch Neurosci. 2018;5(1):e15162. doi: 10.5812/archneurosci.15162
Suri P, Miyakoshi A, Hunter DJ, et al. Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population. BMC Musculoskelet Disord. 2011;13;12:202. doi: 10.1186/1471-2474-12-202
Motley G, Nyland J, Jacobs J, Caborn DN. The pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression. J Athl Train. 1998;33(4):351-358.
Standaert CJ, Herring SA, Halpern B, King O. Spondylolysis. Phys Med Rehabil Clin N Am. 2000;11(4):785-803.
Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011;20 Suppl 5(Suppl 5):609-618.
Hresko MT, Hirschfeld R, Buerk AA, Zurakowski D. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop. 2009;29(2):157-162. doi: 10.1097/BPO.0b013e3181977de8
Cosgun Z, Dagistan E, Dagistan Y. Effects of sagittal balance diferences on spondylolisthesis. Acta Ortop Bras. 2019;27(2):120-123. doi: 10.1590/1413-785220192702205665
Leng Y, Tang C, He B, et al. Correlation between the spinopelvic type and morphological characteristics of lumbar facet joints in degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2022;38(4):425-435. doi: 10.3171/2022.11.SPINE22979
Hsieh MK, Kao FC, Chen WJ, Chen IJ, Wang SF. The influence of spinopelvic parameters on adjacent-segment degeneration after short spinal fusion for degenerative spondylolisthesis. J Neurosurg Spine. 2018;29(4):407-413. doi:10.3171/2018.2.SPINE171160
Tunckale T, Gurdal SO, Caliskan T, et al. The impact of various breast sizes of women on vertebral column and spinopelvic parameters. Turk Neurosurg. 2021;31(5):699-703. doi: 10.5137/1019-5149.JTN.30936-20.2
Sawant n, Abraham M, George T, et al. Clinical, functional and radiological spinopelvic balance parameters assessment after transforaminal lumbar interbody fusion in grade 1 spondylolisthesis. Int Surg J. 2021;8(1):232-237. doi: 10.18203/2349-2902.isj20205886
Haddas R, Kosztowski T, Mar D, et al. Balance effort, cone of economy, and dynamic compensatory mechanisms in common degenerative spinal pathologies. Gait Posture. 2021;89:67-73. doi: 10.1016/j.gaitpost.2021.04.038
El-Daw, Sherif MD; El-Tantawy, et al. Role of machine learning in management of degenerative spondylolisthesis: a systematic review. Curr Orthop Pract. 2021;32(3):302-308. doi: 10.1097/BCO.0000000000000992
Lazennec JY, Ramaré S, Arafati N, et al. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000;9(1):47-55. doi: 10.1007/ s005860050008
Grobler LJ, Robertson PA, Novotny JE, et al. Etiology of spondylolisthesis. Assessment of the role played by lumbar facet joint morphology. Spine. 1993;18(1):80-91.
Legaye J. The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum. Eur Spine J. 2007;16(2):219-225. doi: 10.1007/s00586-006-0090-3
Liu H, Li S, Zheng Z, et al. Pelvic retroversion is the key protective mechanism of L4-5 degenerative spondylolisthesis. Eur Spine J. 2015;24(6):1204-1211. doi: 10.1007/s00586-014-3395-7
Funao H, Tsuji T, Hosogane N, et al. Comparative study of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J. 2012;21(11):2181-2187. doi: 10.1007/s00586-012-2374-0
Kırcelli A, Coven ı, Sen P, et al. The effects of spinopelvic parameters such as lumbar lordosis and sacral slope angles in the development of lumbar disc degeneration. Bezmialem Sci. 2019; 7(1):23-27. doi: 10.14235/bs.2018.2172
Ergun T, Lakadamyali H, Sahin M. The relation between sagittal morphology of the lumbosacral spine and the degree of lumbar intervertebral disc degeneration. Acta Orthopaedica et Traumatologica Turcica. 2010;44(4):293-299.
Boulay C, Tardieu C, Hecquet J, et al. Anatomical reliability of two fundamental radiological and clinical pelvic parameters: incidence and thickness. Eur J Orthop Surg Traumatol. 2005; 15(3):197-204.
Seitsalo S, Osterman K, Poussa M. Scoliosis associated with lumbar spondylolisthesis. A clinical survey of 190 young patients. Spine. 1988;13(8):899-904.