Correlation between spinopelvic angles and radiological findings of lumbar spondylolisthesis patients

Abstract

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

Lomber spondilolistezis saptanan hastaların radyolojik ve klinik verilerinin karşılaştırılması

Abstract

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.

Keywords

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

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