Bel ağrılı hastalarda, radyografi ile spondilolistezisin özelliklerinin incelenmesi

Öz

Amaç: Bu çalışmanın amacı hem bel ağrılı hastalarda spondilolistezisin yaş ve cinsiyete göre spondilolistezis özelliklerini tanımlamak olup, hem de spondilolistezis ile diğer radyolojik bulguların ilişkisini değerlendirmektir. Yöntem: Bel ağrısı ile kliniğimize başvuran 904 hasta dosyası incelendi. Kriterleri karşılayan 348 (245 kadın, 103 erkek) hasta çalışmaya alındı ve yaş, cinsiyet ve anterior/lateral lomber grafi bilgileri kaydedildi. Lomber grafileri, osteofit, intervertebral disk daralması, spondiloz, skolyoz, kırık, lordozda düzleşme, hiperlordoz, sakralizasyon, lumbarizasyon, spina bifida okkülta ve “Meyerding Skalası” ile spondilolistezis açısından değerlendirildi. Bulgular: İncelenen radyografilerde en sık saptanan bulgu hem kadınlarda (%77.6), hem de erkeklerde (%75.1) spondiloz (%75.8) idi. Spondilolistezis ise 348 hastanın %11.4’ünde saptandı. (erkek/kadın oranı: 2.95/1 idi). Tüm erkek hastaların L5-S1 aralığında, tek seviyeli spondilolistezisi mevcut olup, 35 spondilolistezisli kadın hasta incelendiğinde; 32 (%91.5) hastanın L5-S1’te tek seviyeli idi. 40 hastanın 37’sinde (%92.5) spondilolistezis anterolistezis karakterli idi. Ayrıca hastaların %77.5’inde meyerding evre 1 karakterli idi. Spondilolistezisli hastalarda en sık saptanan radyolojik bulgular sırasıyla skleroz (%95), osteofit (%62.5), intervertebral disk daralması (%62.5) ve skolyoz (%37.5) idi. Sonuç: Spondilolistezis sıklığı kadınlarda fazla saptanmış olup, her iki cinsiyette de yaşla arttığı gözlenmiştir. Spondilolistezisin saptanan genel özellikleri: çoğunlukla tek seviyeli ve Meyerding’e göre evre 1 olmasıdır. Ayrıca anterolistezis, retrolistezise göre belirgin fazla saptanmıştır. Spondilolistezise en sık eşlik eden radyolojik bulgular ise: skleroz, osteofit ve intervertebral disk daralması olarak saptanmıştır.

Anahtar Kelimeler

• Bel ağrısı
• Spondilolistezis
• Spondiloz

Evaluating the characteristics of spondylolisthesis in low back pain by radiography

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.

Keywords

• Low back pain
• Spondylolisthesis
• Spondylosis

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