Clinical evaluation, with a thorough physical examination and detailed penetration of symptomatology, is an important step in the diagnosis of DS.
To investigate whether upright radiographs can predict lumbar spinal canal stenosis using supine lumbar magnetic resonance imaging (MRI) and to investigate the detection performance for spondylolisthesis on upright radiographs compared with supine MRI in patients with suspected lumbar spinal canal stenosis (LSS).
In this retrospective study, conventional radiographs and MR images of 143 consecutive patients with suspected LSS (75 female, mean age 72 years) were evaluated.
The range of segmental vertebral mobility in DS is wide, without any universally accepted definition for either the term “instability” or which imaging techniques should be adopted to verify it – uniform reference standards are lacking.
To quantify mobility in DS, many doctors employ the use of functional imaging techniques, such as lateral flexion/extension radiographs, since they have the potential to reveal an increased translation. were one of the first to state that flexion/extension radiographs revealed instability, with many followers also claiming that such functional imaging is important for assessing grade of pathological translation in DS. found what they defined as a pathological slip in 11% of their 100 studied spondylolisthesis patients (83% DS) with flexion/extension radiographs, which had not been apparent in standing/recumbent position radiographs.
This study was approved by the local ethical committee of the University of Zurich, Switzerland.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.Perpendicular lines are drawn along the posterior border of the superior vertebra (B) and the inferior vertebra (C) respectively. Schematic illustrations of Meyerding Classification (A) and Taillard Method (B), respectively.The distance between B) and C) at the level of A) are measured to obtain the grade of sagittal translation (D). In the Meyerding Classification, the inferior vertebral body is divided into quartiles (I-IV).The presence and extent of listhesis (median ± interquartile range) were assessed on upright radiographs and supine MRI of L4/5.In addition, the grade of central spinal stenosis of the same level was evaluated on MRI according to the classification of Schizas and correlated with the severity/grading of anterolisthesis on radiographs.Standard radiographs in anteroposterior (AP) and lateral views in a neutral position are considered the most appropriate imaging test to detect DS.This highlights the importance of performing weight-bearing imaging investigations when diagnosing and evaluating the grade of DS.Spondylolisthesis is classified into how many quartiles the superior vertebra is overhanging the inferior vertebral body. This instability theory is based on the occasional findings of increased translation on functional imaging.With the Taillard Method, the percentage of slip of the superior vertebra relative to the superior aspect of the inferior vertebra is calculated (A/B)x100. This theory has also contributed to the popularity of adding fusion surgery in patients with spinal stenosis in need of decompression surgery, aiming to stabilize a DS segment.Radiographs are particularly able to demonstrate anterolisthesis of one vertebra relative to the subjacent, without a pars interarticularis defect (Fig. In addition, DS is frequently accompanied by degenerative scoliosis, sometimes even with elements of rotational translation, which might be a diagnostic challenge.Regarding alignment, degenerative spinal changes may, in addition to sagittal translation, lead to a kyphotic disc angle at the affected level.