Three dimensional test of lumbar canal volume in degenerative spondylolisthesis patients under physiological load

doi:10.3969/j.issn.2095-4344.2014.53.020

Abstract

Abstract:

BACKGROUND: Lumbar degenerative spondylolisthesis, typically characterized by the forward slippage of the superior vertebra of a lumbar motion segment, is a common spinal pathological condition in elderly individuals. Significant deformation and volume changes of the spinal canal can occur because of the vertebral slippage, but few data have been reported on these anatomic variations in lumbar degenerative spondylolisthesis patients. Whether to restore normal anatomy, such as reduction of the slippage and restoration of disc height, is still not clear in surgery.
OBJECTIVE: To observe the volume change of the spine canal and anatomic factors affecting the spine canal volume in lumbar degenerative spondylolisthesis patients.
METHODS: A total of 15 asymptomatic volunteers (normal group) at the age of 55±7 years and 15 patients with L4 spondylolisthesis (trial group) at the age of 54±6 years were recruited. Dual X-ray imaging system was combined with spiral CT. Lumbar three-dimensional reconstruction models were obtained from lumbar thin-section CT of subjects. In vivo lumbar vertebral motion during functional postures (supine, standing, flexion and extension) was observed using a dual fluoroscopic imaging technique. The volume of the spine canal was measured at each functional posture. Various anatomic parameters (disc height, cross-sectional area of the canal, left-right diameter of the canal, anterior-posterior diameter of the canal, slippage, posture, and intervertebral disc angle) that may potentially affect the canal volume were also measured.
RESULTS AND CONCLUSION: Spine canal volume was larger at supine and flexion postures than at stand and extension postures in both the normal and trial groups. Spine canal volume in the trial group was significantly lower than that in the normal group under all the four postures (P < 0.05). Pearson correlation analysis showed that L_4-5 spine canal volume was strongly correlated with the L_4-5 posterior disc height (γb = 0.80), correlated with the slippage percentage (γb = -0.61), and weakly associated with the L_4-5 anterior disc height (γb = 0.28) and the disc angle (γb = -0.24). Above data indicated that the volume of spine canal is affected by multiple factors in patients with lumbar degenerative spondylolisthesis. Increased spine canal volume at supine and flexion positions may explain the clinical observations of relief of symptoms at these postures in lumbar degenerative spondylolisthesis patients. The reduction of slipped vertebral body, decrease of disc angle, intervertebral distraction, as well as decompression could be effective to increase the canal volume and to relieve clinical symptoms.

Key words: lumbar vertebrae, degenerative spondylolisthesis, spinal stenosis, dissection

CLC Number:

R318

Xu Hong-da, Miao Jun, Xia Qun . Three dimensional test of lumbar canal volume in degenerative spondylolisthesis patients under physiological load[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(53): 8634-8640.

Figures/Tables 1

References

[1] Smorgick Y, Mirovsky Y, Fischgrund JS, et al. Radiographic predisposing factors for degenerative spondylolisthesis. Orthopedics. 2014;37(3): e260-264.
[2] Kepler CK, Hilibrand AS, Sayadipour A, et al. Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification. Spine J. 2014. Epub ahead of print.
[3] Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: review of current trends and controversies. Spine (Phila Pa 1976). 2005;30(6 Suppl): S71-81.
[4] Dai LY, Xu YK, Zhang WM, et al. The effect of flexion-extension motion of the lumbar spine on the capacity of the spinal canal. An experimental study. Spine (Phila Pa 1976). 1989;14(5): 523-525.
[5] Willen J, Danielson B, Gaulitz A, et al. Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976). 1997;22(24): 2968-2976.
[6] Mauch F, Jung C, Huth J, et al. Changes in the lumbar spine of athletes from supine to the true-standing position in magnetic resonance imaging. Spine (Phila Pa 1976). 2010;35(9):1002-1007.
[7] Madsen R, Jensen TS, Pope M, et al. The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis. Spine (Phila Pa 1976). 2008;33(1): 61-67.
[8] Danielson B, Willen J. Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals. Spine (Phila Pa 1976). 2001;26(23):2601-2606.
[9] Hirasawa Y, Bashir WA, Smith FW, et al. Postural changes of the dural sac in the lumbar spines of asymptomatic individuals using positional stand-up magnetic resonance imaging. Spine (Phila Pa 1976). 2007;32(4): E136-140.
[10] Eubanks BA, Cann CE, Brant-Zawadzki M. CT measurement of the diameter of spinal and other bony canals: effects of section angle and thickness. Radiology. 1985;157(1): 243-246.
[11] Bayley JC, Kruger DM, Schlegel JM. Does the angle of the computed tomographic scan change spinal canal measurements? Spine (Phila Pa 1976). 1991;16(10 Suppl): S526-529.
[12] 夏群, Wang SB, Li GA.腰椎椎体间旋转中心的在体研究[J]. 中华骨科杂志,2010,30(4):325-329.
[13] Bai JQ, Hu YC, Du LQ, et al. Assessing validation of dual fluoroscopic image matching method for measurement of in vivo spine kinematics. Chin Med J (Engl). 2011;124(11): 1689-1694.
[14] Niggemann P, Kuchta J, Grosskurth D, et al. Spondylolysis and isthmic spondylolisthesis: impact of vertebral hypoplasia on the use of the Meyerding classification. Br J Radiol. 2012;85(1012):358-362.
[15] Hong SW, Lee HY, Kim KH, et al. Interspinous ligamentoplasty in the treatment of degenerative spondylolisthesis: midterm clinical results. J Neurosurg Spine. 2010;13(1):27-35.
[16] Wan Z, Wang S, Kozanek M, et al. Biomechanical evaluation of the X-Stop device for surgical treatment of lumbar spinal stenosis. J Spinal Disord Tech. 2012;25(7):374-378.
[17] Mannion AF, Pittet V, Steiger F, et al. Development of appropriateness criteria for the surgical treatment of symptomatic lumbar degenerative spondylolisthesis (LDS). Eur Spine J. 2014. Epub ahead of print.
[18] Audat ZM, Darwish FT, Al Barbarawi MM, et al. Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction. Scoliosis. 2011; 6(1):14-21.
[19] Steiger F, Becker HJ, Standaert CJ, et al. Surgery in lumbar degenerative spondylolisthesis: indications, outcomes and complications. A systematic review. Eur Spine J. 2014;23(5): 945-973.
[20] Roussouly P, Gollogly S, Berthonnaud E, et al. Sagittal alignment of the spine and pelvis in the presence of L5-s1 isthmic lysis and low-grade spondylolisthesis. Spine (Phila Pa 1976). 2006; 31(21):2484-2490.
[21] Labelle H, Roussouly P, Chopin D, et al. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J. 2008; 17(9):1170-1176.
[22] Yan DL, Pei FX, Li J, et al. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J. 2008;17(10):1311-1316.
[23] Takahashi K, Kitahara H, Yamagata M, et al. Long-term results of anterior interbody fusion for treatment of degenerative spondylolisthesis. Spine (Phila Pa 1976). 1990; 15(11):1211-1215.
[24] McAfee PC, DeVine JG, Chaput CD, et al. The indications for interbody fusion cages in the treatment of spondylolisthesis: analysis of 120 cases. Spine (Phila Pa 1976). 2005;30 (6 Suppl):S60-65.
[25] Vamvanij V, Ferrara LA, Hai Y, et al. Quantitative changes in spinal canal dimensions using interbody distraction for spondylolisthesis. Spine (Phila Pa 1976). 2001;26(3):E13-18.
[26] Infusa A, An HS, Glover JM, et al. The ideal amount of lumbar foraminal distraction for pedicle screw instrumentation. Spine (Phila Pa 1976). 1996;21(19):2218-2223.
[27] Majid K, Fischgrund JS. Degenerative lumbar spondylolisthesis: trends in management. J Am Acad Orthop Surg. 2008;16(4):208-215.
[28] Bassewitz H, Herkowitz H. Lumbar stenosis with spondylolisthesis: current concepts of surgical treatment. Clin Orthop Relat Res. 2001;(38):54-60.
[29] Chang HS, Fujisawa N, Tsuchiya T, et al. Degenerative spondylolisthesis does not affect the outcome of unilateral laminotomy with bilateral decompression in patients with lumbar stenosis. Spine (Phila Pa 1976). 2014;39(5):400-408.
[30] Chen IR, Wei TS. Disc height and lumbar index as independent predictors of degenerative spondylolisthesis in middle-aged women with low back pain. Spine. 2009;34: 1402-1409.
[31] Kalichman L, Hunter DJ, Kim DH, et al. Association between disc degeneration and degenerative spondylolisthesis? Pilot study. J Back Musculoskelet Rehabil. 2009;22:21-25.
[32] Chagnon A, Aubin CE, Villemure I.Biomechanical influence of disk properties on the load transfer of healthy and degenerated disks using a poroelastic finite element model. J Biomech Eng. 2010;132:136.
[33] Toyone T, Ozawa T, Kamikawa K, et al.Facet joint orientation difference between cephalad and caudad portions: a possible cause of degenerative spondylolisthesis. Spine. 2009;34: 2259-2262.
[34] Fujiwara A, Tamai K, An HS, et al.The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord. 2009;13: 444-450.
[35] Takayanagi K, Takahashi K, Yamagata M, et al.Using cineradiography for continuous dynamic-motion analysis of the lumbar spine. Spine. 2001;26:1858-1865.
[36] Okawa A, Shinomiya K, Komori H, et al.Dynamic motion study of the whole lumbar spine by videofluoroscopy. Spine. 2001;23:1743-1749.