Article
Intermodal comparison of supine magnetic resonance imaging (MRI) and computed tomography (CT) versus functional radiographs to determine dynamic instability in patients with lumbar degenerative spondylolisthesis
Bedeutung von Röntgenfunktionsaufnahmen im Vergleich zur Schnittbildgebung mittels CT und MRT in der Detektion einer Instabilität bei Spondylolisthesis der Lendenwirbelsäule
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Authors
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Harald Krenzlin
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Naureen Keric
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Sven Rainer Kantelhardt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Spondylolisthesis is defined as anterior displacement of one vertebra relative to the subjacent vertebra. Spondylolisthesis is most common on level L4/L5 or, less commonly, L5/S1 or L3/L4. Symptoms arise through a combination of the degenerative changes, segmental instability and consecutive stenosis. In this study, we sought to identify the proportion of patients with dynamic instability using single functional radiographs compared to supine CT or MRI.
Methods: Data acquisition was conducted as a single-center retrospective analysis. Patients presenting with spondylolisthesis from June 1st, 2018, to May 30th, 2020 with functional radiographs and either CT or MRI were included in our analysis. The amount of translation, in millimeters, was calculated on supine MRI, CT and radiographs of inclination while sitting, -standing reclination and prone using the Meyerding technique. The amount of translation was compared between CT and MRI and each radiograph to either CT or MRI.
Results: One hundred and thirteen patients with spondylolisthesis on one hundred twenty-five vertebral levels were included in this study. The mean patient age was 73.52+-12.59 years. 69 (60.5%) patients were female, 45 (39.5%) male. The most commonly affected level was L4-5 (62.4%). Levels L3-4 (16%) and L5-S1 (13.6%) were affected equally. The average translations measured on supine CT was 4.13+-5.93mm and 4.417+-3.492mm on MRI. The difference of inclination while sitting radiographs to slice imaging was 3.373+-3.642mm, inclination while standing to slice imaging was 2.665+-3.031mm, reclination while standing to slice imaging was 1.596+-3.148mm and prone to slice imaging was 2.189+-3.020mm. While no statistically significant difference was detected between CT and MRI, both were statically significant different to all radiographic modalities. The largest differences were detected between inclination while sitting and CT/MRI.
Conclusion: In this study, we analyzed the meaning of different functional radiograph modalities versus CT and MRI for detection of dynamic instability in lumbar spondylolisthesis. We showed that radiograph modality (inclination, reclination or prone) in comparison to CT or MRI is sufficient to detect lumbar instability. Therefore, putting patients through different positions during functional radiographic imaging causes avoidable radiation exposure, discomfort and costs to our health care system.
