Degenerative Spondylolisthesis Is Associated with Low Spinal Bone Density: A Comparative Study between Spinal Stenosis and Degenerative Spondylolisthesis

Abstract

Spinal stenosis and degenerative spondylolisthesis share many symptoms and the same treatment, but their causes remain unclear. Bone mineral density has been suggested to play a role. The aim of this study was to investigate differences in spinal bone density between spinal stenosis and degenerative spondylolisthesis patients. 81 patients older than 60 years, who underwent DXA-scanning of their lumbar spine one year after a lumbar spinal fusion procedure, were included. Radiographs were assessed for disc height, vertebral wedging, and osteophytosis. Pain was assessed using the Low Back Pain Rating Scale pain index. T-score of the lumbar spine was significantly lower among degenerative spondylolisthesis patients compared with spinal stenosis patients (−1.52 versus −0.52, P = 0.04). Thirty-nine percent of degenerative spondylolisthesis patients were classified as osteoporotic and further 30% osteopenic compared to only 9% of spinal stenosis patients being osteoporotic and 30% osteopenic (P = 0.01). Pain levels tended to increase with poorer bone status (P = 0.06). Patients treated surgically for symptomatic degenerative spondylolisthesis have much lower bone mass than patients of similar age treated surgically for spinal stenosis. Low BMD might play a role in the development of the degenerative spondylolisthesis, further studies are needed to clarify this.

A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

“…The study by Anderson et al in 2013 found a higher rate of low bone mass in patients with degenerative spondylolisthesis than spinal stenosis. 3 These patients had higher pain scores at 1 year after surgery. This highlights the importance of the treatment of osteoporosis before surgery to improve postoperative outcomes.…”

Surgical treatment of low grade spondylolisthesis: the modern state of the problem

“…До 80 % случаев выявления дегенеративного спондилолистеза происходят на уровне L 4 -L 5 , 20 % -на L 3 -L 4 и L 5 -S 1 . Наиболее часто дегенеративный спондилолистез возникает у пациентов старше 40 лет, в 39 % случаев сопровождается остеопорозом [14].…”

“…За точку отсчета в шкале Hounsfield (0 HU) принята плотность воды. Средние денситометрические показатели костной плотности составляют +400 HU и выше [14,54].…”

“…Проблема остеопороза является важной для пациентов пожилой и старческой возрастных групп с дегенеративным (low grade) спондилолистезом. Andersen [14] сообщил о 39 % случаев выявления остеопороза у пациентов, оперированных по поводу листеза low grade. Основываясь на данных рентгенологического исследования, Dambacher и Broll [18] описали признаки остеопороза: крупнопетлистый рисунок кости, истончение кортикального слоя, подчеркнутость краев кортикального слоя.…”

Indikationen zur Korrekturspondylodese bei degenerativer Spondylolisthesis

“…Da die Erkrankung bei Frauen etwa 4× häufiger vorkommt als bei Männern, werden auch hormonelle Ursachen diskutiert. Eine verminderte Knochendichte könnte ebenfalls eine Rolle bei der Entstehung der DLS spielen [7]. Rein mechanische Konzepte sehen in einem hohen Beckenneigungswinkel (PI, Pelvic Incidence) einen Risikofaktor für die Entwicklung der degenerativen lumbalen Spondylolisthese [8].…”