Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine

Abstract

Introduction Little is known about when and how progressive spondylolisthesis occurs. In this report segmental motion related to age and disc degeneration at L4/5 disc was investigated. Materials and methods 637 patients with low back and/or leg pain underwent radiologic and MRI examinations simultaneously. Because 190 patients with conditions which might impede accurate measurement were excluded, 447 patients, comprising 268 men and 179 women, were included; age range, was 10-86 (mean: 53) years. Three radiologic parameters slip in neutral position (mm), sagittal translation (mm), and segmental angulation (degrees) were examined at the L4/5 segment. On T2-weighted MRI, severity of disc degeneration at L4/5 was classified by Pfirrmann's criteria, grade 1-5. Results Results showed stage of disc degeneration that progressed according to aging with significant differences except for between grades 4 and 5. Amount of anterior slip was small among grades 1 to 3; however, it greatly increased between grades 3 and 4 and between grades 4 and 5, suggesting that grade 3 disc degeneration has a potential risk of future progression of anterior slip. This finding may also suggest that once significant slip occurs, it will progress to the final grade. Furthermore, the grade 3 degeneration group exhibited large amounts of motion in both angulation and translation, suggesting it was the most unstable group. Conclusion Our results with radiography and MRI indicate that grade 3 disc degeneration is a critical stage for the progression of lumbar spondylolisthesis at L4/5 segment.

Instability of the lumbar spine due to disc degeneration. A finite element simulation

“…That is in line with the majority of published studies, as well as clinical evidence [31][32][33][34][35][36][37].…”

T1ρ and T2 Mapping of the Intervertebral Disk: Comparison of Different Methods of Segmentation

“…The presence of osteophytes should also be considered carefully so that the segmentation does not encompass these regions. 25 Other accentuated postural changes, vertebral fractures, listhesis, or extruded disk herniation could also result in uneven disk degeneration, 24,26 so that using only central sagittal sections for data extraction could result in a different composition assessment of the disk. Our sample had no volunteer with deformities, fractures, or disk herniation.…”

Sensitivity of magnetic resonance imaging in the diagnosis of mobile and nonmobile L4–L5 degenerative spondylolisthesis

“…Disc degeneration was evaluated according to the Pfirrmann classification that rates disc integrity on a scale of one (intact) to five (severe degeneration) [14,15]. Interobserver disagreement for disc degeneration was reconciled in conference [14,16]. We defined spondylolisthesis as a 4.5 mm slip and measured the severity of slip according to the Tailliard method, where the slip distance is divided by the length of the L5 vertebra to obtain a slip percentage [4,7,9,17].…”