Radiographic Incidence of Lumbar Spinal Instability in Patients with Non-spondylolisthetic Low Backache

Abstract

IntroductionRadiological lumbar spinal instability may exist without obvious spondylolisthesis. We aim to determine the incidence of this non-spondylolisthetic cause of instability in conservatively managed patients and operated groups of patients. We also attempted to study the relationship between instability and its occurrence with respect to age, sex, signs and symptoms.Materials and methodsTwenty-three patients treated conservatively (group A) for non-spondylolisthetic backache were studied for radiological evidence of instability by evaluating angular rotation and sagittal translation at each lumbar motion segment. The influence of age, sex, signs and symptoms on the occurrence of instability was studied. A total of 18 patients treated surgically (group B) for non-spondylolisthetic backache in the form of discectomy/decompression were evaluated for occurrence of instability at three months, six months and nine months postoperatively.ResultsFour out of 23 patients (17.4%) in group A had radiological instability. Angular rotation was found to have negative correlation with age, while sagittal translation did not show any consistent correlation with age. Neither had any significant correlation with sex. The incidence of instability in patients treated with discectomy at three months and six months was 20% which reduced to 10% at nine months while that in patients treated with decompression was about 37.5% over three months, six months and nine months of follow-up.ConclusionIf patients with spondylolisthesis were excluded from the study, instability could still result from the rotational component in sagittal plane. Secondary iatrogenic instabilities do result in patients undergoing extensive decompression for spinal stenosis and should always be thought of.

Relationship between the morphology and composition of the lumbar paraspinal and psoas muscles and lumbar intervertebral motion in chronic low‐back pain: An exploratory study

“…This result is in line with previous studies which have used similar radiographic assessment techniques, where the L4-L5 and L3-L4 vertebral levels have been shown to demonstrate the highest amounts of mean angular rotation and sagittal translation. The lack of increased mean angular rotation and sagittal translation observed at the L5-S1 vertebral level on flexion/extension X-rays is also in line with the results of other studies (Golbakhsh et al, 2012;Rathod & Dhake, 2018), despite L5-S1 being a common location of disc degeneration. A recent kinematic MRI study showed that intervertebral disc disease was most common at this level (Roberts et al, 2021) and changes in the morphology of the MF muscle have also been most commonly observed at this vertebral level (Goubert et al, 2016;Wallwork et al, 2009).…”

“…This may be clinically relevant as it has been suggested that muscles with a higher percentage of fatty infiltration may be more resilient to change in response to exercise (Welch et al, 2015). The lack of segmental displacement of the L5–S1 vertebral level observed on standing flexion/extension X‐Rays is thought to be due to the more coronally orientated zygapophyseal joints when compared to the more sagittal orientated joints of the other lumbar vertebrae (Rathod & Dhake, 2018). With respect to the findings of increased segmental angular rotation and sagittal translation at the L3–L4 vertebral level, both displacements were increased at this level, with the rotational displacement being the 2nd highest in this sample.…”

“…Increased intervertebral motion was observed to be quite common in the current investigation, ranging from 25% to 63% of the sample of people with CLBP, at vertebral levels L1–L2 to L4–L5. Another study of a similar population reported that 17.4% of people with LBP (without spondylolisthesis) displayed increased segmental angular rotation and sagittal translation (Rathod & Dhake, 2018). Although we are unable to comment on the integrity of passive structures (such as the intervertebral disc) in the current investigation, standing flexion/extension X‐rays reflect the influence of both passive structures and muscle activation (Landi et al, 2015).…”

“…Frobin et al (Frobin et al, 1997) further progressed the technique and excessive translation or sagittal plane rotation of the lumbar vertebra in relation to their adjacent vertebrae under a physiologic load can be reliably detected (Frobin et al, 1997; Lee & Sclafani, 2013). While this has traditionally been used to assess segmental ‘instability’ associated with deficiencies in passive structures in people with spondylolisthesis, increased intervertebral motion has also been observed in people with LBP, without spondylolisthesis (Rathod & Dhake, 2018). If a relationship between impairments of muscles and increased segmental spinal motion exists in a subgroup of these patients, it could provide clinicians with a possible explanation for why exercises targeting muscles known to be associated with control of segmental motion can be helpful for some people with LBP.…”

To corset or not to corset after lumbar spine fixation surgery?: A prospective randomized clinical trial and literature review

“…[15,16] We used angular rotation, sagittal translation, and slip in neutral position change on lumbar plain film flexion and extension view to evaluate the correction loss between pre-and postoperation. [17] Angular rotation was defined as the angle change during flexion and extension between the line parallel to the lower endplate of the upper vertebra and the line parallel to the upper endplate of the lower vertebra. The sagittal translation was defined as the length change of translation of the posterior border of the upper vertebrae between flexion and extension.…”