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

Nordberg

Semin Musculoskelet Radiol

et al. 2019

Symptoms of degenerative lumbar spinal stenosis include back pain, radiculopathy, claudication, and muscular fatigue that tend to be predominant in the standing position or during walking. Lumbar spondylolisthesis is also a well-known cause of spinal stenosis, lateral recess, and neural foraminal narrowing that tends to become more severe in the upright position. This indicates a functional positional component of both spinal stenosis and spondylolisthesis. Lumbar spinal stenosis and spondylolisthesis are typically evaluated by magnetic resonance imaging (MRI) performed in the supine position with a pillow under the patient's lower limbs that slightly flexes the lumbar spine and ameliorates symptoms. Because these two entities tend to be aggravated in the upright position, it seems rational to also consider performing diagnostic imaging in these patients in the upright position. This article reviews the use of weight-bearing MRI for lumbar spinal stenosis and spondylolisthesis.

Section: Spondylolisthesis With Degenerative Spondylolysismentioning

confidence: 99%

Section: Spondylolisthesis With Degenerative Spondylolysismentioning

confidence: 99%

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Weight-bearing MRI of the Lumbar Spine: Spinal Stenosis and Spondylolisthesis

Nordberg

Semin Musculoskelet Radiol

et al. 2019

“…Additionally, MRI does not expose the patient to radiation. Several studies have found MRI characteristics associated with clinical and radiological instability (2,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). These include facet joint effusion, disc degeneration/height, degenerative spondylolisthesis, facet joint angle and facet joint morphology.…”

Section: Introductionmentioning

confidence: 99%

Definitions of segmental instability in the degenerative lumbar spine and validation of these definitions: a systematic review protocol article according to PRISMA-P 2015 statement

Elmose

Andersen

Carreon

et al. 2020

Preprint

Background The concept of segmental lumbar spine instability is controversial with varying definitions. However, suspicion of instability is used as an indication for vertebral fusion surgery in patients with lumbar degenerative spondylolisthesis and spinal stenosis. The objectives of this systematic review are to describe, the definitions of segmental instability in the degenerative lumbar spine, in studies of patients with lumbar spinal stenosis and/or lumbar degenerative spondylolisthesis, involving diagnostic imaging. And to describe which of the measurable radiological variables used to define instability have been validated against dynamic flexion-extension radiographs. Method Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Systematic literature search will be conducted in MEDLINE and EMBASE databases, supplemented by search in Cochrane Library. International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov will be searched for ongoing or recently completed trials. PROSPERO (International Prospective Register of Systematic Reviews) will be searched before initiating this review. In addition, a gray literature search will be conducted. Studies eligible for inclusion are clinical and biomechanical studies on adult patients with degenerative spondylolisthesis and spinal stenosis and surgical treatment hereof, studies involving diagnostic imaging. We will include studies giving a definition or describing patho-anatomical findings of segmental instability or any synonym or antonym hereof. Two reviewers will independently screen articles, involving a third reviewer as referee. Screening process and data extraction conducted using Covidence software. Data synthesis presented in results checklist and systematic narrative synthesis. Data synthesis on secondary objective by contingency table. Discussion With this systematic review we want to contribute to evidence based treatment planning of lumbar degenerative spondylolisthesis with spinal stenosis. We also aim to present our result in a comprehensive manner, to encourage consensus regarding the definition of segmental instability. Registration This protocol was submitted to the International Prospective Register of Systematic Reviews (PROSPERO) on 29. April 2020, submission ID: 182827

“…5 However, an MRI with the patient in the supine position presents limitations in the evaluation of subtle deformities that appear only when the patient is standing, for example, some cases of vertebral translation. 5,[9][10][11][12][13] The presence of hyperintense signals in T2 in the facet joints in MRI axial cuts of the lumbar spine has been being discussed for many years. 5 T2 weightings are used, since, differently from the T1 used in the evaluation of the normal anatomy, T2 weightings show extracellular water as a high-intensity signal.…”

Section: Introductionmentioning

confidence: 99%

Image Correlation Between Facet Effusion and Lumbar Instability

et al. 2019

Objective To assess the incidence of facet effusion in lumbosacral spine magnetic resonance imaging (MRI) and the relationship with radiographic segmental instability in patients submitted to spinal surgery. Methods Retrospective cohort study of patients submitted to lumbosacral spine surgery over a period of three years, through the evaluation of dynamic radiographs (X-ray) motion and facet effusion in axial section of MRI. Instability was defined as vertebral translation > 3 mm or intervertebral angle > 10º, and facet effusion as fluid in the facet joints > 1.5 mm. Results The total number of patients that fulfilled the criteria for analysis was 244, of which 47 presented movement (≤ 3 mm) and 31 presented excessive movement (> 3 mm), 115 had facet effusion (≤ 1.5 mm) and 46 presented excessive fluid (> 1.5 mm). Statistical analysis did not demonstrate a significant association between increased segmental movement and facet effusion (p = 0.150). Conclusions The total incidence of facet effusion was 47.1% and the excessive fluid was 18.9%.There was no association between facet effusion in MRI and instability in dynamic X-ray. MRI does not replace dynamic X-ray in flexion and extension in the evaluations of lumbar instability. Level of evidence III; Retrospective Cohort.