What are the reliable radiological indicators of lumbar segmental instability?

Hara, Kazuhiro; Shimoda, Haruka; Kitahara, Ko; Sasaki, Kunio; Homma, Takao

doi:10.1302/0301-620x.93b5.25520

Cited by 43 publications

(32 citation statements)

References 32 publications

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“…We used absolute angles, indicating that we did not consider rotation in one direction as positive nor rotation in the opposite direction as negative. The FJ orientation was labeled as coronal if angles were > 45° and sagittal if angles were ≤ 45° [51]. …”

Section: Methodsmentioning

confidence: 99%

Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine

Jentzsch¹,

Geiger²,

Bouaicha³

et al. 2013

BMC Med Imaging

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BackgroundCorrect sagittal alignment with a balanced pelvis and spine is crucial in the management of spinal disorders. The pelvic incidence (PI) describes the sagittal pelvic alignment and is position-independent. It has barely been investigated on CT scans. Furthermore, no studies have focused on the association between PI and facet joint (FJ) arthritis and orientation. Therefore, our goal was to clarify the remaining issues about PI in regard to (1) physiologic values, (2) age, (3) gender, (4) lumbar lordosis (LL) and (5) FJ arthritis and orientation using CT scans.MethodsWe retrospectively analyzed CT scans of 620 individuals, with a mean age of 43 years, who presented to our traumatology department and underwent a whole body CT scan, between 2008 and 2010. The PI was determined on sagittal CT planes of the pelvis by measuring the angle between the hip axis to an orthogonal line originating at the center of the superior end plate axis of the first sacral vertebra. We also evaluated LL, FJ arthritis and orientation of the lumbar spine.Results596 individuals yielded results for (1) PI with a mean of 50.8°. There was no significant difference for PI and (2) age, nor (3) gender. PI was significantly and linearly correlated with (4) LL (p = < 0.0001). Interestingly, PI and (5) FJ arthritis displayed a significant and linear correlation (p = 0.0062) with a cut-off point at 50°. An increased PI was also significantly associated with more sagitally oriented FJs at L5/S1 (p = 0.01).ConclusionPI is not correlated with age nor gender. However, this is the first report showing that PI is significantly and linearly associated with LL, FJ arthritis and more sagittal FJ orientation at the lower lumbar spine. This may be caused by a higher contact force on the lower lumbar FJs by an increased PI. Once symptomatic or in the event of spinal trauma, patients with increased PI and LL could benefit from corrective surgery and spondylodesis.

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Section: Methodsmentioning

confidence: 99%

Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine

Jentzsch¹,

Geiger²,

Bouaicha³

et al. 2013

BMC Med Imaging

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“…Measurement of dynamic intersegmental stability requires technologically demanding methods such as videofluoroscopy [14,15] and intraoperative biomechanical testing [16,17]; although they are reliable, these methods have been shown to have limited clinical applicability. Thus, to overcome this issue, researchers have focused on measuring entire spine motions, while applying external force [18], sudden load release [19,20], or postural perturbation [21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Quantification of Lumbar Stability During Wall Plank‐and‐Roll Activity Using Inertial Sensors

Yoon

Lee

Kim

et al. 2015

PM&R

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Certain amounts and patterns of lumbar postural changes were observed in healthy young subjects, with no significant variations based on gender, rolling side, or truncal muscle power. Application of the evaluation on LBP patients revealed prominent deviations from the healthy postural changes, suggesting potential clinical applicability. Therefore, with appropriate development and case stratification, we believe that the quantification of lumbar postural changes during WPR activity can be used to assess dynamic lumbar stability in clinical practice.

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“…FJ orientation was calculated by averaging the angle between the right and left side of the FJs. The FJ orientation was labeled as coronal if angles were > 45°, sagittal if angles were ≤ 45° and anisotropic if one side was over and the other side under 45° [42].…”

Section: Methodsmentioning

confidence: 99%

Hyperlordosis is Associated With Facet Joint Pathology at the Lower Lumbar Spine

Jentzsch¹,

Geiger²,

König³

et al. 2017

Clinical Spine Surgery: A Spine Publication

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STUDY DESIGN:: A retrospective study. OBJECTIVE:: Our study opted to clarify the remaining issues of lumbar lordosis (LL) in regard to (1) its physiologic values, (2) age, (3) gender, (4) facet joint (FJ) arthritis and orientation using CT scans. SUMMARYOF BACKGROUND DATA:: Recent studies have questioned whether LL really decreases with age, but study sample sizes have been rather small and mostly been based on X-rays. Since hyperlordosis increases the load transferred through the FJs, it seems plausible that hyperlordosis may lead to FJ arthritis at the lower lumbar spine. METHODS:: We retrospectively analyzed CT scans of 620 individuals, with a mean age of 42.5 (range, 14-94) years, who presented to our traumatology department and underwent a whole body CT scan, between 2008 and 2010. LL was evaluated between the superior endplates of L1 and S1. FJs of the lumbar spine were evaluated for arthritis and orientation between the L2 and S1. RESULTS:: (1) The mean LL was 49.0°(SD 11.1°, range 11.4-80.1°). (2) LL increased with age and there was a significant difference in LL in our age groups (30, 31-50, 51-70 and 71 y) (P=0.02). (3) There was no significant difference in LL between females and males (50°and 49°) (P=0.17). (4) LL showed a significant linear association with FJ arthritis (P=0.0026, OR=1.022 [1.008-1.036]) and sagittal FJ orientation at L5/S1 (P=0.001). In a logistic regression analysis the cut-off point for LL was 49.4°. CONCLUSION:: This is the largest CT-based study on LL and FJs. LL significantly increases with age. As a novelty finding, hyperlordosis is significantyly associated with FJ arthritis and sagittal FJ orientation at the lower lumbar spine. Thus hyperlordosis may present with back pain and patients may benefit from surgical correction, for example in the setting of trauma. The authors declare that they have not received funding for research on which our article is based.The authors declare that they have no competing interests. Objective. Our study opted to clarify the remaining issues of lumbar lordosis (LL) in regard to(1) its physiologic values, (2) age, (3) gender, (4) facet joint (FJ) arthritis and orientation using CT scans.Summary of Background Data. Recent studies have questioned whether LL really decreases with age, but study sample sizes have been rather small and mostly been based on X-rays.Since hyperlordosis increases the load transferred through the FJs, it seems plausible that hyperlordosis may lead to FJ arthritis at the lower lumbar spine.Methods. We retrospectively analyzed CT scans of 620 individuals, with a mean age of 42.5(range, 14-94) years, who presented to our traumatology department and underwent a whole body CT scan, between 2008 and 2010. LL was evaluated between the superior endplates of L1 and S1. FJs of the lumbar spine were evaluated for arthritis and orientation between the L2 and S1.Results.(1) The mean LL was 49.0° (SD 11.1°, range 11.4 -80.1°). (2) LL increased with age and there was a significant difference in LL in our age groups (≤ 30, 31...

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What are the reliable radiological indicators of lumbar segmental instability?

Cited by 43 publications

References 32 publications

Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine

Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine

Quantification of Lumbar Stability During Wall Plank‐and‐Roll Activity Using Inertial Sensors

Hyperlordosis is Associated With Facet Joint Pathology at the Lower Lumbar Spine

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