Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association · 2018
Potential pathological mechanisms of L3 degenerative spondylolisthesis in lumbar spinal stenosis patients: A case-control study.
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Fukushima Masayoshi, Oshima Yasushi, Oka Hiroyuki, Chang Chang, Matsubayashi Yoshitaka, Taniguchi Yuki, Matsudaira Ko, Tanaka Sakae
Аннотация
BACKGROUND: Degenerative spondylolisthesis (DS) occurs mostly at L4. However, there are a small number of patients in whom it occurs only at L3. Accordingly, past reports elucidating the factors of DS have been primarily concerned with L4 DS, and few reports are available on DS at L3. The objective of this study was to compare the differences between lumbar spinal stenosis patients with or without L3 DS and to identify the possible pathological mechanisms of their L3 DS.
METHODS: Among the 369 patients with lumbar spinal stenosis who underwent lumbar surgery, we assessed 25 patients who had DS only at L3 and compared them against 50 other age- and gender-matched lumbar spinal stenosis patients without any DS. The following radiographic parameters: pelvic incidence, sacral slope, pelvic tilt, L3 slope, L4 slope, L5 slope, and lumbar lordosis were measured on radiographs. The orientation of facet joints and disc heights were measured via computed tomography.
RESULTS: Imaging findings showed that the L3, L4, and L5 slopes in the L3 DS group were significantly greater than in the non-DS group, and only L3/4 facet joints in the L3 DS group were significantly more sagittally oriented than in the control group. The number of patients with low disc heights at L4/5 in the L3 DS group was significantly greater than in the control group.
CONCLUSIONS: The results suggested that the greater lumbar slope, including L3 together with more sagittally oriented facet joints only at L3/4 and not at L4/5, may lead to DS only at L3.
METHODS: Among the 369 patients with lumbar spinal stenosis who underwent lumbar surgery, we assessed 25 patients who had DS only at L3 and compared them against 50 other age- and gender-matched lumbar spinal stenosis patients without any DS. The following radiographic parameters: pelvic incidence, sacral slope, pelvic tilt, L3 slope, L4 slope, L5 slope, and lumbar lordosis were measured on radiographs. The orientation of facet joints and disc heights were measured via computed tomography.
RESULTS: Imaging findings showed that the L3, L4, and L5 slopes in the L3 DS group were significantly greater than in the non-DS group, and only L3/4 facet joints in the L3 DS group were significantly more sagittally oriented than in the control group. The number of patients with low disc heights at L4/5 in the L3 DS group was significantly greater than in the control group.
CONCLUSIONS: The results suggested that the greater lumbar slope, including L3 together with more sagittally oriented facet joints only at L3/4 and not at L4/5, may lead to DS only at L3.