Vertebral three-dimensional motion characteristics of adjacent segments in patients with isthmic spondylolisthesis <i>in vivo</i> _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Hongda ¹ , LIU Jianan ¹ , LI Hongda ² , WEI Dong ² ,  MIAO Jun ¹ , XIA Qun ²

1. Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China;
2. Department of Orthopedics, Affiliated Hospital of Logistics University of Chinese People’s Armed Police Forces, Tianjin, 300162, P.R.China;

Corresponding?author：

MIAO Jun, Email: mj8866@163.com

Keywords：

Lumbar spine; isthmic spondylolisthesis; kinematics; spinal surgery

DOI：

10.7507/1002-1892.201807026

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ObjectiveTo observe vertebral three-dimensional motion characteristics of adjacent segments in patients with symptomatic L₄ isthmic spondylolisthesis (IS). MethodsFourteen symptomatic L₄ IS patients who underwent surgery treatment (trial group) and 15 asymptomatic volunteers without back pain and other lesions of spine (control group) were recruited. There was no significant difference in gender, age, body mass index, and bone mineral density between the two groups (P>0.05). The three-dimensional reconstruction model of lumbar spine was acquired from the thin slice CT of the lumbar spine of the subjects by combining dual-X-ray fluoroscopy imaging system with spiral CT examination. The model was matched to the double oblique X-ray fluoroscopy images captured by dual-X-ray fluoroscopy imaging system at different active positions of the lumbar spine to reproduce the three-dimensional instantaneous of lumbar spondylolisthesis at different state of motion. The motion and relative displacement of adjacent segments (L_{3, 4} and L₅, S₁) of spondylolisthesis were measured quantitatively by establishing a three-dimensional coordinate system at the geometric center of the vertebral body. The results were compared with those of the control group. ResultsWhen L_{3, 4} in the control group were flexed flexion-extension, left-right twisting, and left-right bending, and when L₅, S₁ in the control group were flexed left-right twisting and left-right bending, the activity along the main axis of motion (main axis of motion) tended to increase compared with that along the corresponding coupled axis of motion (secondary axis of motion); however, this trend disappeared in the trial group, and the main and secondary movements were disordered. Because of the coronal orientation of the facet joints of L₅, S₁, the degree of motion along the main axis of motion decreased during flexion and extension, but this trend disappeared in the trial group. Compared with the control group, L_{3, 4} in the trial group exhibited displacement instability in flexion-extension, left-right twisting, and left-right bending (P<0.05); there was no significant difference in the relative displacement of L₅, S₁ intervertebral bodies along x, y, and z axes between the trial group and the control group in flexion-extension, left-right twisting, and left-right bending curvature (P>0.05). ConclusionPatients with symptomatic L₄ IS have disorders of primary and secondary movement patterns in adjacent segments, while IS showed significantly displacement instability in L_{3, 4} and significantly decreased motion in L₅, S₁.

Citation： XU Hongda, LIU Jianan, LI Hongda, WEI Dong, MIAO Jun, XIA Qun. Vertebral three-dimensional motion characteristics of adjacent segments in patients with isthmic spondylolisthesis in vivo . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1560-1566. doi: 10.7507/1002-1892.201807026 Copy

1.	Noorian S, Sorensen K, Cho W. A systematic review of clinical outcomes in surgical treatment of adult isthmic spondylolisthesis. Spine J, 2018, 18(8): 1441-1454.
2.	Gandhoke GS, Tempel ZJ, Bonfield CM, et al. Technical nuances of the minimally invasive extreme lateral approach to treat thoracolumbar burst fractures. Eur Spine J, 2015, 24(Suppl 3): 353-360.
3.	Grobler LJ, Novotny JE, Wilder DG, et al. L_4-5 isthmic spondylolisthesis. A biomechanical analysis comparing stability in L_4-5 and L₅-S₁ isthmic spondylolisthesis. Spine (Phila Pa 1976), 1994, 19(2): 222-227.
4.	Oh JY, Liang S, Louange D, et al. Paradoxical motion in L₅-S₁ adult spondylolytic spondylolisthesis. Eur Spine J, 2012, 21(2): 262-267.
5.	Niggemann P, Kuchta J, Beyer HK, et al. Spondylolysis and spondylolisthesis: prevalence of different forms of instability and clinical implications. Spine (Phila Pa 1976), 2011, 36(22): E1463-1468.
6.	夏群, 胥鴻達, 苗軍, 等. 生理載荷下腰椎峽部裂滑脫與退變滑脫的三維瞬時運動特征. 中華骨科雜志, 2014, 34(12): 1244-1251.
7.	Pinheiro-Franco J L, Roussouly P. The importance of sagittal balance for the treatment of lumbar degenerative disk disease. Berlin Heidelberg: Springer, 2016: 703-724.
8.	Mihara H, Onari K, Cheng BC, et al. The biomechanical effects of spondylolysis and its treatment. Spine (Phila Pa 1976), 2003, 28(3): 235-238.
9.	Chen L, Feng Y, Che CQ, et al. Influence of sacral slope on the loading of pedicle screws in postoperative L₅/S₁ isthmic spondylolisthesis patient: a finite element analysis. Spine (Phila Pa 1976), 2016, 41(23): E1388-E1393.
10.	Pearcy M, Shepherd J. Is there instability in spondylolisthesis. Spine (Phila Pa 1976), 1985, 10(2): 175-177.
11.	McGregor AH, Anderton L, Gedroyc WM, et al. The use of interventional open MRI to assess the kinematics of the lumbar spine in patients with spondylolisthesis. Spine (Phila Pa 1976), 2002, 27(14): 1582-1586.
12.	Cha TD, Moore G, Liow MH, et al. In vivo characteristics of non-degenerated adjacent segment intervertebral foramina in patients with degenerative disc disease during flexion-extension. Spine (Phila Pa 1976), 2017, 42(6): 359-365.
13.	Miao J, Wang S, Wan Z, et al. Motion characteristics of the vertebral segments with lumbar degenerative spondylolisthesis in elderly patients. Eur Spine J, 2013, 22(2): 425-431.
14.	Xia Q, Wang S, Kozanek M, et al. In-vivo motion characteristics of lumbar vertebrae in sagittal and transverse planes. J Biomech, 2010, 43(10): 1905-1909.
15.	王博韜, 夏群, 苗軍, 等. 應用數字骨科技術觀測腰椎失穩節段間在體三維運動特點. 中華醫學雜志, 2014, 94(29): 2264-2268.
16.	李宏達, 夏群, 白劍強, 等. 健康成人下頸椎在體三維瞬時運動特點研究. 中國修復重建外科雜志, 2015, 29(12): 1494-1499.
17.	Kim R, Singla A, Samdani AF. Classification of Spondylolisthesis//Richard Kim. Spondylolisthesis. US: Springer, 2015: 95-106.
18.	Legaspi O, Edmond SL. Does the evidence support the existence of lumbar spine coupled motion? A critical review of the literature J Orthop Sports Phys Ther, 2007, 37(4): 169-178.
19.	Panjabi MM, Krag MH, White AA 3rd, et al. Effects of preload on load displacement curves of the lumbar spine. Orthop Clin North Am, 1977, 8(1): 181-192.
20.	Pearcy MJ. Stereo radiography of lumbar spine motion. Acta Orthop Scand Suppl, 1985, 212: 1-45.
21.	Shin JH, Wang S, Yao Q, et al. Investigation of coupled bending of the lumbar spine during dynamic axial rotation of the body. Eur Spine J, 2013, 22(12): 2671-2677.
22.	Toyone T, Ozawa T, Kamikawa K, et al. Facet joint orientation difference between cephalad and caudad portions: a possible cause of degenerative spondylolisthesis. Spine (Phila Pa 1976), 2009, 34(21): 2259-2262.
23.	Ehara S, Shimamura T. Paradoxical motion in spondylolisthesis due to two-segment instability. Arch Orthop Trauma Surg, 1997, 116(6-7): 435-436.
24.	Szypryt EP, Twining P, Mulholland RC, et al. The prevalence of disc degeneration associated with neural arch defects of the lumbar spine assessed by magnetic resonance imaging. Spine (Phila Pa 1976), 1989, 14(9): 977-981.
25.	Abumi K, Panjabi MM, Kramer KM, et al. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine (Phila Pa 1976), 1990, 15(11): 1142-1147.
26.	Goel VK, Goyal S, Clark C, et al. Kinematics of the whole lumbar spine. Effect of discectomy. Spine (Phila Pa 1976), 1985, 10(6): 543-554.
27.	Vialle R, Ilharreborde B, Dauzac C, et al. Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study Eur Spine J, 2007, 16(10): 1641-1649.
28.	Lamartina C, Berjano P. Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J, 2014, 23(6): 1177-1189.
29.	Henson J, McCall IW, O’Brien JP. Disc damage above a spondylolisthesis. Br J Radiol, 1987, 60(709): 69-72.
30.	Been E, Li L, Hunter DJ, et al. Geometry of the vertebral bodies and the intervertebral discs in lumbar segments adjacent to spondylolysis and spondylolisthesis: pilot study. Eur Spine J, 2011, 20(7): 1159-1165.
31.	Morishita Y, Ohta H, Naito M, et al. Kinematic evaluation of the adjacent segments after lumbar instrumented surgery: a comparison between rigid fusion and dynamic non-fusion stabilization. Eur Spine J, 2011, 20(9): 1480-1485.
32.	Jeong HY, You JW, Sohn HM, et al. Radiologic evaluation of degeneration in isthmic and degenerative spondylolisthesis. Asian Spine J, 2013, 7(1): 25-33.
33.	Phan KH, Daubs MD, Kupperman AI, et al. Kinematic analysis of diseased and adjacent segments in degenerative lumbar spondylolisthesis. Spine J, 2015, 15(2): 230-237.
34.	Takayanagi K, Takahashi K, Yamagata M, et al. Using cineradiography for continuous dynamic-motion analysis of the lumbar spine. Spine (Phila Pa 1976), 2001, 26(17): 1858-1865.
35.	Don AS, Robertson PA. Facet joint orientation in spondylolysis and isthmic spondylolisthesis. J Spinal Disord Tech, 2008, 21(2): 112-115.
36.	Chen IR, Wei TS. Disc height and lumbar index as independent predictors of degenerative spondylolisthesis in middle-aged women with low back pain. Spine (Phila Pa 1976), 2009, 34(13): 1402-1409.
37.	Lee SH, Daffner SD, Wang JC, et al. The change of whole lumbar segmental motion according to the mobility of degenerated disc in the lower lumbar spine: a kinetic MRI study. Eur Spine J, 2015, 24(9): 1893-1900.
38.	胥鴻達, 夏群, 苗軍. 腰椎退變滑脫對相鄰節段在體運動的影響. 中華醫學雜志, 2014, 94(47): 3731-3734.

1. Noorian S, Sorensen K, Cho W. A systematic review of clinical outcomes in surgical treatment of adult isthmic spondylolisthesis. Spine J, 2018, 18(8): 1441-1454.
2. Gandhoke GS, Tempel ZJ, Bonfield CM, et al. Technical nuances of the minimally invasive extreme lateral approach to treat thoracolumbar burst fractures. Eur Spine J, 2015, 24(Suppl 3): 353-360.
3. Grobler LJ, Novotny JE, Wilder DG, et al. L_4-5 isthmic spondylolisthesis. A biomechanical analysis comparing stability in L_4-5 and L₅-S₁ isthmic spondylolisthesis. Spine (Phila Pa 1976), 1994, 19(2): 222-227.
4. Oh JY, Liang S, Louange D, et al. Paradoxical motion in L₅-S₁ adult spondylolytic spondylolisthesis. Eur Spine J, 2012, 21(2): 262-267.
5. Niggemann P, Kuchta J, Beyer HK, et al. Spondylolysis and spondylolisthesis: prevalence of different forms of instability and clinical implications. Spine (Phila Pa 1976), 2011, 36(22): E1463-1468.
6. 夏群, 胥鴻達, 苗軍, 等. 生理載荷下腰椎峽部裂滑脫與退變滑脫的三維瞬時運動特征. 中華骨科雜志, 2014, 34(12): 1244-1251.
7. Pinheiro-Franco J L, Roussouly P. The importance of sagittal balance for the treatment of lumbar degenerative disk disease. Berlin Heidelberg: Springer, 2016: 703-724.
8. Mihara H, Onari K, Cheng BC, et al. The biomechanical effects of spondylolysis and its treatment. Spine (Phila Pa 1976), 2003, 28(3): 235-238.
9. Chen L, Feng Y, Che CQ, et al. Influence of sacral slope on the loading of pedicle screws in postoperative L₅/S₁ isthmic spondylolisthesis patient: a finite element analysis. Spine (Phila Pa 1976), 2016, 41(23): E1388-E1393.
10. Pearcy M, Shepherd J. Is there instability in spondylolisthesis. Spine (Phila Pa 1976), 1985, 10(2): 175-177.
11. McGregor AH, Anderton L, Gedroyc WM, et al. The use of interventional open MRI to assess the kinematics of the lumbar spine in patients with spondylolisthesis. Spine (Phila Pa 1976), 2002, 27(14): 1582-1586.
12. Cha TD, Moore G, Liow MH, et al. In vivo characteristics of non-degenerated adjacent segment intervertebral foramina in patients with degenerative disc disease during flexion-extension. Spine (Phila Pa 1976), 2017, 42(6): 359-365.
13. Miao J, Wang S, Wan Z, et al. Motion characteristics of the vertebral segments with lumbar degenerative spondylolisthesis in elderly patients. Eur Spine J, 2013, 22(2): 425-431.
14. Xia Q, Wang S, Kozanek M, et al. In-vivo motion characteristics of lumbar vertebrae in sagittal and transverse planes. J Biomech, 2010, 43(10): 1905-1909.
15. 王博韜, 夏群, 苗軍, 等. 應用數字骨科技術觀測腰椎失穩節段間在體三維運動特點. 中華醫學雜志, 2014, 94(29): 2264-2268.
16. 李宏達, 夏群, 白劍強, 等. 健康成人下頸椎在體三維瞬時運動特點研究. 中國修復重建外科雜志, 2015, 29(12): 1494-1499.
17. Kim R, Singla A, Samdani AF. Classification of Spondylolisthesis//Richard Kim. Spondylolisthesis. US: Springer, 2015: 95-106.
18. Legaspi O, Edmond SL. Does the evidence support the existence of lumbar spine coupled motion? A critical review of the literature J Orthop Sports Phys Ther, 2007, 37(4): 169-178.
19. Panjabi MM, Krag MH, White AA 3rd, et al. Effects of preload on load displacement curves of the lumbar spine. Orthop Clin North Am, 1977, 8(1): 181-192.
20. Pearcy MJ. Stereo radiography of lumbar spine motion. Acta Orthop Scand Suppl, 1985, 212: 1-45.
21. Shin JH, Wang S, Yao Q, et al. Investigation of coupled bending of the lumbar spine during dynamic axial rotation of the body. Eur Spine J, 2013, 22(12): 2671-2677.
22. Toyone T, Ozawa T, Kamikawa K, et al. Facet joint orientation difference between cephalad and caudad portions: a possible cause of degenerative spondylolisthesis. Spine (Phila Pa 1976), 2009, 34(21): 2259-2262.
23. Ehara S, Shimamura T. Paradoxical motion in spondylolisthesis due to two-segment instability. Arch Orthop Trauma Surg, 1997, 116(6-7): 435-436.
24. Szypryt EP, Twining P, Mulholland RC, et al. The prevalence of disc degeneration associated with neural arch defects of the lumbar spine assessed by magnetic resonance imaging. Spine (Phila Pa 1976), 1989, 14(9): 977-981.
25. Abumi K, Panjabi MM, Kramer KM, et al. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine (Phila Pa 1976), 1990, 15(11): 1142-1147.
26. Goel VK, Goyal S, Clark C, et al. Kinematics of the whole lumbar spine. Effect of discectomy. Spine (Phila Pa 1976), 1985, 10(6): 543-554.
27. Vialle R, Ilharreborde B, Dauzac C, et al. Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study Eur Spine J, 2007, 16(10): 1641-1649.
28. Lamartina C, Berjano P. Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J, 2014, 23(6): 1177-1189.
29. Henson J, McCall IW, O’Brien JP. Disc damage above a spondylolisthesis. Br J Radiol, 1987, 60(709): 69-72.
30. Been E, Li L, Hunter DJ, et al. Geometry of the vertebral bodies and the intervertebral discs in lumbar segments adjacent to spondylolysis and spondylolisthesis: pilot study. Eur Spine J, 2011, 20(7): 1159-1165.
31. Morishita Y, Ohta H, Naito M, et al. Kinematic evaluation of the adjacent segments after lumbar instrumented surgery: a comparison between rigid fusion and dynamic non-fusion stabilization. Eur Spine J, 2011, 20(9): 1480-1485.
32. Jeong HY, You JW, Sohn HM, et al. Radiologic evaluation of degeneration in isthmic and degenerative spondylolisthesis. Asian Spine J, 2013, 7(1): 25-33.
33. Phan KH, Daubs MD, Kupperman AI, et al. Kinematic analysis of diseased and adjacent segments in degenerative lumbar spondylolisthesis. Spine J, 2015, 15(2): 230-237.
34. Takayanagi K, Takahashi K, Yamagata M, et al. Using cineradiography for continuous dynamic-motion analysis of the lumbar spine. Spine (Phila Pa 1976), 2001, 26(17): 1858-1865.
35. Don AS, Robertson PA. Facet joint orientation in spondylolysis and isthmic spondylolisthesis. J Spinal Disord Tech, 2008, 21(2): 112-115.
36. Chen IR, Wei TS. Disc height and lumbar index as independent predictors of degenerative spondylolisthesis in middle-aged women with low back pain. Spine (Phila Pa 1976), 2009, 34(13): 1402-1409.
37. Lee SH, Daffner SD, Wang JC, et al. The change of whole lumbar segmental motion according to the mobility of degenerated disc in the lower lumbar spine: a kinetic MRI study. Eur Spine J, 2015, 24(9): 1893-1900.
38. 胥鴻達, 夏群, 苗軍. 腰椎退變滑脫對相鄰節段在體運動的影響. 中華醫學雜志, 2014, 94(47): 3731-3734.

Chinese Journal of Reparative and Reconstructive Surgery

Vertebral three-dimensional motion characteristics of adjacent segments in patients with isthmic spondylolisthesis in vivo

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