Correlation of listhesis on upright radiographs and central lumbar spinal canal stenosis on supine MRI: is it possible to predict lumbar spinal canal stenosis?

  • Tim Finkenstaedt
  • Filippo Del Grande
  • Nicolae Bolog
  • Nils H. Ulrich
  • Sina Tok
  • Jakob M. Burgstaller
  • Johann Steurer
  • Christine B. Chung
  • Gustav Andreisek
  • Sebastian Winklhofer
  • on behalf of the LSOS working group
Scientific Article
  • 41 Downloads

Abstract

Objective

To investigate whether upright radiographs can predict lumbar spinal canal stenosis using supine lumbar magnetic resonance imaging (MRI) and to investigate the detection performance for spondylolisthesis on upright radiographs compared with supine MRI in patients with suspected lumbar spinal canal stenosis (LSS).

Materials and Methods

In this retrospective study, conventional radiographs and MR images of 143 consecutive patients with suspected LSS (75 female, mean age 72 years) were evaluated. The presence and extent of listhesis (median ± interquartile range) were assessed on upright radiographs and supine MRI of L4/5. In addition, the grade of central spinal stenosis of the same level was evaluated on MRI according to the classification of Schizas and correlated with the severity/grading of anterolisthesis on radiographs.

Results

Anterolisthesis was detected in significantly more patients on radiographs (n = 54; 38%) compared with MRI (n = 28; 20%), p < 0.001. Pairwise comparison demonstrated a significantly larger extent of anterolisthesis on radiographs (9 ± 5 mm) compared with MRI (5 ± 3 mm), p < 0.001. A positive correlation was found regarding the extent of anterolisthesis measured on radiographs and the grade of stenosis on MRI (r = 0.563, p < 0.001). Applying a cutoff value of ≥5 mm anterolisthesis on radiographs results in a specificity of 90% and a positive predictive value of 78% for the detection of patients with LSS, as defined by the Schizas classification.

Conclusion

Upright radiographs demonstrated more and larger extents of anterolisthesis compared with supine MRI. In addition, in patients with suspected LSS, the extent of anterolisthesis on radiographs (particularly ≥5 mm) is indicative of LSS and warrants lumbar spine MRI.

Keywords

Magnetic resonance imaging Radiography Spine Lumbar spine Spinal canal stenosis Degenerative spinal changes Lower back pain Claudication Listhesis Anterolisthesis Spondylolisthesis 

Notes

Compliance with ethical standards

Conflicts of interest

This study was supported by the Helmut Horten Foundation, Baugarten Foundation, Pfizer-Foundation for geriatrics and research into geriatrics, Symphasis Charitable Foundation and OPO-Foundation. We disclose any financial support or author involvement with organization(s) with a financial interest in the subject matter.

IRB statement

This study was approved by the local ethical committee of the University of Zurich, Switzerland. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

All patients received written and oral information about the study and gave their written informed consent for participation. The project was registered at http://www.research-projects.uzh.ch/p16804.htm.

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Copyright information

© ISS 2018

Authors and Affiliations

  • Tim Finkenstaedt
    • 1
    • 2
  • Filippo Del Grande
    • 3
  • Nicolae Bolog
    • 4
  • Nils H. Ulrich
    • 5
  • Sina Tok
    • 5
  • Jakob M. Burgstaller
    • 6
  • Johann Steurer
    • 6
  • Christine B. Chung
    • 2
  • Gustav Andreisek
    • 7
  • Sebastian Winklhofer
    • 8
  • on behalf of the LSOS working group
  1. 1.Institute of Diagnostic and Interventional Radiology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
  2. 2.Department of RadiologyUniversity of California, San Diego, School of MedicineLa JollaUSA
  3. 3.Institute of Diagnostic and Interventional RadiologyOspedale Regionale di LuganoLuganoSwitzerland
  4. 4.Phoenix Diagnostic ClinicBucharestRomania
  5. 5.Department of Neurosurgery, Spine CenterSchulthess ClinicZurichSwitzerland
  6. 6.Horten Center for Patient Oriented Research and Knowledge TransferUniversity of ZurichZurichSwitzerland
  7. 7.Department of RadiologyKantonsspital MuensterlingenMünsterlingenSwitzerland
  8. 8.Department of Neuroradiology, University Hospital ZurichUniversity of ZurichZurichSwitzerland

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