European Spine Journal

, Volume 27, Issue 4, pp 752–762 | Cite as

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2018: dynamic imaging of degenerative spondylolisthesis reveals mid-range dynamic lumbar instability not evident on static clinical radiographs

  • Malcolm E. Dombrowski
  • Bryan Rynearson
  • Clarissa LeVasseur
  • Zach Adgate
  • William F. Donaldson
  • Joon Y. Lee
  • Ameet Aiyangar
  • William J. Anderst
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

Degenerative spondylolisthesis (DS) in the setting of symptomatic lumbar spinal stenosis is commonly treated with spinal fusion in addition to decompression with laminectomy. However, recent studies have shown similar clinical outcomes after decompression alone, suggesting that a subset of DS patients may not require spinal fusion. Identification of dynamic instability could prove useful for predicting which patients are at higher risk of post-laminectomy destabilization necessitating fusion. The goal of this study was to determine if static clinical radiographs adequately characterize dynamic instability in patients with lumbar degenerative spondylolisthesis (DS) and to compare the rotational and translational kinematics in vivo during continuous dynamic flexion activity in DS versus asymptomatic age-matched controls.

Methods

Seven patients with symptomatic single level lumbar DS (6 M, 1 F; 66 ± 5.0 years) and seven age-matched asymptomatic controls (5 M, 2 F age 63.9 ± 6.4 years) underwent biplane radiographic imaging during continuous torso flexion. A volumetric model-based tracking system was used to track each vertebra in the radiographic images using subject-specific 3D bone models from high-resolution computed tomography (CT). In vivo continuous dynamic sagittal rotation (flexion/extension) and AP translation (slip) were calculated and compared to clinical measures of intervertebral flexion/extension and AP translation obtained from standard lateral flexion/extension radiographs.

Results

Static clinical radiographs underestimate the degree of AP translation seen on dynamic in vivo imaging (1.0 vs 3.1 mm; p = 0.03). DS patients demonstrated three primary motion patterns compared to a single kinematic pattern in asymptomatic controls when analyzing continuous dynamic in vivo imaging. 3/7 (42%) of patients with DS demonstrated aberrant mid-range motion.

Conclusion

Continuous in vivo dynamic imaging in DS reveals a spectrum of aberrant motion with significantly greater kinematic heterogeneity than previously realized that is not readily seen on current clinical imaging.

Level of evidence

Level V data

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Degenerative spondylolisthesis Dynamic instability Dynamic imaging In vivo kinematics Arthrokinematics 
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Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict.

Supplementary material

586_2018_5489_MOESM1_ESM.pptx (2.9 mb)
Supplementary material 1 (PPTX 3017 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Malcolm E. Dombrowski
    • 1
  • Bryan Rynearson
    • 1
  • Clarissa LeVasseur
    • 1
  • Zach Adgate
    • 1
  • William F. Donaldson
    • 1
  • Joon Y. Lee
    • 1
  • Ameet Aiyangar
    • 1
    • 2
  • William J. Anderst
    • 1
  1. 1.Department of Orthopaedic Surgery, Orthopaedic Biodynamics LaboratoryUniversity of PittsburghPittsburghUSA
  2. 2.EMPA (Swiss Federal Laboratories for Materials Science and Research)Mechanical Systems Engineering (Lab 304)DuebendorfSwitzerland

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