Abstract：
Spondylolisthesis is a common finding in middle-aged and older adults with back pain. The pathophysiology of degenerative spondylolisthesis is a subject of controversy regarding not only its etiology but also the mechanisms of its progression. It is theorized that degeneration of the facets and discs can lead to segmental instability, leading to displacement over time. Kirkaldy-Willis divided degenerative spondylolisthesis into three phases: dysfunction, instability, and finally, restabilization. There is a paucity of literature on the unification of the radiological hallmarks seen in spondylolisthesis within these phases. The radiographic features include (1) facet morphology/arthropathy, (2) facet effusion, (3) facet vacuum, (4) synovial cyst, (5) interspinous ligament bursitis, and (6) vacuum disc as markers of dysfunction, instability, and/or restabilization. We discuss these features, which can be seen on X-ray, CT, and MRI, with the intention of establishing a timeline upon which they present clinically. Spondylolisthesis is initiated as either degeneration of the intervertebral disc or facet joints. Early degeneration can be seen as facet vacuum without considerable arthropathy. As the vertebral segment becomes increasingly dynamic, fluid accumulates within the facet joint space. Further degeneration will lead to the advancement of facet arthropathy, degenerative disc disease, and posterior ligamentous complex pathology. Facet effusion can eventually be replaced with a vacuum in severe facet osteoarthritis. Intervertebral disc vacuum continues to accumulate with further cleft formation and degeneration. Ultimately, autofusion of the vertebra at the facets and endplates can be observed. With this review, we hope to increase awareness of these radiographical markers and their timeline, thus placing them within the framework of the currently accepted model of degenerative spondylolisthesis, to help guide future research and to help refine management guidelines.
摘要：
脊椎前移是中老年人背痛的常见病。退行性腰椎滑脱的病理生理学不仅是其病因，而且是其进展机制的争议主题。从理论上讲，小面和椎间盘的退化会导致节段性不稳定，随着时间的推移导致流离失所。Kirkaldy-Willis将退行性腰椎滑脱分为三个阶段：功能障碍，不稳定性,最后，重新稳定。关于在这些阶段中脊椎滑脱中看到的放射学标志的统一的文献很少。影像学特征包括（1）小平面形态/关节病，(2)小平面积液，(3)刻面真空，（4）滑膜囊肿，（5）棘间韧带滑囊炎，和（6）真空盘作为功能障碍的标志，不稳定性,和/或重新稳定。我们讨论这些特征，可以在X光片上看到，CT,MRI,目的是建立一个时间表，他们在临床上提出。脊椎滑脱是由于椎间盘或小关节的退化而引起的。早期变性可以看作是没有严重关节病的小关节真空。随着椎骨节段变得越来越动态，流体积聚在小平面关节空间内。进一步的退化将导致关节突关节病的进展，椎间盘退行性疾病，和后韧带复杂病理。在严重的小面骨关节炎中，小面积液最终可以用真空代替。椎间盘真空继续积聚，并进一步形成裂隙和变性。最终,可以观察到椎骨在小平面和终板的自动融合。通过这次审查,我们希望提高人们对这些影像标记及其时间表的认识，因此将它们置于目前公认的退行性腰椎滑脱模型的框架内，以帮助指导未来的研究并帮助完善管理指南。
