PDF(Pubmed)
Abstract：
OBJECTIVE: Isthmic spondylolisthesis (IS) is distinguished by a congenital defect or acquired fracture of the pars interarticularis. Numerous studies on L5 low-grade IS have been carried out; however, there is a paucity of data regarding the condition of L5 IS concomitant with L4/5 disc herniation. This study aimed to identify the incidence rate and to illustrate the possible risk factors for L4/5 disc herniation in L5 low-grade IS patients.
METHODS: A total of 268 consecutive patients diagnosed as L5/S1 low-grade IS between May 2017 and May 2022 were retrospectively enrolled in this study. Depending on the presence of L4/5 disc herniation or not, patients were divided into an L4/5 disc herniation group (L4/5 DH) and an L4/5 non-disc herniation group (L4/5 non-DH). Radiographic parameters were measured, and the ratios of L4-S1 segmental lordosis (SL) to lumbar lordosis (LDI), L4 inferior endplate (IEP) to L5 superior endplate (SEP) (L4 IEP/L5 SEP), and L5 IEP to S1 SEP (L5 IEP/S1 SEP) were compared between groups. The Pfirrmann grade of the L4/5 disc and the L5/S1 disc, and Roussouly classifications of each patient were also recorded. Univariate analysis (including independent-samples t-test and χ2 -test) and multiple logistic regression analysis were performed to analyze the data.
RESULTS: There were 40 patients (14.9%) in the L4/5 DH group. The Roussouly classification differed significantly between groups. As demonstrated by the Pfirrmann grade, the L4/5 DH group showed more advanced disc degeneration at L4/5 than the L4/5 non-DH group. In contrast to the L4/5 non-DH group, the L4/5 DH group had a significantly larger L4 IEP, L4 IEP/L5 SEP, S1 SEP, and LDI while smaller L4/5 disc angle, L4/5 disc height, slip percentage, lumbar lordosis, and sacral slope. Multivariate logistic regression analysis revealed that higher L4/5 disc Pfirrmann grade (p = 0.004), decreased L4/5 disc height (p < 0.001), and lower L5 slip percentage (p = 0.022) were significantly associated with the occurrence of L4/5 DH.
CONCLUSIONS: L4/5 disc herniation is not unusually accompanied by L5/S1 low-grade IS. Advanced L4/5 disc degeneration, decreased L4/5 disc height, and lower L5 slip percentage might be significantly associated with L4/5 disc herniation.
METHODS: A total of 268 consecutive patients diagnosed as L5/S1 low-grade IS between May 2017 and May 2022 were retrospectively enrolled in this study. Depending on the presence of L4/5 disc herniation or not, patients were divided into an L4/5 disc herniation group (L4/5 DH) and an L4/5 non-disc herniation group (L4/5 non-DH). Radiographic parameters were measured, and the ratios of L4-S1 segmental lordosis (SL) to lumbar lordosis (LDI), L4 inferior endplate (IEP) to L5 superior endplate (SEP) (L4 IEP/L5 SEP), and L5 IEP to S1 SEP (L5 IEP/S1 SEP) were compared between groups. The Pfirrmann grade of the L4/5 disc and the L5/S1 disc, and Roussouly classifications of each patient were also recorded. Univariate analysis (including independent-samples t-test and χ2 -test) and multiple logistic regression analysis were performed to analyze the data.
RESULTS: There were 40 patients (14.9%) in the L4/5 DH group. The Roussouly classification differed significantly between groups. As demonstrated by the Pfirrmann grade, the L4/5 DH group showed more advanced disc degeneration at L4/5 than the L4/5 non-DH group. In contrast to the L4/5 non-DH group, the L4/5 DH group had a significantly larger L4 IEP, L4 IEP/L5 SEP, S1 SEP, and LDI while smaller L4/5 disc angle, L4/5 disc height, slip percentage, lumbar lordosis, and sacral slope. Multivariate logistic regression analysis revealed that higher L4/5 disc Pfirrmann grade (p = 0.004), decreased L4/5 disc height (p < 0.001), and lower L5 slip percentage (p = 0.022) were significantly associated with the occurrence of L4/5 DH.
CONCLUSIONS: L4/5 disc herniation is not unusually accompanied by L5/S1 low-grade IS. Advanced L4/5 disc degeneration, decreased L4/5 disc height, and lower L5 slip percentage might be significantly associated with L4/5 disc herniation.
摘要：
目的：峡部滑脱（IS）的特征是先天性缺损或获得性关节间壁骨折。已经对L5低等级IS进行了大量研究；然而，L5IS合并L4/5椎间盘突出症的相关数据很少.本研究旨在确定L5低级别IS患者L4/5椎间盘突出症的发生率并说明可能的危险因素。
方法：对2017年5月至2022年5月期间诊断为L5/S1低度IS的268例连续患者进行回顾性研究。取决于L4/5椎间盘突出的存在与否，患者分为L4/5椎间盘突出组(L4/5DH)和L4/5非椎间盘突出组(L4/5非DH).测量射线照相参数，L4-S1节段前凸（SL）与腰椎前凸（LDI）的比值，L4下端板(IEP)至L5上端板(SEP)(L4IEP/L5SEP),组间比较L5IEP至S1SEP(L5IEP/S1SEP)。L4/5光盘和L5/S1光盘的Pfirrmann等级，并记录每位患者的Roussouly分类。采用单因素分析(包括独立样本t检验和χ2检验)和多因素logistic回归分析。
结果：L4/5DH组40例（14.9%）。Roussouly分类在组间有显著差异。正如Pfirrmann等级所证明的那样，与L4/5非DH组相比,L4/5DH组的椎间盘退变程度更高.与L4/5非DH组相比，L4/5DH组的L4IEP明显更大，L4IEP/L5SEP,S1SEP,和LDI，而更小的L4/5盘角度，L4/5盘高度，滑移百分比,腰椎前凸,和骶骨斜坡。多因素logistic回归分析显示L4/5椎间盘Pfirrmann分级较高(p=0.004),L4/5椎间盘高度降低（p<0.001），较低的L5滑移百分比（p=0.022）与L4/5DH的发生显着相关。
结论：L4/5椎间盘突出症并不罕见地伴有L5/S1低度IS。晚期L4/5椎间盘退变，L4/5盘高度降低，较低的L5滑脱率可能与L4/5椎间盘突出显著相关。
方法：对2017年5月至2022年5月期间诊断为L5/S1低度IS的268例连续患者进行回顾性研究。取决于L4/5椎间盘突出的存在与否，患者分为L4/5椎间盘突出组(L4/5DH)和L4/5非椎间盘突出组(L4/5非DH).测量射线照相参数，L4-S1节段前凸（SL）与腰椎前凸（LDI）的比值，L4下端板(IEP)至L5上端板(SEP)(L4IEP/L5SEP),组间比较L5IEP至S1SEP(L5IEP/S1SEP)。L4/5光盘和L5/S1光盘的Pfirrmann等级，并记录每位患者的Roussouly分类。采用单因素分析(包括独立样本t检验和χ2检验)和多因素logistic回归分析。
结果：L4/5DH组40例（14.9%）。Roussouly分类在组间有显著差异。正如Pfirrmann等级所证明的那样，与L4/5非DH组相比,L4/5DH组的椎间盘退变程度更高.与L4/5非DH组相比，L4/5DH组的L4IEP明显更大，L4IEP/L5SEP,S1SEP,和LDI，而更小的L4/5盘角度，L4/5盘高度，滑移百分比,腰椎前凸,和骶骨斜坡。多因素logistic回归分析显示L4/5椎间盘Pfirrmann分级较高(p=0.004),L4/5椎间盘高度降低（p<0.001），较低的L5滑移百分比（p=0.022）与L4/5DH的发生显着相关。
结论：L4/5椎间盘突出症并不罕见地伴有L5/S1低度IS。晚期L4/5椎间盘退变，L4/5盘高度降低，较低的L5滑脱率可能与L4/5椎间盘突出显著相关。
