PDF(Pubmed)
Abstract：
BACKGROUND: Degenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs.
METHODS: We reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups.
RESULTS: A total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27-3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68-3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32-2.84; P = 0.021) were identified as factors associated with instability.
CONCLUSIONS: Our findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.
METHODS: We reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups.
RESULTS: A total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27-3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68-3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32-2.84; P = 0.021) were identified as factors associated with instability.
CONCLUSIONS: Our findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.
摘要：
背景：退变性腰椎管狭窄症（LSS）是一种常见的疾病，涉及椎管狭窄。传统上，诊断不稳定性需要站立的横向射线照片来检测动态平移，但是，由于患者的不适和辐射暴露等挑战，有关于完全依赖射线照片的争论。这项研究旨在评估磁共振成像（MRI）的发现是否可以有效地诊断X射线照片上观察到的不稳定性。
方法：我们回顾了在我们机构接受手术的478例退行性LSS患者。不稳定定义为在伸展和屈曲的站立侧位X线片上的矢状平移超过3mm。将患者分为稳定组(平移<3mm的组)和不稳定组(平移>3mm的组)。这项研究评估了潜在的不稳定变量，包括小关节积液等MRI表现,面接头角度,磁盘高度索引,椎间盘内真空存在，终板硬化,黄韧带肥大，多裂肌脂肪变性，比较两组之间的这些因素。
结果：共纳入478例连续诊断为退行性腰椎管狭窄（LSS）的患者。患者平均年龄为66.32岁,其中43.3%是男性。大约27.6％的病例在伸展和屈曲期间在站立的侧面X光片上表现出不稳定的迹象。使用二元逻辑回归的多变量分析显示小关节积液（比值比[OR]2.73;95％置信区间[CI]1.27-3.94;P=0.002），圆盘高度指数(OR2.22；95%CI1.68-3.35；P=0.009)，和真空体征的存在（OR1.77;95％CI1.32-2.84;P=0.021）被确定为与不稳定性相关的因素。
结论：我们的研究结果表明较高的小关节积液，真空标志的存在,在退行性LSS患者中，较大的椎间盘高度指数与站立侧位X线片上的伸展和屈曲不稳定有关。
方法：我们回顾了在我们机构接受手术的478例退行性LSS患者。不稳定定义为在伸展和屈曲的站立侧位X线片上的矢状平移超过3mm。将患者分为稳定组(平移<3mm的组)和不稳定组(平移>3mm的组)。这项研究评估了潜在的不稳定变量，包括小关节积液等MRI表现,面接头角度,磁盘高度索引,椎间盘内真空存在，终板硬化,黄韧带肥大，多裂肌脂肪变性，比较两组之间的这些因素。
结果：共纳入478例连续诊断为退行性腰椎管狭窄（LSS）的患者。患者平均年龄为66.32岁,其中43.3%是男性。大约27.6％的病例在伸展和屈曲期间在站立的侧面X光片上表现出不稳定的迹象。使用二元逻辑回归的多变量分析显示小关节积液（比值比[OR]2.73;95％置信区间[CI]1.27-3.94;P=0.002），圆盘高度指数(OR2.22；95%CI1.68-3.35；P=0.009)，和真空体征的存在（OR1.77;95％CI1.32-2.84;P=0.021）被确定为与不稳定性相关的因素。
结论：我们的研究结果表明较高的小关节积液，真空标志的存在,在退行性LSS患者中，较大的椎间盘高度指数与站立侧位X线片上的伸展和屈曲不稳定有关。
