背景:峡部椎体滑脱(IS)的定义是由于单侧或双侧关节间壁骨折导致一个腰椎相对于下一个尾段的前移。这些骨折可互换地称为“pars缺损”或“脊椎裂”。已经提出了许多风险因素来解释脊椎滑脱缺陷进展为IS,然而,没有验证。
目的:本系统综述提供了各种放射学和影像学参数的概述,这些参数可以帮助预测脊椎溶解缺损进展为IS的风险。
方法:系统评价方法:Medline,检索Embase和Cochrane在线数据库。评估了影像学特征与所观察到的脊椎滑脱患病率或严重程度或脊椎滑脱率之间的各种相关性,以提供预测IS的影像学危险因素列表。记录了原始文章中相关性的重要性,以比较收集到的单独图像特征的证据。
结果:所有搜索组合共产生431个结果,其中26篇文章被纳入本研究。在确定的22个潜在风险因素中,5被发现在统计上不显著,发现8个是显著的,9个具有混合结果。至少在研究中发现以下特征是重要的危险因素:椎间盘退变,横向工艺宽度,盆腔斜入,骨盆倾斜,骶骨斜坡,腰椎前凸,腰椎指数,胸椎后凸,小平面关节角度高于缺陷水平,小平面关节退化,方面的热带,多裂大小,外侧勃起脊柱大小,肠系膜脂肪厚度,皮下脂肪厚度和软组织钙化。
结论:我们的研究表明,只有椎间盘退变有适度的证据,与脊椎滑脱患者的IS发展有一致的显著关联。横向工艺宽度,盆腔斜入,骨盆倾斜,骶骨斜坡,腰椎前凸,腰椎指数,胸椎后凸,小平面关节角度高于缺陷水平,小平面关节退化,方面的热带,多裂大小,外侧勃起脊柱大小,肠系膜脂肪厚度,皮下脂肪厚度和软组织钙化有一定的证据。所有其他放射学因素都缺乏证据。这项研究的结果可用于改善脊椎裂患者的早期临床决策。
BACKGROUND: Isthmic
spondylolisthesis (IS) is defined as the anterior translation of one lumbar vertebra relative to the next caudal segment as a result of a unilateral or bilateral fracture of the pars interarticularis. These fractures are interchangeably known as \"pars defects\" or \"spondylolysis.\" Many risk factors have been proposed to explain the progression of a spondylolytic defect to IS, however, none are validated.
OBJECTIVE: This systematic
review provides an overview of various radiological and imaging parameters that can help predict the risk of progression of a spondylolytic defect into IS.
METHODS: Systematic
review.
METHODS: Medline, Embase and Cochrane online database were searched. The various correlations between imaging features with observed
spondylolisthesis prevalence or severity or spondylolysis rates of
spondylolisthesis were evaluated to provide a list of imaging risk factors to predict IS. Significance of the correlations in the original article was recorded to enable comparison of the collected evidence of separate image features.
RESULTS: All searches combined generated a total of 431 results of which 26 articles were included into this study. Of the 22 potential risk factors identified, 5 were found to be statistically insignificant, 8 were found to be significant and 9 had mixed results. The following features were found to be significant risk factors in at least on study: disc degeneration, transverse process width, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lumbar index, thoracic kyphosis, facet joint angle above the level of defect, facet joint degeneration, facet tropism, multifidus size, lateral erector spinae size, mesenteric fat thickness, subcutaneous fat thickness and soft tissue calcification.
CONCLUSIONS: Our research suggests that only disc degeneration had moderately strong evidence with consistent significant associations with development of IS in patients with spondylolysis. Transverse process width, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lumbar index, thoracic kyphosis, facet joint angle above the level of defect, facet joint degeneration, facet tropism, multifidus size, lateral erector spinae size, mesenteric fat thickness, subcutaneous fat thickness and soft tissue calcification had some evidence. All other radiological factors had weak evidence. The results of this study can be used to improve early clinical decision making for patients with spondylolysis.