Breaking Down Instability: The Associations between Muscle Health, Facet Joint Morphology, Spinopelvic Alignment, and Stability Status in Degenerative Lumbar Spondylolisthesis.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-05-19 DOI:10.1097/BRS.0000000000005393

Eric Zhao, Sereen Halayqeh, Troy Amen, Austin Kaidi, Zora Hahn, John Lama, Arsen Omurzakov, Tim Xu, Luis Colon, Tomoyuki Asada, Stephane Owusu-Sarpong, Quante Singleton, Farah Musharbash, Atahan Durbas, Adrian Lui, Andrea Pezzi, Adin Ehrlich, Myles Allen, Olivia Tuma, Kasra Araghi, Tarek Harhash, James Dowdell, Kyle Morse, Francis Lovecchio, Sheeraz Qureshi, Sravisht Iyer

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引用次数: 0

Abstract

Study design: Retrospective cohort study.

Objective: to compare muscle health and imaging markers in patients with 1-level L4-L5 stable versus unstable degenerative lumbar spondylolisthesis (DLS).

Summary of background data: DLS may be stable or unstable. It is unknown how muscle health and other imaging markers are associated with DLS stability.

Methods: Patients≥18 years with 1-level L4-L5 DLS and preoperative flexion/extension radiographs were included. Normalized total psoas area (NTPA), body mass index (BMI)-normalized paralumbar (PL) (multifidus [MF]+erector spinae [ES]) cross-sectional area (PL-CSA/BMI), and Goutallier were assessed. Other L4-L5 markers included: facet orientation, slip percentage, pelvic incidence (PI), tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI-LL. Instability was defined as>3 mm translation or>10 degrees endplate change on flexion-extension. Low versus normal muscle health was defined as NTPA or PL-CSA/BMI below the lowest sex-specific quartile. Multivariate logistic regression was used to determine variables associated with instability.

Results: 251 patients (unstable=50; stable=201) were included. There were no significant differences in muscle health at L3, L4, or L5 or Goutallier on univariate analysis. The stable cohort had smaller slip percentage (19±9% vs. 15±8%, P=0.007) and PI-LL (13.56±12.75 vs. 5.81±14.46, P=0.001). The stable cohort had more patients with MF and ES total Goutallier≤2 (P=0.031, P=0.002, respectively) at L3-L4 versus L4-L5 and more patients with MF and ES total Goutallier≤2 (P=0.013, P=0.004, respectively) at L4-L5 versus L5-S1. On regression, low L4-L5 MF Goutallier was associated with instability (OR: 2.50, 95% CI [1.01 - 6.20], P=0.047).

Conclusion: Patients with unstable L4-L5 spondylolisthesis have lower multifidus Goutallier at the slip level, greater slip percentage, and greater PI-LL mismatch. Patients with stable L4-L5 spondylolisthesis have greater Goutallier of the caudal paralumbars.

Level of evidence: 3.

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打破不稳定性：退行性腰椎滑脱中肌肉健康、小关节形态、脊柱骨盆对齐和稳定性状态之间的关系。

研究设计：回顾性队列研究。目的：比较1级L4-L5稳定型与不稳定型退行性腰椎滑脱（DLS）患者的肌肉健康和影像学指标。背景资料总结：DLS可能稳定，也可能不稳定。肌肉健康和其他影像学指标与DLS稳定性的关系尚不清楚。方法：纳入年龄≥18岁的1级L4-L5 DLS患者和术前屈伸片。评估归一化腰大肌总面积（NTPA）、体重指数(BMI)-归一化腰旁肌（多裂肌[MF]+竖脊肌[ES]）横截面积（PL- csa /BMI）和Goutallier。其他L4-L5指标包括：关节突方向、滑移率、骨盆发生率（PI）、倾斜（PT）、骶骨坡度（SS）、腰椎前凸（LL）和PI-LL。不稳定性被定义为> - 3mm平移或> - 10度终板屈伸变化。与正常肌肉健康相比，低肌肉健康被定义为NTPA或PL-CSA/BMI低于最低性别特异性四分位数。多变量逻辑回归用于确定与不稳定性相关的变量。结果：251例患者(不稳定=50例；稳定=201)。单变量分析中，L3、L4、L5或Goutallier的肌肉健康状况无显著差异。稳定组的失速率（19±9%比15±8%，P=0.007）和PI-LL（13.56±12.75比5.81±14.46，P=0.001）较小。稳定队列在L3-L4阶段比L4-L5阶段有更多MF和ES总Goutallier≤2的患者（P=0.031， P=0.002）， L4-L5阶段比L5-S1阶段有更多MF和ES总Goutallier≤2的患者（P=0.013， P=0.004）。在回归分析中，低L4-L5 MF Goutallier与不稳定性相关（OR: 2.50, 95% CI [1.01 - 6.20]， P=0.047）。结论：不稳定L4-L5椎体滑脱患者的多裂肌滑移水平较低，滑移率较大，PI-LL失配较大。稳定的L4-L5椎体滑脱患者有较大的尾侧前凸。证据等级：3。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

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