19. 腰椎退行性椎体滑脱的影像学进展：自然史和相关危险因素

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100713

Hae-Dong Jang PhD, MD , Jae Chul Lee MD, PhD , Byung-Joon Shin PhD

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引用次数: 0

摘要

背景背景退行性椎体滑脱（DS）的自然历史仍然知之甚少，特别是关于其进展和相关因素。目的评价退行性椎体滑移的影像学进展率及其相关危险因素。研究设计/设置：回顾性比较研究。患者样本：我们招募了至少5年随访的退行性椎体滑移患者（L3-4、L4-5或L5-S1）。我们回顾性分析了76例DS患者（80个级别），诊断时平均年龄为60.2岁。平均随访时间104.8个月（60.7 ~ 239.4个月）。我们评估了人口统计学、合并症、吸烟史、随访时间和手术的存在（至少5年的非手术随访）。在站立x线平片上采用滑动距离（mm）和tailard法（%）测量滑移程度。与初始状态相比，随访期间滑移增加至少3mm的患者被归类为退行性椎体滑移的进展。方法比较两组（进展组与非进展组）的各项指标。统计分析确定了与进展相关的因素，包括年龄、随访时间和初始脊椎滑脱严重程度。此外，我们还进行了逻辑回归分析和生存分析，以评估与DS进展相关的因素。结果初始滑移距离平均为3.9 mm（占tailard法的9.6%），最终随访时滑移距离增加至6.7 mm（占tailard法的16.6%）。41.3%（33/80）的患者在随访期间出现滑移进展（滑移距离增加3mm）。当比较两组时，进展组表现出较年轻的诊断年龄（57.6 vs 62.1岁，p=0.009），较长的随访时间（117.9 vs 95.6个月，p=0.043），较轻的初始滑移(2.3 mm vs 5.0 mm, p<；0.001)。多元逻辑回归分析发现，滑移距离的初始程度是决定因素，截止值为<；4mm表明有较高的进展风险（AUC: 0.751，敏感性：81.8%，特异性：61.7%）。初始滑移距离= 4mm的患者退行性椎体滑移的进展明显减少。Kaplan-Meier生存曲线显示，5年和10年的DS进展率分别为15%和54%。Cox比例风险模型证实，初始滑移的进展率明显更高；4 mm （p=0.011）。结论滑移距离较初诊增加3 mm的DS总体进展率为41.3%（33/80）。退行性椎体滑移主要发生在初始轻度(<；4毫米滑移距离)，诊断时年龄较小，随访时间较长。生存分析显示，基于初始滑移距离4毫米阈值，DS进展风险有明显区别。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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19. Radiographic progression of lumbar degenerative spondylolisthesis: natural history and associated risk factors

BACKGROUND CONTEXT

The natural history of degenerative spondylolisthesis (DS) remains poorly understood, particularly regarding its progression and related factors.

PURPOSE

To evaluate the radiographic progression rate of DS and its associated risk factors over a long-term follow-up period.

STUDY DESIGN/SETTING

Retrospective comparative study.

PATIENT SAMPLE

We enrolled patients with DS (at L3-4, L4-5, or L5-S1) who underwent at least 5 years of follow-up. We retrospectively analyzed 76 patients with DS (80 levels) with a mean age at diagnosis of 60.2 years. The mean follow-up period was 104.8 months (range, 60.7-239.4 months).

OUTCOME MEASURES

We evaluated the demographics, comorbidities, smoking history, follow-up duration, and the presence of surgery (after at least 5 years of nonsurgical follow-up). The degree of DS was measured using the slippage distance (mm) and Taillard method (%) on the standing plain radiographs. Patients with a slippage increase of at least 3 mm during follow-up compared to the initial status were classified as having progression of DS.

METHODS

The variables were compared between two groups (progression vs nonprogression). Statistical analysis identified factors associated with progression, including age, follow-up duration, and initial spondylolisthesis severity. In addition, we performed logistic regression analyses and survival analysis to evaluate the related factors associated with DS progression.

RESULTS

Initial slippage distance averaged 3.9 mm (9.6% of the Taillard method), increasing to 6.7 mm (16.6% of the Taillard method) at the final follow-up. The DS progression (=3 mm increased slippage distance) occurred in 41.3% (33/80) during follow-up. When comparing the two groups, the progression group exhibited younger age at diagnosis (57.6 vs 62.1 years, p=0.009), longer follow-up (117.9 vs 95.6 months, p=0.043), and milder initial slippage (2.3 mm vs 5.0 mm, p< 0.001). Multiple logistic regression analysis identified an initial degree of DS (slippage distance) as the determinant factor, with a cutoff of < 4 mm indicating higher progression risk (AUC: 0.751, sensitivity: 81.8%, specificity: 61.7%). Patients with =4 mm initial slippage distance exhibited significantly reduced DS progression. Kaplan-Meier survivorship curve showed DS progression rates were 15% at 5 years and 54% at 10 years. Cox proportional hazards modeling confirmed significantly higher progression rates for initial slippage < 4 mm (p=0.011).

CONCLUSIONS

The overall rate of DS progression (=3 mm increased slippage distance compared to initial diagnosis) was 41.3% (33/80). DS progression predominantly occurred in patients with mild initial degree (< 4 mm of slippage distance), younger age at diagnosis, and longer follow-up periods. Survival analysis showed a clear distinction in DS progression risk based on the 4 mm threshold of initial slippage distance.