Cruz-Medina E, Coronado-Zarco R, Vázquez-Sotelo D, Chávez-Arias D, Juárez-García R, Macías-Hernández S

Language: English
References: 13
Page: 22-25
PDF size: 166.15 Kb.

ABSTRACT

Background: Radiographic instability has been frequently described as an important component in clinical evaluation of patients with lumbar spine pathologies, there is a controversy about its real utility and clinical implications in lumbar pathology, because it has been described as high frequent also in asymptomatic patients and not correlated with clinical symptoms. The aim of the study was to describe the frequency of radiographic instability in a sample of patients with symptomatic structural pathologies of the lumbar spine. Material and methods: It was conducted a descriptive, observational, cross-sectional study. There were included patients with lumbar spine structural pathologies and measured dynamic lumbar radiographs. The radiographs were evaluated for instability using the Dupuis technique. Descriptive statistics and bivariate analysis were calculated. Results: Sixty patients were included, of which 76% presented some grade of instability, 60% of this instability was angular (60% in the affected segment and 40% in the adjacent) and 16% translational (55% affected segment and 45% adjacent). Conclusions: Segmental instability is highly prevalent in both, but more in angular than translational planes, although it has been described in the same proportion in healthy asymptomatic individuals; neither type or intensity of symptoms were correlated with angular or translational instability.

REFERENCES

1. Ferrari S, Vanti C, Piccarreta R, Monticone M. Pain, disability, and diagnostic accuracy of clinical instability and endurance tests in subjects with lumbar spondylolisthesis. J Manipulative Physiol Ther. 2014; 37(9): 647-659.

2. Hasegawa K, Kitahara K, Shimoda H, Ishii K, Ono M, Homma T et al. Lumbar degenerative spondylolisthesis is not always unstable: clinic biomechanical evidence. Spine. 2014; 39(26): 2127-2135.

3. Knutsson F. The instability associated with disc degeneration in the lumbar spine. Acta Radiologica. 1944; 25(5-6): 593-609.

4. Dupuis PR, Yong-Hing K, Cassidy JD, Kirkaldy-Willis WH. Radiologic diagnosis of degenerative lumbar spinal instability. Spine. 1985; 10(3): 262-276.

5. Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar intervertebral instability: a review. Radiology. 2007; 245(1): 62-77.

6. Wright JG, Swiontkowski MF. Introducing a new journal section: evidence-based orthopaedics. J Bone Joint Surg Am. 2000; 82(869): 759-760.

7. Reyes-Sánchez A, Miramontes V, Rosales-Olivares L, Mercado-Almillo LM. Medición radiográfica de los rangos de movilidad translacional y angulatoria en sujetos sanos de nuestro medio. Rev Mex Ortop Traumatol. 1998; 12(6): 526-539.

8. Hayes MA, Howard TC, Gruel CR, Kopta JA. Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine. 1989; 14(3): 327-331.

9. Macnab I. The traction spur. J Bone Joint Surg Am. 1971; 53(4): 663-670.

10. Hasegawa K, Kitahara K, Shimoda H, Hara T. Facet joint opening in lumbar degenerative diseases indicating segmental instability. J Neurosurgery Spine. 2010; 12(6): 687-693.

11. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982; 165: 110-123.

12. Panjabi MM, Abumi K, Duranceau J, Oxland TR. Spinal stability and intersegmental muscle forces: a biomechanical model. Spine. 1989; 14(2): 194-200.

13. Alam WCA. Radiological evaluation of lumbar intervertebral instability. Ind J Aerospace Med. 2002; 46(2): 48-53.