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Skeletal Radiol. 2018 Sep;47(9):1269-1275. doi: 10.1007/s00256-018-2935-3. Epub 2018 Apr 13.

Correlation of listhesis on upright radiographs and central lumbar spinal canal stenosis on supine MRI: is it possible to predict lumbar spinal canal stenosis?

Author information

1
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
2
Department of Radiology, University of California, San Diego, School of Medicine, La Jolla, CA, 92093, USA.
3
Institute of Diagnostic and Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland.
4
Phoenix Diagnostic Clinic, Bucharest, Romania.
5
Department of Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland.
6
Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
7
Department of Radiology, Kantonsspital Muensterlingen, Münsterlingen, Switzerland.
8
Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. sebastian.winklhofer@usz.ch.

Abstract

OBJECTIVE:

To investigate whether upright radiographs can predict lumbar spinal canal stenosis using supine lumbar magnetic resonance imaging (MRI) and to investigate the detection performance for spondylolisthesis on upright radiographs compared with supine MRI in patients with suspected lumbar spinal canal stenosis (LSS).

MATERIALS AND METHODS:

In this retrospective study, conventional radiographs and MR images of 143 consecutive patients with suspected LSS (75 female, mean age 72 years) were evaluated. The presence and extent of listhesis (median ± interquartile range) were assessed on upright radiographs and supine MRI of L4/5. In addition, the grade of central spinal stenosis of the same level was evaluated on MRI according to the classification of Schizas and correlated with the severity/grading of anterolisthesis on radiographs.

RESULTS:

Anterolisthesis was detected in significantly more patients on radiographs (n = 54; 38%) compared with MRI (n = 28; 20%), p < 0.001. Pairwise comparison demonstrated a significantly larger extent of anterolisthesis on radiographs (9 ± 5 mm) compared with MRI (5 ± 3 mm), p < 0.001. A positive correlation was found regarding the extent of anterolisthesis measured on radiographs and the grade of stenosis on MRI (r = 0.563, p < 0.001). Applying a cutoff value of ≥5 mm anterolisthesis on radiographs results in a specificity of 90% and a positive predictive value of 78% for the detection of patients with LSS, as defined by the Schizas classification.

CONCLUSION:

Upright radiographs demonstrated more and larger extents of anterolisthesis compared with supine MRI. In addition, in patients with suspected LSS, the extent of anterolisthesis on radiographs (particularly ≥5 mm) is indicative of LSS and warrants lumbar spine MRI.

KEYWORDS:

Anterolisthesis; Claudication; Degenerative spinal changes; Listhesis; Lower back pain; Lumbar spine; Magnetic resonance imaging; Radiography; Spinal canal stenosis; Spine; Spondylolisthesis

PMID:
29651713
DOI:
10.1007/s00256-018-2935-3

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