일부 50대 척추전방전위증 환자의 유형별 자기공명영상상 추간판 변형 형태 고찰

김석,반효정,윤현석,한경완,우재혁,Kim, Seok,Bahn, Hyo-Jung,Yoon, Hyun-Seok,Han, Kyung-Wan,Woo, Jae-Hyuk 척추신경추나의학회 2011 척추신경추나의학회지 Vol.6 No.2

Objectives : The purpose of this study is to find out the characteristics of intervertebral disc changes and relative factors of the spondylolisthesis patients in fifties by type of spondylolisthesis. Methods : We investigated 69 cases of patients who visited one Korean traditional medicine hospital and were diagnosed as spondylolisthesis on L-spine X-ray and L-spine magnetic resonance imaging(MRI). We selected 37 lytic spondylolisthesis patients and 32 degenerative spondylolisthesis patients. We analysed the relativity between the numbers of changed discs, types of changed disc, locations of nerve compression and types of spondylolisthesis. Results : 1. The number of changed discs increase in lytic type, but there is no statistically significant difference. 2. Bulging disc is the dominant type of disc change. There is no significant difference between two types. 3. Both foraminal type was shown dominantly in lytic spondylolisthesis, diffuse type in degenerative spondylolisthesis by the analysis of the location of the nerve compression. But the symptoms of patients and dermatome did not match in most of the cases. Conculsions : The direction of nerve compression is different while the disc changing aspects are similar in both types. In several spondylolisthesis patients in fifties, symptoms of patient are related to degeneration of vertebrae, not to the type of spondylolisthesis.

Significance of Facet Fluid Index in Anterior Cervical Degenerative Spondylolisthesis

Lee Yunsoo,Heard Jeremy C.,Lambrechts Mark J.,Kern Nathaniel,Wiafe Bright,Goodman Perry,Mangan John J.,Canseco Jose A.,Kurd Mark F.,Kaye Ian D.,Hilibrand Alan S.,Vaccaro Alexander R.,Kepler Christophe 대한척추외과학회 2024 Asian Spine Journal Vol.18 No.1

Study Design: Retrospective cohort study.Purpose: To correlate cervical facet fluid characteristics to radiographic spondylolisthesis, determine if facet fluid is associated with instability in cervical degenerative spondylolisthesis, and examine whether vertebral levels with certain facet fluid characteristics and spondylolisthesis are more likely to be operated on.Overview of Literature: The relationship between facet fluid and lumbar spondylolisthesis is well-documented; however, there is a paucity of literature investigating facet fluid in degenerative cervical spondylolisthesis.Methods: Patients diagnosed with cervical degenerative spondylolisthesis were identified from a hospital’s medical records. Demographic and surgical characteristics were collected through a structured query language search and manual chart review. Radiographic measurements were made on preoperative MRIs for all vertebral levels diagnosed with spondylolisthesis and adjacent undiagnosed levels between C3 and C6. The facet fluid index was calculated by dividing the facet fluid measurement by the width of the facet. Bivariate analysis was conducted to compare facet characteristics based on radiographic spondylolisthesis and spondylolisthesis stability.Results: We included 154 patients, for whom 149 levels were classified as having spondylolisthesis and 206 levels did not. The average facet fluid index was significantly higher in patients with spondylolisthesis (0.26±0.07 vs. 0.23±0.08, p <0.001). In addition, both fluid width and facet width were significantly larger in patients with spondylolisthesis (p <0.001 each). Cervical levels in the fusion construct demonstrated a greater facet fluid index and were more likely to have unstable spondylolisthesis than stable spondylolisthesis (p <0.001 each).Conclusions: Facet fluid index is associated with cervical spondylolisthesis and an increased facet size and fluid width are associated with unstable spondylolisthesis. While cervical spondylolisthesis continues to be an inconclusive finding, vertebral levels with spondylolisthesis, especially the unstable ones, were more likely to be included in the fusion procedure than those without spondylolisthesis.

경추 및 요추 퇴행성 척추전위증의 병발성 유병률

박문수,황지효,김태환,오재근,장호근,김형준,박건태,임진규,K. Daniel Riew 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.4

Study Design: Retrospective radiographic study. Objective: To evaluate the characteristics of concurrent degenerative cervical and lumbar spondylolisthesis. Summary of Literature Review: Concurrent degenerative cervical and lumbar spondylotic diseases have been reported. Given that severe spondylosis can result in spondylolisthesis, one might expect that concurrent spondylolisthesis of the cervical and lumbar spines might also be prevalent. However, the incidence of spondylolistheses in the lumbar and cervical spines might differ due to anatomical differences between the 2 areas. Nonetheless, there is minimal information in the literature concerning the incidence of concurrent cervical and lumbar spondylolisthesis. Material and Methods: We evaluated standing cervical and lumbar lateral radiographs of 2510 patients with spondylosis. Concurrence, age group, gender, and direction of spondylolisthesis were evaluated. Lumbar spondylolisthesis was defined as at least Meyerding grade I and degenerative cervical spondylolisthesis was defined as over 2 mm of displacement on standing lateral radiographs. Results: Lumbar spondylolisthesis was found in 125 patients (5.0%) and cervical spondylolisthesis was found in 193 patients (7.7%). Seventeen patients had both degenerative cervical and lumbar spondylolistheses (0.7%). Lumbar spondylolisthesis is a risk factor for coexisting cervical spondylolisthesis. Lumbar spondylolisthesis was more common in females than males, independent of advancing age. In contrast, degenerative cervical spondylolisthesis was more common in older patients, independent of gender. Anterolisthesis was more common in the lumbar spine. Retrolisthesis was more common in the cervical spine. Conclusions: There was a higher prevalence of degenerative cervical spondylolisthesis in patients with degenerative lumbar spondylolisthesis. 연구 계획: 후향적 방사선 연구목적: 경추와 요추에 동시에 발생한 퇴행성 척추전위증을 알아보고자 한다. 선행 연구논문의 요약: 경추와 요추에 동시에 발생한 퇴행성 척추질환에 대한 여러 보고가 있었다. 퇴행성 척추전위증은 퇴행성 변화에 의하여 시발되므로 경추와 요추에 척추전위증이 병발할 것으로 추정된다. 반면에, 요추와 경추의 해부학적 구조가 서로 다르므로 두 질환의 진행이 동일하지 않을 것으로추정할 수도 있다. 그러나, 경추와 요추에 동시에 발생한 퇴행성 척추전위증에 대한 보고는 적었다. 대상 및 방법: 요추 및 경추 부위에 기립위 단순방사선 검사를 둘다 시행한 퇴행성 척추 질환 환자 2,510명을 대상으로 하였다. 병발여부, 나이, 성별, 전위증의 방향에 대하여 조사하였다. 퇴행성 요추전위증은 기립위 단순방사선영상에서 Meyerding 방법을 사용하여 grade 1 이상인 경우 진단하였으며 퇴행성 경추전위증은 기립위 단순방사선영상에서 2 mm 이상의 전위가 보이는 경우 진단하였다. 결과: 퇴행성 요추전위증은 125명에서 관찰되었으며(5.0%) 퇴행성 경추전위증은 193명에서 관찰되었다(7.7%). 요추전위증과 경추전위증은 17명에서같이 관찰되었다(0.7%). 요추전위증이 있는 환자가 없는 환자에 비하여 경추전위증이 더 많이 관찰되었다. 요추전위증은 남자보다 여자에서 더 흔하였으나, 모든 연령군에서 비슷하게 발생하였다. 경추전위증은 고령의 연령군에서 더 많이 발생하였으나, 남녀의 발생 비율이 비슷하였다. 요추전위증에서는전방으로 많이 발생하였고, 경추전위증에서는 후방으로 많이 발생하였다. 결론: 퇴행성 요추전위증이 있는 경우가 없는 경우에 비하여 퇴행성 경추전위증이 더 많이 발생하였다. 약칭 제목: 동시에 발생한 척추전위증

Radiological Characteristics of Low-Grade Lytic Spondylolisthesis: Similarity to Dysplastic Spondylolisthesis

Cho Sung Tan,Kim Jin Hwan 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

Study Design: Retrospective case-control study.Purpose: This study aimed to analyze the etiology of low-grade lytic spondylolisthesis based on the radiologic features of the vertebra.Overview of Literature: According to the Marchetti-Bartolozzi classification scheme, high-grade lytic spondylolisthesis (Meyerding grade 3–5) is classified as dysplastic. However, determination of the etiology for low-grade lytic spondylolisthesis as developmental or traumatic remains controversial.Methods: Patients admitted and treated for one-level (L4/5 or L5/S1) low-grade spondylolisthesis were included in the study. A total of 135 patients were divided into the degenerative or lytic spondylolisthesis groups according to their condition (81 patients [degenerative group] vs. 54 patients [lytic group]). To assess the level of similarity in the radiological findings between low-grade lytic spondylolisthesis and dysplastic spondylolisthesis, the pedicle diameters and vertebral heights of the L4 and L5 vertebrae were measured on computed tomography images. Measurements were then converted to each vertebra’s ratio to reduce confounding factors among individuals.Results: The affected vertebra had a smaller sagittal pedicle diameter/transverse pedicle diameter ratio in the low-grade lytic spondylolisthesis group compared to the degenerative group, and the posterior vertebral height/anterior vertebral height ratio of L5 was smaller in the L5/S1 lytic spondylolisthesis group compared to the degenerative spondylolisthesis group.Conclusions: Low-grade lytic spondylolisthesis and dysplastic spondylolisthesis demonstrated similar radiological findings. Hence, surgeons should be attentive to the morphology of the vertebral body and posterior column during preoperative planning for the treatment of low-grade lytic spondylolisthesis.

척추전방전위증 환자에서의 자기공명영상 상 추간판 변형 형태 고찰

김석 ( Seok Kim ),반효정 ( Hyo Jung Bahn ),유현석 ( Hyun Seok Yoon ),김선민 ( Sun Min Kim ),전병철 ( Byung Chul Jun ) 한방재활의학과학회 2011 한방재활의학과학회지 Vol.21 No.4

Objectives: The purpose of this study is to find out the characteristics of intervertebral disc changes and relative factors of the patients with spondylolisthesis. Methods: We investigated 95 cases of patients who visited one Korean traditional medicine hospital and were diagnosed as spondylolisthesis on lumbar spine X-ray and lumbar spine magnetic resonance imaging(MRI). We selected these cases retrospectively and randomly. We analysed the relativity between number of changed discs and type of changed disc and age, level of spondylolisthesis and type of spondylolisthesis. Results: 1. The number of changed discs increased with older age and degenerative spondylolisthesis type(p<0.05) and was not related to the level of spondylolisthesis. 2. Bulging disc is the dominant type of disc change(74.12%). The type of changed disc was shown to be similar in lytic and degenerative spondylolisthesis. It was not relative to the level of spondylolisthesis(p>0.05). 3. The direction of nerve compression was diffuse type in about halfly of the patients(47.06%) and the symptoms of patient and dermatome did not matched in 54 cases. Conclusions: The patients who visited a Korean medicine hospital and were diagnosed as spondylolithesis have different characteristics from the established studies. Their discs changed dominantly to diffuse bulging type and the symptoms of patient were not related with the direction and level of the changed discs where spondylolisthesis existed.

Disc Height Narrowing Could Not Stabilize the Mobility at the Level of Cervical Spondylolisthesis: A Retrospective Study of 83 Patients with Cervical Single-Level Spondylolisthesis

Aoyama Ryoma,Yamane Junichi,Ninomiya Ken,Takahashi Yuichiro,Kitamura Kazuya,Nori Satoshi,Suzuki Satoshi,Shiraishi Tateru 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.1

Study Design: A retrospective study at a single academic institution.Purpose: We aimed to understand the pathogenesis of cervical spondylolisthesis by analyzing whether narrowing of the disc height stabilizes the slipped disc level according to the degenerative cascade.Overview of Literature: According to Kirkaldy-Willis’ degenerative cascade, the narrowing of the disc height at slipped level contributes to intervertebral stability in lumbar spondylolisthesis. Conversely, the pathogenesis of cervical spondylolisthesis is unknown due to a scarcity of reports on the condition.Methods: The images of 83 patients with cervical single-level spondylolisthesis were studied. We looked at 52 slipped levels for anterior slippage and 31 for posterior slippage. The imaging parameters included slippage in the neutral, flexed, and extended positions, axial facet joint orientation, sagittal facet slope, global cervical alignment, C2–C7 angle, C2–C7 sagittal vertical axis, range of motion (ROM), and slipped disc angle ROM.Results: With the narrowing of the intervertebral disc height, slippage in the flexed position of both anterior and posterior spondylolisthesis increased. However, in both anterior and posterior spondylolisthesis, disc height narrowing did not show stability. The narrowing of the intervertebral disc height was found to be a risk factor for a translation of slippage of 1.8 mm or more in flexionextension motion in anterior spondylolisthesis in multivariate regression analysis.Conclusions: Narrowing the intervertebral disc height did not stabilize the translation of slippage in flexion-extension motion in cervical spondylolisthesis. Instead, narrowing of the disc height was associated with a translation of slippage of 1.8 mm or more in flexion-extension motion in cases of anterior slippage. Therefore, we discovered that degenerative cascade stabilization for cervical spondylolisthesis was difficult to achieve.

협부형과 퇴행성형 요추 전방전위증에서 유합방법에 따른 치료 결과의 비교

이규열,손성근,김성완,이성원 대한척추외과학회 2002 대한척추외과학회지 Vol.9 No.4

척추전방전위증의 한의학적 치료에 대한 국내 연구 동향

김영준 ( Young Jun Kim ),백지영 ( Ji Yeong Baek ),안희덕 ( Hee Duk Ahn ),우창훈 ( Chang Hoon Woo ) 한방재활의학과학회 2016 한방재활의학과학회지 Vol.26 No.1

Objectives The purpose of this study is to investigate the trends of Korean medicine treatments of spondylolisthesis. Methods We investigated the studies on Korean medicine treatments for spondylolisthesis via searching 4 Korean web databases (OASIS, KTKP, RISS, DBpia). We used “Spondylolisthesis”, “Lumbar spondylolisthesis” as keyword. Limitations were as follows; Domestic studies, mentioning the treatments of spondylolisthesis in Korean medicine. This study researched and classified the papers according to type of study, published year, titles of journals, published institution, the number of cases, and types of treatments. Results 14 research papers were found to be analyzed according to their published year, the titles of journals, published institution, the types of study, the number of cases, and the types of treatments. 14 papers were published since 2000. The studies on Korean medicine treatments about spondylolisthesis were mainly published in the journal of Korean acupuncture & moxibustion medicine. 7 case reports, 6 case series, 1 RCT had been under research. In 14 cases of the studies, various Korean medicine treatments were used to treat the symptoms. Numeric rating scale (NRS) was used as primary assessments. Conclusions In this study, we analyzed the trends of Korean medicine treatments of spondylolisthesis. Reviewing the domestic trends of studies on Korean medicine treatments of spondylolisthesis and examining the strong and weak points of those treatments are essential for the further studies. (J Korean Med Rehab 2016;26(1):41-47)

Prognostic Importance of Spinopelvic Parameters in the Assessment of Conservative Treatment in Patients with Spondylolisthesis

Sai Krishna M L V,Deep Sharma,Jagdish Menon 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: This was a prospective, two-group comparative study. Purpose: The present study aimed to determine the importance of the spinopelvic parameters in the causation and progression of spondylolisthesis. Overview of Literature: Spondylolisthesis is slippage of one vertebra over the vertebra below. Since the discovery of pelvic incidence (PI) in 1998 in addition to documentation of other parameters in spinopelvic balance, slippage in spondylolisthesis has been attributed to these parameters. Many studies on the Caucasian population have implicated high PI as a causative factor of spondylolisthesis. To the best of our knowledge, no study has described the role of these parameters in the progression of spondylolisthesis. Methods: The study was conducted in Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. Seventy-nine patients with spondylolisthesis consented to participate in the study. All patients were advised to undergo conservative treatment and were regularly followed up according to the protocol. Seventy-five asymptomatic volunteers were recruited as a control group. Of the total of 79 patients, 54 were followed up for 6 months, during which 46 improved, eight showed no improvement, and 25 were lost to follow-up. Sagittal spinopelvic parameters were measured by a single observer using the Surgimap spine software ver. 2.1.2 (Nemaris, New York, NY, USA). Parameters measured were PI, pelvic tilt (PT), sacral slope (SS), thoracic kyphosis, and lumbar lordosis. The results from patients and controls were compared using appropriate statistical methods. Results: The normal and spondylolisthesis groups significantly differed with respect to PI, SS, and PT (p <0.001). There were no significant differences in the measured spinopelvic parameters between patients with high- and low-grade spondylolisthesis or between those whose condition improved and those whose condition worsened. Conclusions: PI, the most important of all spinopelvic parameters, is responsible for the slip in spondylolisthesis, but not for its progression.

척추 전방전위증의 전산화 단층촬영 소견 : 협부형과 퇴행형의 비교

이종덕,변재영,Lee, Jong-Deok,Byun, Jae-Young 대한침구의학회 2000 대한침구의학회지 Vol.17 No.4

Objectives : To evaluate the findings useful for differential diagnosis and associated abnormaiities of isthmic spondylolisthesis and degenerative spondylolisthesis on CT. Materials and methods : We reviewed retrospectively the CT images of 65 patients who were diagnosed spondylolisthesis during 3 years period. Our technique was 5mm slices at 5mm intervals with gantry angle to parallel the interspaces. Also reformatted sagittal views were taken. 41 patients were isthmic spondylolisthesis and 24 patients were degenerative spondylolisthesis. Resuits : Isthmic spondylolisthesis. 1. Isthmic type was more common at L5-S1. 2. The degree of anterior displacement was grade I and II. 3. The plane of defect was more horizontal than the usual facet joint. 4. The defect had an irregular shape. 5. Medial aspect of bone just anterior to defect had a small round prominence. 6. Anteroposterior elongation of the spinal canal was common. 7. Pseudobulging disk was common. 8. The most common associated abnormality was a HNP at the upper level of the defect. Degenerative spondylolisthesis. 1. Degenerative type was more common at L4-5. 2. The degree of anterior disptacement was grade I and II. 3. The Plane of facet joint was oriented obliquely instead of horizontally. 4. The posterior facet(inferior facet of superior vertebra) was anteriorly displaced. 5. Bony spur of the posterior portion of anterior facet was seen. 6. The facet joints often contain gas(vaccum phenomenum). 7. The most common associated abnormality was a HNP at the level of the displacement. Conclusions : CT is a highly accurate and most sensitive technique for recognition, differential diagnosis of isthmic and degenerative types and the detection of associated abnormalities.