Skip to main content
  • Comparative Utility of Dynamic and Static Imaging in the Management of Lumbar Spondylolisthesis

    Final Number:

    Jeffrey Hatef MD; Sina Aghili-Mehrizi; Vibhu Krishnan Viswanathan; Amy Minnema; Francis Farhadi MD PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: Spinal instability refers to the inability of the spine to withstand daily stresses without incapacitating pain or neurologic deficit. Instability is traditionally investigated with flexion and extension (F-E) X-rays. Recently, abnormal spinal motion between supine and standing (S-S) views has been proposed as another diagnostic tool.

    Methods: Between February 2010 and August 2016, 97 consecutive patients were identified that underwent either one- or two-level instrumented arthrodesis for degenerative lumbar instability. Patients were grouped into either Group 1 (=3 mm difference in spondylolisthesis between F-E X-rays) or Group 2 (=3 mm difference in spondylolisthesis between S-S imaging and otherwise not meeting Group 1 criteria). Pre-operative and post-operative clinical and radiologic data were collected ambispectively and compared between groups at a minimum of 1-year follow-up.

    Results: Seventy-seven of 97 identified patients (80%) achieved at least one-year follow-up (average 32.4 months). Group 1 (n=27) and Group 2 (n= 50) patients did not differ in average age (p=0.351), percent male (p=0.806), BMI (p=0.953), percent smoker (p=0.712), average spondylolisthesis (p=0.711), percent with severe index level foraminal stenosis (p=0.155). Average follow-up for Group 1 and Group 2 was 32.7 and 32.2 months, respectively (p=0.485). ?SlipFE (average change in flexion-extension) was 4.8 mm for Group 1 and ?SlipSS (average change in supine-standing) was 5.3 mm for Group 2. Posterolateral fusion was graded using the Lenke classification and found to be 88.9% A/B for Group 1 and 94.0% A/B for Group 2 (p=0.659). For both Group 1 and Group 2, VAS back (p=0.043 and p=0.001), VAS leg (p<0.0001 and p=0.001), ODIv2.1a (p=0.024 and p=0.002), and SF-36 RAND (p=0.016 and p=0.004) improved significantly. ?VAS back (p=0.580) and leg (p=0.577), ?ODIv2.1a (p=0.585), and ?SF-36 RAND (p=0.404) were not significantly different between the two groups.

    Conclusions: No differences were noted in outcomes between Group 1 and 2 patients. These data suggest that assessment of instability based on static S-S imaging may identify a distinct group of patients that similarly benefit from surgery.

    Patient Care: Assessment of supine-standing views may represent an alternative diagnostic modality for lumbar spondylolisthesis. This work may therefore help identify movement on supine-standing imaging as a distinct form of spinal instability that smilarly benefits from surgical intervention.

    Learning Objectives: 1. Patients with instability on F-E and S-S imaging appear to benefit similarly from lumbar decompression/fusion surgery 2. Movement on S-S imaging may represent a distinct form of spinal instability 3. S-S imaging may represent an alternative diagnostic modality in lumbar spondylolisthesis


We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy