Skeletal Radiology

, Volume 47, Issue 9, pp 1269–1275 | Cite as

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

  • Tim Finkenstaedt
  • Filippo Del Grande
  • Nicolae Bolog
  • Nils H. Ulrich
  • Sina Tok
  • Jakob M. Burgstaller
  • Johann Steurer
  • Christine B. Chung
  • Gustav Andreisek
  • Sebastian Winklhofer
  • on behalf of the LSOS working group
Scientific Article



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.


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.


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.


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


Compliance with ethical standards

Conflicts of interest

This study was supported by the Helmut Horten Foundation, Baugarten Foundation, Pfizer-Foundation for geriatrics and research into geriatrics, Symphasis Charitable Foundation and OPO-Foundation. We disclose any financial support or author involvement with organization(s) with a financial interest in the subject matter.

IRB statement

This study was approved by the local ethical committee of the University of Zurich, Switzerland. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

All patients received written and oral information about the study and gave their written informed consent for participation. The project was registered at


  1. 1.
    Englund J. Lumbar spinal stenosis. Curr Sports Med Rep. 2007;6(1):50–5.PubMedGoogle Scholar
  2. 2.
    Frymoyer JW. Degenerative spondylolisthesis: diagnosis and treatment. J Am Acad Orthopaed Surg. 1994;2(1):9–15.CrossRefGoogle Scholar
  3. 3.
    Rosenberg NJ. Degenerative spondylolisthesis. Predisposing factors. J Bone Joint Surg Am. 1975;57(4):467–74.CrossRefPubMedGoogle Scholar
  4. 4.
    Farfan HF. The pathological anatomy of degenerative spondylolisthesis. A cadaver study. Spine (Phila Pa 1976). 1980;5(5):412–8.CrossRefGoogle Scholar
  5. 5.
    Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976). 1995;20(10):1178–86.CrossRefGoogle Scholar
  7. 7.
    Lohman CM, Tallroth K, Kettunen JA, Lindgren KA. Comparison of radiologic signs and clinical symptoms of spinal stenosis. Spine (Phila Pa 1976). 2006;31(16):1834–40.CrossRefGoogle Scholar
  8. 8.
    Sirvanci M, Bhatia M, Ganiyusufoglu KA, Duran C, Tezer M, Ozturk C, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry disability index and MR imaging. Eur Spine J. 2008;17(5):679–85.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Singh K, Samartzis D, Vaccaro AR, Nassr A, Andersson GB, Yoon ST, et al. Congenital lumbar spinal stenosis: a prospective, control-matched, cohort radiographic analysis. Spine J. 2005;5(6):615–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Schonstrom N, Lindahl S, Willen J, Hansson T. Dynamic changes in the dimensions of the lumbar spinal canal: an experimental study in vitro. J Orthop Res. 1989;7(1):115–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Penning L, Wilmink JT. Posture-dependent bilateral compression of L4 or L5 nerve roots in facet hypertrophy. A dynamic CT-myelographic study. Spine (Phila Pa 1976). 1987;12(5):488–500.CrossRefGoogle Scholar
  12. 12.
    Bolender NF, Schonstrom NS, Spengler DM. Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Joint Surg Am. 1985;67(2):240–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Laurencin CT, Lipson SJ, Senatus P, Botchwey E, Jones TR, Koris M, et al. The stenosis ratio: a new tool for the diagnosis of degenerative spinal stenosis. Int J Surg Investig. 1999;1(2):127–31.PubMedGoogle Scholar
  14. 14.
    Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976). 2010;35(21):1919–24.CrossRefGoogle Scholar
  15. 15.
    Weber C, Giannadakis C, Rao V, Jakola AS, Nerland U, Nygaard OP, et al. Is there an association between radiological severity of lumbar spinal stenosis and disability, pain, or surgical outcome?: a multicenter observational study. Spine (Phila Pa 1976). 2016;41(2):E78–83.CrossRefGoogle Scholar
  16. 16.
    Steurer J, Nydegger A, Held U, Brunner F, Hodler J, Porchet F, et al. LumbSten: the lumbar spinal stenosis outcome study. BMC Musculoskelet Disord. 2010;11:254.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dupuis PR, Yong-Hing K, Cassidy JD, Kirkaldy-Willis WH. Radiologic diagnosis of degenerative lumbar spinal instability. Spine (Phila Pa 1976). 1985;10(3):262–76.CrossRefGoogle Scholar
  18. 18.
    Vogt MT, Rubin D, Valentin RS, Palermo L, Donaldson WF 3rd, Nevitt M, et al. Lumbar olisthesis and lower back symptoms in elderly white women. The Study of Osteoporotic Fractures. Spine (Phila Pa 1976). 1998;23(23):2640–7.CrossRefGoogle Scholar
  19. 19.
    Meyerding HW. Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg. 1956;26(5 Part 1):566–91.PubMedGoogle Scholar
  20. 20.
    Niggemann P, Kuchta J, Grosskurth D, Beyer HK, Hoeffer J, Delank KS. Spondylolysis and isthmic spondylolisthesis: impact of vertebral hypoplasia on the use of the Meyerding classification. Br J Radiol. 2012;85(1012):358–62.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Meyers CR, Blesh TE. Measurement in physical education. New York: Ronald Press; 1962.Google Scholar
  22. 22.
    Kanno H, Ozawa H, Koizumi Y, Morozumi N, Aizawa T, Ishii Y, et al. Changes in lumbar spondylolisthesis on axial-loaded MRI: do they reproduce the positional changes in the degree of olisthesis observed on X-ray images in the standing position? Spine J. 2015;15(6):1255–62.CrossRefPubMedGoogle Scholar
  23. 23.
    Chung SS, Lee CS, Kim SH, Chung MW, Ahn JM. Effect of low back posture on the morphology of the spinal canal. Skeletal Radiol. 2000;29(4):217–23.CrossRefPubMedGoogle Scholar
  24. 24.
    Kubosch D, Vicari M, Siller A, Strohm PC, Kubosch EJ, Knoller S, et al. The lumbar spine as a dynamic structure depicted in upright MRI. Medicine (Baltimore). 2015;94(32):e1299.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Benoist M. Natural history of the aging spine. Eur Spine J. 2003;12(Suppl 2):S86–9.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976). 2007;32(1):120–5.CrossRefGoogle Scholar
  27. 27.
    Fitzgerald JA, Newman PH. Degenerative spondylolisthesis. J Bone Joint Surg Br. 1976;58(2):184–92.CrossRefPubMedGoogle Scholar
  28. 28.
    Hansen BB, Hansen P, Christensen AF, Trampedach C, Rasti Z, Bliddal H, et al. Reliability of standing weight-bearing (0.25T) MR imaging findings and positional changes in the lumbar spine. Skeletal Radiol. 2017;47(1):25–35.CrossRefPubMedGoogle Scholar
  29. 29.
    Miao J, Wang S, Park WM, Xia Q, Fang X, Torriani MP, et al. Segmental spinal canal volume in patients with degenerative spondylolisthesis. Spine J. 2013;13(6):706–12.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Segebarth B, Kurd MF, Haug PH, Davis R. Routine upright imaging for evaluating degenerative lumbar stenosis: incidence of degenerative spondylolisthesis missed on supine MRI. J Spinal Disord Tech. 2015;28(10):394–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Resnick DK, Watters WC 3rd, Sharan A, Mummaneni PV, Dailey AT, Wang JC, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. IX. Lumbar fusion for stenosis with spondylolisthesis. J Neurosurg Spine. 2014;21(1):54–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Gopinath P. Lumbar segmental instability: points to ponder. J Orthop. 2015;12(4):165–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • Tim Finkenstaedt
    • 1
    • 2
  • Filippo Del Grande
    • 3
  • Nicolae Bolog
    • 4
  • Nils H. Ulrich
    • 5
  • Sina Tok
    • 5
  • Jakob M. Burgstaller
    • 6
  • Johann Steurer
    • 6
  • Christine B. Chung
    • 2
  • Gustav Andreisek
    • 7
  • Sebastian Winklhofer
    • 8
  • on behalf of the LSOS working group
  1. 1.Institute of Diagnostic and Interventional Radiology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
  2. 2.Department of RadiologyUniversity of California, San Diego, School of MedicineLa JollaUSA
  3. 3.Institute of Diagnostic and Interventional RadiologyOspedale Regionale di LuganoLuganoSwitzerland
  4. 4.Phoenix Diagnostic ClinicBucharestRomania
  5. 5.Department of Neurosurgery, Spine CenterSchulthess ClinicZurichSwitzerland
  6. 6.Horten Center for Patient Oriented Research and Knowledge TransferUniversity of ZurichZurichSwitzerland
  7. 7.Department of RadiologyKantonsspital MuensterlingenMünsterlingenSwitzerland
  8. 8.Department of Neuroradiology, University Hospital ZurichUniversity of ZurichZurichSwitzerland

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