Skip to main content
SpringerLink
Log in

Hidden spondylolisthesis: unrecognized cause of low back pain? Prospective study about the use of dynamic projections in standing and recumbent position for the individuation of lumbar instability

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Dynamic X-rays (DXR) are widely recognized as an effective method to detect lumbar instability (LI). They are usually performed with the patient in standing position (SDXR). In our opinion, standing position inhibits micromovements of the lumbar segment interested by the listhesis, thanks to paravertebral muscles antalgic contraction and augmented tone. We aim to demonstrate that DXR in recumbent position (RDXR), reducing the action of paravertebral muscles, can discover hypermovements not evidenced in SDXR.

Methods

Between January 2011 and January 2013, we studied 200 consecutive patients with lumbar degenerative disease with MRI, SDXR, and RDXR. We aimed to find a correlation between low back or radicular pain and the presence of a spondylolisthesis not showed by the SDXR, but showed by the RDXR.

Results

We analysed 200 patients: of the 133 not pathologic in SDXR, 43 patients (32.3 %) showed an hypermovement in RDXR (p = 0.0001) without any significant correlation between hidden listhesis and age, sex, or level involved.

Conclusions

The aim of our study is to determine whether in patients with lumbalgy without evidence of listhesis in SDXR, pain can be attributed to a faccettal syndrome or to a spondylolisthesis. Consequence of pain is augmented muscular tone of the paravertebral musculature, particularly in standing position. Augmented muscular tone tries to inhibit the pain generator, attempting to limit the slippage of the involved segment. In patients examined in RDXR, the tone of paravertebral musculature is reduced, showing the hidden spondylolisthesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pope MH, Panjabi M (1985) Biomechanical definitions of spinal instability. Spine (Phila Pa 1976) 10:255–256

    Article  CAS  Google Scholar 

  2. Frymoyer JW, Selby DK (1985) Segmental instability. Rationale for treatment. Spine (Phila Pa 1976) 10:280–286

    Article  CAS  Google Scholar 

  3. Watters WC, Bono CM, Gilbert TJ et al (2009) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 9:609–614. doi:10.1016/j.spinee.2009.03.016

    Article  PubMed  Google Scholar 

  4. Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L (2007) Lumbar intervertebral instability: a review. Radiology 245:62–77. doi:10.1148/radiol.2451051359

    Article  PubMed  Google Scholar 

  5. Wood KB, Popp CA, Transfeldt EE, Geissele AE (1994) Radiographic evaluation of instability in spondylolisthesis. Spine (Phila Pa 1976) 19:1697–1703

    Article  CAS  Google Scholar 

  6. Cabraja M, Mohamed E, Koeppen D, Kroppenstedt S (2012) The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis. Eur Spine J 21:256–261. doi:10.1007/s00586-011-1870-y

    Article  PubMed Central  PubMed  Google Scholar 

  7. Hammouri QM, Haims AH, Simpson AK et al (2007) The utility of dynamic flexion-extension radiographs in the initial evaluation of the degenerative lumbar spine. Spine (Phila Pa 1976) 32:2361–2364. doi:10.1097/BRS.0b013e318155796e

    Article  Google Scholar 

  8. Otani K, Okawa A, Shinomiya K, Nakai O (2005) Spondylolisthesis with postural slip reduction shows different motion patterns with video-fluoroscopic analysis. J Orthop Sci 10:152–159. doi:10.1007/s00776-004-0877-1

    Article  PubMed  Google Scholar 

  9. Penning L, Blickman JR (1980) Instability in lumbar spondylolisthesis: a radiologic study of several concepts. AJR Am J Roentgenol 134:293–301. doi:10.2214/ajr.134.2.293

    Article  CAS  PubMed  Google Scholar 

  10. Lowe RW, Hayes TD, Kaye J et al (1976) Standing roentgenograms in spondylolisthesis. Clin Orthop Relat Res :80–84.

  11. Dupuis PR, Yong-Hing K, Cassidy JD, Kirkaldy-Willis WH (1985) Radiologic diagnosis of degenerative lumbar spinal instability. Spine (Phila Pa 1976) 10:262–276

    Article  CAS  Google Scholar 

  12. Kanemura A, Doita M, Kasahara K et al (2009) The influence of sagittal instability factors on clinical lumbar spinal symptoms. J Spinal Disord Tech 22:479–485. doi:10.1097/BSD.0b013e31818d1b18

    Article  PubMed  Google Scholar 

  13. Posner I, White AA, Edwards WT, Hayes WC (1982) A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine. Spine (Phila Pa 1976) 7:374–389

    Article  CAS  Google Scholar 

  14. Morgan FP, King T (1957) Primary instability of lumbar vertebrae as a common cause of low back pain. J Bone Joint Surg (Br) 39-B:6–22

    CAS  Google Scholar 

  15. Boden SD, Wiesel SW (1990) Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine (Phila Pa 1976) 15:571–576

    Article  CAS  Google Scholar 

  16. Hanley EN (1995) The indications for lumbar spinal fusion with and without instrumentation. Spine (Phila Pa 1976) 20:143S–153S

    Article  Google Scholar 

  17. Kälebo P, Kadziolka R, Swärd L (1990) Compression-traction radiography of lumbar segmental instability. Spine (Phila Pa 1976) 15:351–355

    Article  Google Scholar 

  18. Friberg O (1987) Lumbar instability: a dynamic approach by traction-compression radiography. Spine (Phila Pa 1976) 12:119–129

    Article  CAS  Google Scholar 

  19. Pitkänen M, Manninen HI, Lindgrer KA et al (1997) Limited usefulness of traction-compression films in the radiographic diagnosis of lumbar spinal instability. Comparison with flexion-extension films. Spine (Phila Pa 1976) 22:193–197

    Article  Google Scholar 

  20. Friberg O (1991) Instability in spondylolisthesis. Orthopedics 14:463–465

    CAS  PubMed  Google Scholar 

  21. Pearcy M, Portek I, Shepherd J (1985) The effect of low-back pain on lumbar spinal movements measured by three-dimensional X-ray analysis. Spine (Phila Pa 1976) 10:150–153

    Article  CAS  Google Scholar 

  22. Knutsson F (1944) The instability associated with disc degeneration in the lumbar spine. Acta Radiol 25:593–609

    Article  Google Scholar 

  23. Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5:383–389, discussion 397

    Article  CAS  PubMed  Google Scholar 

  24. Panjabi MM (2003) Clinical spinal instability and low back pain. J Electromyogr Kinesiol 13:371–379. doi:10.1016/S1050-6411(03)00044-0

    Article  PubMed  Google Scholar 

  25. Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5:390–396, discussion 397

    Article  CAS  PubMed  Google Scholar 

  26. Panjabi MM, Goel VK, Takata K (1982) Physiologic strains in the lumbar spinal ligaments. An in vitro biomechanical study 1981 Volvo Award in Biomechanics. Spine (Phila Pa 1976) 7:192–203

    Article  CAS  Google Scholar 

  27. Kirkaldy-Willis WH, Farfan HF (1982) Instability of the lumbar spine. Clin Orthop Relat Res :110–123

  28. Kreiner S, Shaffer WO, Baisden J, Gilbert T, Summers J, Toton J, Hwang S, Mendel R RC (2014) Evidence-based clinical guidelines for multidisciplinary spine care diagnosis and treatment of degenerative lumbar spinal stenosis. North Am. Spine Soc

  29. Eck JC, Sharan A, Ghogawala Z, Resnick DK (2014) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: intractable low-back pain without stenosis or spondylolisthesis. J Neurosurg Spine 2:670–672. doi:10.3171/2014.4.SPINE14270

    Google Scholar 

  30. Chaparian A, Kanani A, Baghbanian M (2014) Reduction of radiation risks in patients undergoing some X-ray examinations by using optimal projections: a Monte Carlo program-based mathematical calculation. J Med Phys 39:32–39. doi:10.4103/0971-6203.125500

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Ethical standards and patient consent

We declare that this manuscript does not contain clinical studies or patient data.

Conflict of interest

NM consults for B-Braun.

Author information

Authors and Affiliations

  1. Department of Neurology and Psychiatry, Division of Neurosurgery, “Sapienza” University of Rome - Policlinico Umberto I, viale del Policlinico 155, 00181, Rome, Italy

    Alessandro Landi, Fabrizio Gregori, Nicola Marotta, Pasquale Donnarumma & Roberto Delfini

Authors
  1. Alessandro Landi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrizio Gregori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicola Marotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pasquale Donnarumma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Delfini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Landi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Landi, A., Gregori, F., Marotta, N. et al. Hidden spondylolisthesis: unrecognized cause of low back pain? Prospective study about the use of dynamic projections in standing and recumbent position for the individuation of lumbar instability. Neuroradiology 57, 583–588 (2015). https://doi.org/10.1007/s00234-015-1513-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-015-1513-9

Keywords

Search

Navigation