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Disc Height Narrowing Could Not Stabilize the Mobility at the Level of Cervical Spondylolisthesis: A Retrospective
Ryoma Aoyama1, Junichi Yamane2, Ken Ninomiya3
1Department of Orthopaedics, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.
Insights
Narrowing disc height in cervical spondylolisthesis does not stabilize slippage. Instead, it increases slippage, particularly in anterior cases, challenging the degenerative cascade theory for cervical spine stability.
Area of Science:
- Spine surgery
- Orthopedics
- Radiology
Background:
- The Kirkaldy-Willis degenerative cascade suggests disc height narrowing stabilizes lumbar spondylolisthesis.
- The pathogenesis of cervical spondylolisthesis remains poorly understood due to limited research.
Purpose of the Study:
- To investigate if reduced disc height contributes to intervertebral stability in cervical spondylolisthesis.
- To analyze the relationship between disc height narrowing and the degenerative cascade in the cervical spine.
Main Methods:
- Retrospective analysis of 83 patients with single-level cervical spondylolisthesis.
- Evaluation of imaging parameters including slippage, facet joint orientation, cervical alignment, and range of motion (ROM).
- Analysis of both anterior (52 cases) and posterior (31 cases) slippage.
Main Results:
- Disc height narrowing correlated with increased slippage in the flexed position for both anterior and posterior cervical spondylolisthesis.
- Disc height narrowing did not demonstrate a stabilizing effect on intervertebral levels.
- Multivariate regression identified disc height narrowing as a risk factor for ≥1.8 mm slippage translation in flexion-extension for anterior spondylolisthesis.
Conclusions:
- Reduced intervertebral disc height does not stabilize cervical spondylolisthesis.
- Disc height narrowing is associated with increased slippage translation, especially in anterior cervical spondylolisthesis.
- Achieving stabilization via the degenerative cascade model is challenging in cervical spondylolisthesis.
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.
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