Abstract
Background context
Retrolisthesis is relatively rare but when present has been associated with increased
back pain and impaired back function. Neither the prevalence of this condition in
individuals with lumbar disc herniations nor its possible relation to preoperative
back pain and dysfunction has been well studied.
Purpose
The purposes of this study were as follows: (1) to determine the prevalence of retrolisthesis
(alone or in combination with other degenerative conditions) in individuals with confirmed
L5–S1 disc herniation who later underwent lumbar discectomy; (2) to determine if there
is any association between retrolisthesis and degenerative changes within the same
vertebral motion segment; and (3) to determine the relation between retrolisthesis
(alone or in combination with other degenerative conditions) and preoperative low
back pain, physical function, and quality of life.
Study design/setting
Cross-sectional study.
Patient sample
A total of 125 individuals were identified for incorporation into this study. All
patients had confirmed L5–S1 disc herniation on magnetic resonance imaging (MRI) and
later underwent L5–S1 discectomy. All patients were enrolled in the Spine Patient
Outcomes Research Trial (SPORT) study; data were obtained from the multi-institutional
database comprised of SPORT patients from across the United States.
Outcome measures
Retrolisthesis, degenerative change on MRI, and Modic changes.
Methods
MRI scans of the lumbar spine were assessed at spinal level L5–S1 for all 125 patients.
Retrolisthesis was defined as posterior subluxation of 8% or more. Disc degeneration
was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1
to 3 and collectively classified as vertebral endplate degenerative changes. The presence
of facet arthropathy and ligamentum flavum hypertrophy was classified jointly as posterior
degenerative changes.
Results
The overall incidence of retrolisthesis at L5–S1 in our study was 23.2%. Retrolisthesis
combined with posterior degenerative changes, degenerative disc disease, or vertebral
endplate changes had incidences of 4.8%, 16%, and 4.8% respectively. The prevalence
of retrolisthesis did not vary by sex, age, race, smoking status, or education level
when compared with individuals with normal sagittal alignment. However, individuals
with retrolisthesis were more likely to be receiving workers' compensation than those
without retrolisthesis. Increased age was found to be associated with individuals
having vertebral endplate degenerative changes (both alone and in conjunction with
retrolisthesis) and degenerative disc disease. Individuals who had retrolisthesis
with concomitant vertebral endplate degenerative changes were more often smokers and
had no insurance. The presence of retrolisthesis was not associated with an increased
incidence of having degenerative disc disease, posterior degenerative changes, or
vertebral endplate changes. No statistical significance was found between the presence
of retrolisthesis on the degree of patient preoperative low back pain and physical
function. Patients with degenerative disc disease were found to have increased leg
pain compared with those patients without degenerative disc changes.
Conclusions
We found no significant relationship between retrolisthesis in patients with L5–S1
disc herniation and worse baseline pain or function. It is possible that the contribution
of pain or dysfunction related to retrolisthesis was far overshadowed by the presence
of symptoms caused by the concomitant disc herniation. It remains to be seen whether
retrolisthesis will affect outcome after discectomy in these patients.
Keywords
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Article info
Publication history
Published online: January 02, 2007
Accepted:
August 15,
2006
Received:
June 16,
2006
Footnotes
FDA device/drug status: not applicable.
The authors wish to acknowledge funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS #U01-AR45444-01A1).
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
