Radiographs are particularly able to demonstrate anterolisthesis of one vertebra relative to the subjacent, without a pars interarticularis defect (Fig. In addition, DS is frequently accompanied by degenerative scoliosis, sometimes even with elements of rotational translation, which might be a diagnostic challenge.
Regarding alignment, degenerative spinal changes may, in addition to sagittal translation, lead to a kyphotic disc angle at the affected level.
It is important to highlight that although functional imaging methods may reveal/increase translation and movement in a spinal segment, this is not synonymous with required changes to clinical decision making. showed in their RCT that despite a sagittal slip over 7 mm on lateral radiographs, there was no difference in clinical outcome comparing decompression combined with fusion with decompression alone.
There are no universally accepted quantitative criteria for which MRI parameters that are best for evaluation of spinal stenosis.
Clinical evaluation, with a thorough physical examination and detailed penetration of symptomatology, is an important step in the diagnosis of DS.
The clinical presentation of DS has a wide spectrum ranging from no symptoms at all to back pain with or without radicular symptoms, leg pain, neurogenic claudication, muscle weakness, etc.The range of segmental vertebral mobility in DS is wide, without any universally accepted definition for either the term “instability” or which imaging techniques should be adopted to verify it – uniform reference standards are lacking.To quantify mobility in DS, many doctors employ the use of functional imaging techniques, such as lateral flexion/extension radiographs, since they have the potential to reveal an increased translation. were one of the first to state that flexion/extension radiographs revealed instability, with many followers also claiming that such functional imaging is important for assessing grade of pathological translation in DS. found what they defined as a pathological slip in 11% of their 100 studied spondylolisthesis patients (83% DS) with flexion/extension radiographs, which had not been apparent in standing/recumbent position radiographs.The importance of imaging and how to define potential “instability” in DS patients thus needs to be questioned.However, functional imaging is still widely used and the body of literature regarding DS “instability,” and how to best image it, is extensive, which is why this subject will be briefly covered here.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).In this retrospective study, conventional radiographs and MR images of 143 consecutive patients with suspected LSS (75 female, mean age 72 years) were evaluated.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.Details regarding clinical evaluation of symptomatology are covered in Section 15 Chapter 1 of this publication.When the symptomatology and physical examination points to DS, radiological imaging is then used to confirm the diagnosis and possibly also advise regarding the clinical relevance of the DS in relation to other radiological findings.