The Comparison Study Of The Lumbar Isthmic And Degenerative Spondylolisthesis With Multi-slices Spiral CT

Objective:To evaluate the value and appearances of multiplanar reformation(MPR)with multi-slices spiral CT in the diagnosis of the lumbar isthmic and degenerative spondylolisthesis.Materials and Methods:There were 50 patients with lumbar isthmic spondylolisthesis, 50 patients with degenerative spondylolisthesis and 20 volunteers randomly choosed from the healthy population without the lumbar spondylolisthesis as the controls.All of three groups were performed volumetric imaging with 64-slices spiral CT,and then the volumetric data was transferred to the workstation for post-processing of images in multiplanar reformation technique(MPR).There were the different appearances of the MPR images between the lumbar isthmic and degenerative spondylolisthesis.Those different MPR images appearances were retrospectively contrasted and analyzed.At the same time the different angles and planes MPR images were evaluated to display the isthmic rupture and isthmic rupture changes.Result:There were 50 cases of the lumbar isthmic spondylolisthesis with 94 lumbar pars defects and in 50 cases of the degenerative spondylolisthesis without lumbar pars defects. The lumbar pars defects and tissues of the isthmic spondylolisthesis had different appearances and relevance ratios in the different angles and planes MPR images.The sensitivity of detecting the lumbar pars defects and disruption shift was the highest by the sagittal MPR(100%).The lumbar pars defects could also been clearly displayed by the lumbar transverse and oblique transverse MPR images(100%).And the lumbar transverse and oblique transverse MPR images had more advantages to manifest the bone fragments and the pseudo-joint formation than the other MPR images.The degree and direction of the displacing vertibrae had notable difference between the lumbar isthmic and degenerative spondylolisthesis(X~2=9.72,7.16,P＜0.05,0.05).The degree of the lumbar isthmic spondylolisthesis had more than those of the degenerative spondylolisthesis(u=2.667,P＜0.05 ).Except for the forward slip in the degenerative spondylolisthesis,the vertebrae displaced were more easier to other directions than those of the lumbar isthmic spondylolisthesis(u=3.077,P＜0.05 ).The degenerative cases and degrees of the lumbar intervertebral disc and intervertebral joint in the degenerative spondylolisthesis were more than those in the lumbar isthmic spondylolisthesis(X~2= 25.06,13.26,P＜0.005).Comparison to the normal control groups,the angles of the facet joints in the degenerative spondylolisthesis were smaller in transverse MPR images and larger in the sagittal MPR images respectively(P＜0.005).And the angles were not any differences between the isthmic spondylolisthesis and normal controls group(P＞0.05 ). The sagittal diameters of the lumbar spinal canal and intervertebral foramina were larger in the lumbar isthmic spondylolisthesis than those in the degenerative spondylolisthesis.Conclusion:The lumbar isthmic defect was a direct sign in diagnosis of the the lumbar isthmic spondylolisthesis.The relevance ratio of the lumbar isthmic defect were 100%in the MPR images.The directions and degrees of the lumbar isthmic and degenerative spondylolisthesis had statistically evident difference.The degeneration of the intervertebral disc and the intervertebral joint and the sagittal form of the intervertebral joint had obvious relations to the degenerative spondylolisthesis.The sagittal diameter of the spinal canal and intervertebral foramina were larger in the lumbar isthmic spondylolisthesis than those in the degenerative spondylolisthesis.The MPR images with multi-slices spiral CT had advantages to make differential diagnosis of the lumbar isthmic and degenerative spondylolisthesis.