Radiological Analysis Of Risk Factors For The Development Of Isthmic Spondylolisthesis

Objective:1.To explore the imaging parameters of spine-pelvis and lower lumbar spine of lumbar spondylolysis and isthmic spondylolisthesis,and analyze the imaging risk factors of spondylolysis and isthmic spondylolisthesis.2.To describe normal adult spine-pelvic balance parameters and lower lumbar anatomical parameters,analyze their correlation,and design a composite physiological anatomical lumbar isthmus repairing laminar hook device based on clinical experience.Methods:1.A total of 97 subjects with anteroposterior and lateral lumbar spine X-ray films were selected,including the normal group(group A),34 cases;the simple isthmic fissure group(group B),21 cases;the isthmic fissure with isthmic degeneration group(group C),23 cases;and the spondylospial spondylolisthesis group(group D),19 cases.Observe the subjects’ spine-pelvic sagittal X-ray balance parameters and lower lumbar anatomical parameters,compare the parameters between the 4 groups,and analyze the risk factors of spondylolisthesis and spondylolisthesis.2.The subjects with complete MSCT data from July 2018 to August 2020 were retrospectively collected.After strict screening,a total of 30 cases were included in the study,with an average age of 34.83±10.31 years old(range 15-50 years old).Measure the isthmus/posterior edge angle of the vertebral body,the isthmus (inferior edge)/pedicle angle,the lamina/spinous process angle,and the thickness of the bilateral lamina,and analyze its mean,standard deviation and range,based on the data,combined with clinical experience to design a new type of internal fixation device for the isthmus.Results:1.From group A to group D,PI,PT,SS,SVA,TK,L3 lamina angle,L4 lamina angle all showed an increasing trend,and the differences were statistically significant(P<0.05 or 0.01);although LL also It showed an increasing trend,but the difference was not statistically significant(P>0.05);L3/4 intervertebral space angle,L4/5 intervertebral space angle and LSA intervertebral space angle showed a decreasing trend,and the difference was not statistically significant(P>0.05).Regression analysis results show that SS and TK are risk factors for isthmus fissure.When SS>28.4° and TK>25.8°,the risk of isthmus fissure is significantly increased;while L3/4 intervertebral space angle and LSA are protective factors,when L3/4 When the intervertebral space angle is greater than 10.8° and LSA is greater than 6.0°,isthmic fissure is less likely to occur.PI and SVA are the risk factors for secondary spondylolisthesis.When PI>50.5° and SVA>10.8mm,the risk of spondylolisthesis increases significantly.2.The isthmus/posterior edge angle of the vertebral body,the isthmus(inferior edge)/pedicle angle,the lamina/spinous process angle,and the thickness of the bilateral lamina conform to a normal distribution and have statistical significance.Conclusion:1.The imaging parameters of the spine-pelvis and lower lumbar spine are closely related to the occurrence and development of spondylolisthesis.SS and TK are risk factors for lumbar spondylolysis,while L3/4 intervertebral space angle and LSA are its protective factors.PI and SVA are risk factors for spondylolisthesis.2.Lumbar isthmus repair technology is a safe and effective way to treat lumbar spondylolysis.The existing internal fixation devices are difficult to place,and are insufficient to block the bone grafting area,which increases the operation time,the amount of bleeding,and the risk of complications.The data of this study accurately and detailedly provide the normal lumbar anatomical parameters related to internal fixation,which can effectively support the development of new internal fixation devices.