| Objectives:With a five-repetition sit-to-stand test and imaging examination,we evaluated the lumbar stability in patients with degenerative lumbar spondylolisthesis.This study also elucidated the clinical benefits of the normal sitting radiograph with a supine sagittal MR image,when it is used for assessing the stability of the slipped segment in patients which have degenerative lumbar spondylolisthesis.Methods:This study collected and analyzed the clinical data of 78 spine surgery patients with degenerative lumbar spondylolisthesis from April 2020 to December 2021 in Anhui Provincial Hospital,including 23 males and 55 females with an average age of 60.7 ±8.4 years.In this study,all patients finished the patient self-evaluation questionnaire,which included the Oswestry disability index(ODI)and the Visual analog scale(VAS)of back and leg pain.In addition,all the patients also finished a five-repetition sit-to-stand test and then recorded the test time.During this test,the patients which have degenerative lumbar spondylolisthesis completed a questionnaire survey on the pain characteristics to observe the features of low back pain.Besides,all the patients were examined by sagittal radiographs in standing,sitting,flexion,and extension positions as well as magnetic resonance imaging in a supine position.The sagittal parameters were then investigated and recorded in the standing,sitting,flexion,and extension positions.During the phase of data analysis,according to the time limit of the five-repetition sit-to-stand test which is significant than 22 seconds,the patients were divided into two groups: group S vs.group M.The lumbar instability was also evaluated for all the patients by using collected imaging data.Results:According to the results of the five-repetition of the sit-to-stand test,31 patients with severe objective functional impairment were divided into group S,and 47 patients with or without mild to moderate objective functional impairment were divided into group M.The low back pain of the VAS score(7.6 ± 1.0 vs 5.2 ± 0.9,P < 0.001)and the Oswestry disability index in group S(47.3 ± 6.2 vs 34.1 ± 3.1,P < 0.001)were significantly higher than group M,but there was no significant difference in the leg VAS pain scores between the group S and group M(5.7 ± 1.2 vs 5.9 ± 1.1 P = 0.25).The pain characteristics of patients in group S were mainly focused on the incidence of pain during daily exercise,bending over to tie shoelaces,climbing stairs,and standing up from a chair(all P values < 0.05).There was no significant difference in pain characteristics between the two groups when walking a distance or standing for long periods of time.Patients in the sitting radiographs showed the greatest slippage rate both in the group S and group M.In the sitting position,the slip rate of the group S was significantly higher than the group M(24.1% vs.19.6%;P = 0.002).All patients in group S had objective functional impairment: 28 patients in group S were diagnosed with lumbar instability by the normal sitting radiograph with a supine sagittal MR image,and only 7 patients were diagnosed with lumbar instability by flexion and extension radiographs.Conclusion:The cause of patient’s back pain in the five-repetition sit-to-stand test was mianly associated with the lumbar instability.The normal sitting radiograph with a supine sagittal MR image is an effectively technology to identify lumbar instability in patients with degenerative lumbar spondylolisthesis. |
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