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Regarding posterior translation, increased incidence has been reported adjacent to discs that are ankylosed or fused.For example, retrolisthesis has been shown postoperatively in 15% of segments cranial to fused disc levels on extension radiographs.
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.
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.
Perpendicular lines are drawn along the posterior border of the superior vertebra (B) and the inferior vertebra (C) respectively. Schematic illustrations of Meyerding Classification (A) and Taillard Method (B), respectively.
The distance between B) and C) at the level of A) are measured to obtain the grade of sagittal translation (D). In the Meyerding Classification, the inferior vertebral body is divided into quartiles (I-IV).
Spondylolisthesis is classified into how many quartiles the superior vertebra is overhanging the inferior vertebral body. This instability theory is based on the occasional findings of increased translation on functional imaging.
With the Taillard Method, the percentage of slip of the superior vertebra relative to the superior aspect of the inferior vertebra is calculated (A/B)x100. This theory has also contributed to the popularity of adding fusion surgery in patients with spinal stenosis in need of decompression surgery, aiming to stabilize a DS segment.
Schematic illustration of measurement technique to estimate the degree of sagittal translation.
In sagittal view a line is drawn along the superior endplate of the inferior vertebra (A).