EC Orthopaedics

Research Article Volume 16 Issue 3 - 2025

Imaging Controversies in Assessing Instability in Lumbar Degenerative Spondylolisthesis

Diya Sethi1*, Aashish Ghodke2 and Abraham Manoj Thomas2

1University of Buckingham Medical School, Hunter Street, Buckingham, United Kingdom
2Royal Gwent Hospital, Cardiff Rd, Newport, United Kingdom

*Corresponding Author: Diya Sethi, University of Buckingham Medical School, Hunter Street, Buckingham, United Kingdom.
Received: March 07, 2025; Published: March 31, 2025




Objectives: To evaluate the controversies surrounding imaging modalities for diagnosing instability in lumbar degenerative spondylolisthesis (LDS) and their clinical implications for surgical decision-making.
Methods: A comprehensive review of conventional and advanced imaging techniques, including standing lateral and dynamic flexion-extension X-rays, MRI, and CT, was conducted. Their advantages, limitations, and reliability in detecting instability in LDS were analyzed based on existing literature.
Results: Conventional radiographs remain the primary tool for assessing instability but have limitations in detecting subtle cases. MRI and CT provide valuable insights into disc degeneration, facet joint integrity, and neural element compression but may not reliably quantify instability. The lack of a standardized imaging protocol contributes to ongoing debate.
Conclusion: Accurate imaging-based assessment of instability in LDS is essential for optimizing patient selection for surgical intervention. Further research is needed to establish standardized imaging criteria that enhance diagnostic accuracy and improve clinical outcomes.


 Keywords: Arthroscopy; Anatomy; Movement; Knee Joint

  1. Bridwell KH., et al. “The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis”. Journal of Spinal Disorders 6 (1993): 461-472.
  2. Hasegawa K., et al. “Lumbar degenerative spondylolisthesis is not always unstable: clinicobiomechanical evidence”. Spine (Phila Pa 1976)26 (2014): 2127-2135.
  3. Herkowitz HN. “Spine update. Degenerative lumbar spondylolisthesis”. Spine (Phila Pa 1976)9 (1995): 1084-1090.
  4. Vibert BT., et al. “Treatment of instability and spondylolisthesis”. Clinical Orthopaedics and Related Research 443 (2006): 222-227.
  5. Kirkaldy-Willis WH and Farfan HF. “Instability of the lumbar spine”. Clinical Orthopaedics and Related Research 165 (1982): 110-123.
  6. Kalichman L., et al. “Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population”. Spine (Phila Pa 1976)2 (2009): 199-205.
  7. Hasegawa K., et al. “What are the reliable radiological indicators of lumbar segmental instability?” Journal of Bone and Joint Surgery - Series B5 (2011): 650-657.
  8. Hayes MA., et al. “Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals”. Spine (Phila Pa 1976)3 (1989): 327-331.
  9. Stokes IAF and Frymoyer JW. “Segmental motion and instability”. Spine (Phila Pa 1976)7 (1987): 688-691.
  10. Panjabi MM and White III AA. “Clinical biomechanics of the spine: biomechanically relevant anatomy”. Published online (1978): 1-35.
  11. Saremi A., et al. “Evolution of lumbar degenerative spondylolisthesis with key radiographic features”. The Spine Journal6 (2024): 989-1000.
  12. Axelsson P and Karlsson BS. “Intervertebral mobility in the progressive degenerative process. A radiostereometric analysis”. European Spine Journal 6 (2004): 567-572.
  13. Soini J., et al. “Disc degeneration and angular movement of the lumbar spine: comparative study using plain and flexion-extension radiography and discography”. Journal of Spinal Disorders and Techniques 2 (1991): 183-187.
  14. Murata M., et al. “Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain”. Archives of Orthopaedic and Trauma Surgery 6 (1994): 297-301.
  15. Macnab I. “The traction spur. An indicator of segmental instability”. Journal of Bone and Joint Surgery, American Volume 4 (1971): 663-670.
  16. Kirkaldy-Willis WH., et al. “Pathology and pathogenesis of lumbar spondylosis and stenosis”. Spine (Phila Pa 1976)4 (1978): 319-328.
  17. Knutsson F. “The instability associated with disk degeneration in the lumbar spine”. Acta Radiologica 5-6 (1944): 593-609.
  18. Tsukamoto M., et al. “Traction spurs in the lumbar spine: A historical overview and future perspectives”. Spine Surgery and Related Research 4 (2024): 354-361.
  19. Caelers I., et al. “The variability of lumbar sequential motion patterns: observational study”. JMIR Biomedical Engineering 8 (2023): e41906.
  20. M Mimura. “[Rotational instability of the lumbar spine--a three-dimensional motion study using bi-plane X-ray analysis system]”. Nihon Seikeigeka Gakkai Zasshi7 (1990): 546-559.
  21. Gertzbein SD., et al. “Centrode patterns and segmental instability in degenerative disc disease”. Spine 3 (1985): 257-261.
  22. Pope MH and Panjabi M. “Biomechanical definitions of spinal instability”. Spine (Phila Pa 1976)3 (1985): 255-256.
  23. Nizard RS., et al. “Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis”. Radiologic Clinics of North America 1 (2001): 55-71.
  24. Wood KB., et al. “Radiographic evaluation of instability in spondylolisthesis”. Spine (Phila Pa 1976)15 (1994): 1697-1703.
  25. Chatprem T., et al. “A diagnostic tool for people with lumbar instability: a criterion-related validity study”. BMC Musculoskeletal Disorders 1 (2021): 976.
  26. Pennal GF., et al. “Motion studies of the lumbar spine: a preliminary report”. The Journal of Bone and Joint Surgery. British Volume3 (1972): 442-452.
  27. Penning L., et al. “Inability to prove instability. A critical appraisal of clinical-radiological flexion-extension studies in lumbar disc degeneration”. Diagnostic Imaging in Clinical Medicine 4 (1984): 186-192.
  28. D’Andrea G., et al. ““Supine-prone” dynamic X-ray examination: new method to evaluate low-grade lumbar spondylolisthesis”. Journal of Spinal Disorders and Techniques 1 (2005): 80-83.
  29. Cabraja M., et al. “The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis”. European Spine Journal 2 (2012): 256-261.
  30. Paris S V. “Physical signs of instability”. Spine (Phila Pa 1976)3 (1985): 277-279.
  31. Wang X Wen., et al. “Analysis of lumbar lateral instability on upright left and right bending radiographs in symptomatic patients with degenerative lumbar spondylolisthesis”. BMC Musculoskeletal Disorders 1 (2022): 1-7.
  32. Boden SD and Wiesel SW. “Lumbosacral segmental motion in normal individuals: Have we been measuring instability properly?” Spine (Phila Pa 1976)6 (1990): 571-576.
  33. Elmose SF., et al. “Radiological definitions of sagittal plane segmental instability in the degenerative lumbar spine - a systematic review”. Global Spine Journal2 (2022): 523-533.
  34. Posner I., et al. “A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine”. Spine (Phila Pa 1976) 4 (1982): 374-389.
  35. Yone K and Sakou T. “Usefulness of Posner’s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis”. Journal of Spinal Disorders 1 (1999): 40-44.
  36. Nachemson AL., et al. “Mechanical properties of human lumbar spine motion segments. Influence of age, sex, disc level, and degeneration”. Spine (Phila Pa 1976)1 (1979): 1-8.
  37. Morgan FP and King T. “Primary instability of lumbar vertebrae as a common cause of low back pain”. The Journal of Bone and Joint Surgery. British Volume 39-B.1 (1957): 6-22.
  38. Min HK., et al. “Kinetic magnetic resonance imaging analysis of abnormal segmental motion of the functional spine unit”. Journal of Neurosurgery: Spine 4 (2009): 357-365.
  39. Fujiwara A., et al. “The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study”. European Spine Journal 5 (1999): 396-401.
  40. Schinnerer KA., et al. “MR findings of exaggerated fluid in facet joints predicts instability”. Journal of Spinal Disorders and Techniques7 (2008): 468-472.
  41. Junfeng M., et al. “Correlation between facet joint effusion in magnetic resonance imaging and lumbar stability after interspinous and degenerative lumbar spondylolisthesis”. Chinese Journal of Tissue Engineering Research24 (2019): 3845.
  42. Cho IY., et al. “MRI findings of lumbar spine instability in degenerative spondylolisthesis”. Journal of Orthopaedic Surgery (Hong Kong) 2 (2017): 2309499017718907.
  43. Tarantino U., et al. “Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes”. Journal of Orthopaedics and Traumatology 1 (2013): 15-22.
  44. Mahato NK. “Load-bearing shifts in laminar and ligament morphology: comparing spinal canal dimensions using supine versus upright lumbar MRI in adults without back pain”. Indian Journal of Radiology and Imaging 3 (2023): 344-350.
  45. Kanno H., et al. “Dynamic change of dural sac cross-sectional area in axial loaded magnetic resonance imaging correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis”. Spine (Phila Pa 1976)3 (2012): 207-213.
  46. Weishaupt D., et al. “Positional MR imaging of the lumbar spine: does it demonstrate nerve root compromise not visible at conventional MR imaging?” Radiology1 (2000): 247-253.
  47. Doyle AJ and Merrilees M. “Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging”. Spine (Phila Pa 1976)8 (2004): 874-878.
  48. Bydon A., et al. “Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes”. The Spine Journal 9 (2010): 820-826.
  49. Mattei TA and Rodriguez AH. “True synovial cysts of the lumbar spine: an epiphenomenon of instability of the functional spine unit?” Neurosurgical Review 3 (2013): 495-500.
  50. Ramhmdani S., et al. “Synovial cyst as a marker for lumbar instability: a systematic review and meta-analysis”. World Neurosurgery 122 (2019): e1059-e1068.
  51. Rihn JA., et al. “Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease?” Spine (Phila Pa 1976)14 (2007): 1555-1560.
  52. Jiang J., et al. “High intensity in interspinous ligaments: a diagnostic sign of lumbar instability and back pain for degenerative lumbar spondylolisthesis”. BMC Musculoskeletal Disorders 1 (2024): 949.
  53. Huang Y., et al. “The relationship between MRI findings of posterior ligamentous complex and lumbar instability in degenerative spondylolisthesis”. International Journal of General Medicine 17 (2024): 2279-2287.
  54. Sun ZM., et al. “Vacuum facet phenomenon in computed tomography imaging: a sign of instability in degenerative spondylolisthesis?” World Neurosurgery 129 (2019): e393-e400.
  55. Shur N., et al. “Radiological and radionuclide imaging of degenerative disease of the facet joints”. Indian Journal of Nuclear Medicine 30.3 (2015): 191-198.

Diya Sethi., et al. “Imaging Controversies in Assessing Instability in Lumbar Degenerative Spondylolisthesis”. EC Orthopaedics 16.3 (2025): 01-10.

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