Study Design: 

Retrospective radiologic analysis.

Objective: 

The aim was to investigate if lateral flexion-extension radiographs identify additional cases of degenerative cervical spondylolisthesis (DCS) that would be missed by obtaining solely neutral upright radiographs, and determine the reliability of magnetic resonance imaging (MRI) in diagnosis.

Summary of Background Data: 

DCS and instability can be a cause of neck pain, radiculopathy, and even myelopathy. Standard anteroposterior and lateral radiographs and MRI of the cervical spine will identify most cervical spine pathology, but spondylolisthesis and instability are dynamic issues. Standard imaging may also miss DCS in some cases.

Methods: 

We compared the number of patients who demonstrated cervical spondylolisthesis on lateral neutral and flexion-extension radiographs in addition to MRI. We used established criteria to define instability as ≥2 mm of listhesis on neutral imaging, and ≥1 mm of motion between flexion-extension radiographs.

Results: 

A total of 111 patients (555 cervical levels) were analyzed. In all, 41 patients (36.9%) demonstrated cervical spondylolisthesis on neutral and/or flexion-extension radiographs. Of the 77 levels of spondylolisthesis, 17 (22.1%) were missed on neutral radiographs (P,0.05). Twenty levels (26.0%) were missed when flexion-extension radiographs were used alone (P=0.02). Twenty-nine levels (37.7%) of DCS identified on radiograph were missed by MRI (P=0.004).

Conclusions: 

Lateral flexion-extension views can be useful in the diagnosis of DCS. These views provide value by identifying a significant cohort of patients that would be undiagnosed based on neutral radiographs alone. Moreover, MRI missed 38% of DCS cases identified by radiographs. Therefore, lateral radiographs can be a useful adjunct to neutral radiographs and MRI when instability is suspected or if these imaging modalities are unable to identify the source of a patient’s neck or arm pain.

中文翻译：

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屈伸X线片在退行性颈椎滑脱症中的应用

学习规划： 

回顾性放射学分析。

客观的： 

目的是调查侧屈伸X光片是否可以识别出仅获得中立直立X光片时会漏掉的退行性颈椎滑脱（DCS）的其他病例，并确定磁共振成像（MRI）在诊断中的可靠性。

背景数据摘要： 

DCS 和不稳定可能是颈部疼痛、神经根病甚至脊髓病的原因。标准的颈椎前后位和侧位 X 光片以及MRI可以识别大多数颈椎病理，但脊椎滑脱和不稳定是动态问题。在某些情况下，标准成像也可能会错过 DCS。

方法： 

除了MRI之外，我们还比较了在侧向中立位和屈伸 X 光片上表现出颈椎滑脱的患者数量。我们使用既定标准将不稳定性定义为中性成像上≥2毫米的滑脱，以及屈伸X线照片之间≥1毫米的运动。

结果： 

总共对 111 名患者（555 个宫颈层面）进行了分析。总共有 41 名患者 (36.9%) 在中立位和/或屈伸 X 光片上表现出颈椎滑脱。在 77 个滑脱节段中，中性 X 线片漏掉了 17 个节段（22.1%）（P <0.05）。单独使用屈伸X线片时，漏检了20个水平（26.0%）（P =0.02）。MRI漏掉了 X 光片上发现的 29 个 DCS 级别（37.7%）（P = 0.004）。

结论： 

侧屈伸视图可用于 DCS 的诊断。这些观点通过识别仅根据中性放射线照片无法诊断的重要患者群体而提供了价值。此外，MRI漏掉了 38% 通过 X 光检查发现的 DCS 病例。因此，当怀疑不稳定或这些成像方式无法识别患者颈部或手臂疼痛的来源时，侧位X光片可以成为中性X光片和MRI的有用辅助。