The role of lumbar lordosis, vertebral end-plate inclination, disc height,and facet orientation in degenerative spondylolisthesis

Degenerative spondylolisthesis (DS) is a common condition of the aging spin e, but the underlying pathomechanisms remain controversial. Most previous s tudies focused on the role of facet-joint alignment and reported a pronounc ed sagittal orientation. This, however, may also be a secondary feature to the slippage. This study analyzed several radiologic Endings in the lower l umbar spine in 23 patients with DS (group A) and 40 age- and sex-matched co ntrols (group B). Facet-joint angulation, intervertebral disc height, lordo sis of the lumbar spine (L1-S1), and inclination of the LA, L5, and S1 end plates were assessed from neutral standing lateral radiographs and computed tomography (CT) or magnetic resonance imaging (MRI) investigations, Two fi ndings were found to be significantly different between the groups. Facet j oints were aligned more sagittal in group A, and the inclination of the ver tebral end plates was more horizontal in group B. There was no statistical difference in lumbar lordosis or L4-5 disc height between the two groups, w ith disc height being decreased in both groups. In group A, more gliding wa s associated with a further decrease in disc space, pronounced sagittal ali gnment of the L4-5 facet joints, and a decrease in lumbar lordosis. We conc luded that further studies should focus on the analysis of spinal alignment and lower lumbar end-plate orientation Co identify patients at risk for de velopment of DS.