• Tetsuhiro Iguchi, Kotaro Nishida, Takuma Ozaki, Atsushi Kitagawa, Nobuhiro Tsumura, Kenichiro Kakutani, Takashi Yurube, and Ryosuke Kuroda.
• Department of Rehabilitation Science, Kobe University Graduate School of Medicine in Hyogo Rehabilitation Center, 1070 Akebono-cho, Nishi-ku, Kobe, 651-2181, Japan. t_iguchi@hwc.or.jp
• Eur Spine J. 2012 Nov 1;21(11):2134-9.

IntroductionLittle is known about when and how progressive spondylolisthesis occurs. In this report segmental motion related to age and disc degeneration at L4/5 disc was investigated.Materials And Methods637 patients with low back and/or leg pain underwent radiologic and MRI examinations simultaneously. Because 190 patients with conditions which might impede accurate measurement were excluded, 447 patients, comprising 268 men and 179 women, were included; age range, was 10-86 (mean: 53) years. Three radiologic parameters slip in neutral position (mm), sagittal translation (mm), and segmental angulation (degrees) were examined at the L4/5 segment. On T2-weighted MRI, severity of disc degeneration at L4/5 was classified by Pfirrmann's criteria, grade 1-5.ResultsResults showed stage of disc degeneration that progressed according to aging with significant differences except for between grades 4 and 5. Amount of anterior slip was small among grades 1 to 3; however, it greatly increased between grades 3 and 4 and between grades 4 and 5, suggesting that grade 3 disc degeneration has a potential risk of future progression of anterior slip. This finding may also suggest that once significant slip occurs, it will progress to the final grade. Furthermore, the grade 3 degeneration group exhibited large amounts of motion in both angulation and translation, suggesting it was the most unstable group.ConclusionOur results with radiography and MRI indicate that grade 3 disc degeneration is a critical stage for the progression of lumbar spondylolisthesis at L4/5 segment.

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