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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.
This study was supported by the Helmut Horten Foundation, Baugarten Foundation, Pfizer-Foundation for geriatrics and research into geriatrics, Symphasis Charitable Foundation and OPO-Foundation.
We disclose any financial support or author involvement with organization(s) with a financial interest in the subject matter.
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.
This study was approved by the local ethical committee of the University of Zurich, Switzerland.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.The presence and extent of listhesis (median ± interquartile range) were assessed on upright radiographs and supine MRI of L4/5.In addition, the grade of central spinal stenosis of the same level was evaluated on MRI according to the classification of Schizas and correlated with the severity/grading of anterolisthesis on radiographs.Malalignment of the spinal processes on lateral radiographs can be seen in DS, due to anterior translation of the entire vertebra, since the neural arch is intact as opposed to in isthmic spondylolysis. In the Meyerding Classification, the superior aspect of the inferior vertebra is divided into quartiles on the sagittal view and graded I-IV, representing a slip of the superior vertebra of I, II, III or IV quarters, respectively (Fig. Grade V refers to when one vertebra has slipped off the inferior vertebra entirely, i.e., spondyloptosis.According to Taillard, the sagittal translation is classified in percentage of the slip of the superior vertebra relative to the superior aspect of the inferior vertebra (Fig. Due to higher reproducibility, the Taillard Method is favored by most authors.Standard radiographs in anteroposterior (AP) and lateral views in a neutral position are considered the most appropriate imaging test to detect DS.This highlights the importance of performing weight-bearing imaging investigations when diagnosing and evaluating the grade of DS.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).Upright radiographs demonstrated more and larger extents of anterolisthesis compared with supine MRI.In addition, in patients with suspected LSS, the extent of anterolisthesis on radiographs (particularly ≥5 mm) is indicative of LSS and warrants lumbar spine MRI.