Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Progression for radiographic lumbar spondylolisthesis in the general population : a 10-year follow-up of the ROAD study (#83)

Yuyu Ishimoto 1 , Satoshi Arita 1 , Hiroshi Hashizume 1 , Keiji Nagata 1 , Shigeyuki Muraki 2 , Hiroyuki Oka 3 , Masanari Takami 1 , Shunji Tsutsui 1 , Hiroshi Iwasaki 1 , Toshiko Iidaka 4 , Hiroshi Kawaguchi 5 , Sakae Tanaka 6 , Kozo Nakamura 7 , Munehito Yoshida 8 , Noriko Yoshimura 2
  1. Wakayama Medical University, Wakayama City, WAKAYAMA PREFECTURE, Japan
  2. Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
  3. Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
  4. Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
  5. Department of Orthopaedic Surgery, Tokyo Neurological Center, Tokyo, Japan
  6. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
  7. Towa Hospital, Tokyo, Japan
  8. Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama City, Wakayama prefecture, Japan

Background

Lumbar spondylolisthesis (LS) is clinically significant due to its association with lower back pain and neurogenic symptoms. With aging populations, its prevalence and impact on public health are projected to increase. Understanding the epidemiological trends and progression of LS is vital for developing preventive healthcare strategies.

 

Methods

From the cohort of 1551 participants involved in the 2nd survey of the ROAD study (2008-2010), comprising 735 individuals from mountainous and 816 from coastal communities, a total of 799 general residents who also partook in the 5th survey a decade later (2018-19) and underwent lumbar spine X-ray in both surveys were encompassed. Among these, 115 individuals (comprising 26 males and 89 females, with a mean age of 63.7±8.4 years) who has LS which was defined as a displacement of 3mm or more in the 2nd survey were categorized into the LS group. The progression of LS was defined as the displacement of 3mm or more in the lateral lumbar X-ray.

 

Results

The baseline prevalence of LS was 22.6% at L3, 57.4% at L4, and 23.4% at L5. Over ten years, 11.3% exhibited progression, with a marked gender disparity: females progressed at 14.6%, while no progression was observed in males (Chi-Square P=0.039). Progression by vertebral level occurred in 3.8% at L3, 18.4% at L4, and 11.1% at L5. Notably, female participants from mountainous areas showed a higher progression rate than those from coastal regions (21.7% vs. 7.0%, Chi-Square P=0.049). Age and BMI were not significant predictors of progression, with P-values of 0.664 and 0.615, respectively. Further, logistic regression indicated that mountainous residence had an odds ratio of 0.28 for LS progression (95% CI: 0.055-1.090, P=0.067). In detailed analysis, the mean slippage at L3 was 1.17mm for men and 1.16mm for women (P=0.988), at L4 was 1.65mm for men and 1.81mm for women (P=0.869), and at L5 was 0.90mm for men and 2.16mm for women (P=0.262). No multi-level progression was observed.

 

Conclusion:

This study confirmed a significant progression of LS in females over a decade, with no corresponding progression in males. The lack of correlation with age or BMI and the suggestive, though non-significant, association with mountainous residence indicate that LS progression is influenced by multiple factors. These findings underscore the necessity for further research to elucidate the complex etiology of LS and enhance preventive measures, especially for at-risk female populations in certain geographical locations.