ArticleBrain & spine2026
Is flexion-extension imaging necessary for surgical decision-making in degenerative lumbar spondylolisthesis? Supine MRI and upright radiographs offer superior diagnostic value.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Association of Postoperative Slip Reduction With Patient-Reported Outcomes at Two Years After Fusion Surgery for Low-Grade Degenerative Spondylolisthesis: A Single-Center Study.Global spine journal · 2026Article
- Multifidus fatty infiltration and vertebral translation are key factors associated with movement-related low back pain in L5 isthmic spondylolisthesis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
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8 authors.
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Abstract
Introduction: Degenerative lumbar spondylolisthesis (DLS) is a major indication for lumbar surgery. Surgical decision-making, particularly regarding the need for fusion, often depends on radiographic detection of segmental instability. Flexion-extension (FE) radiographs remain the reference standard but are limited by radiation exposure, motion-related discomfort, and poor reproducibility, whereas upright-supine (US) imaging - combining upright lateral radiographs with supine MRI - may offer a comparable, low-radiation alternative using routinely acquired images. Research question: To compare segmental motion at L4/5 between FE and US imaging and evaluate their respective abilities to identify patients with radiographic signs of instability. Material and methods: In this retrospective cross-sectional study, 128 patients surgically treated for isolated L4/5 DLS were included. Segmental motion was analyzed using FE and US imaging by determining relative slippage, dynamic slip angle, and radiographic instability, defined as sagittal translation ≥8% and/or a dynamic slip angle ≥10°. Results: Relative slippage was comparable between US and FE imaging (US: 7.43 ± 5.10%; FE: 7.29 ± 4.57%; p = 0.994). The dynamic slip angle was significantly higher in US imaging compared to FE imaging (US: 6.42 ± 4.20°; FE: 4.03 ± 2.98°; p < 0.001). US imaging identified more patients with radiographic signs of instability compared to FE imaging (US: n = 68, 53.1%; FE: n = 42, 32.8%; p < 0.001). Discussion and conclusion: US imaging identified a higher proportion of patients meeting established thresholds for radiographic instability compared to FE radiographs. Although FE imaging remains the diagnostic standard, US imaging may offer a practical, low-radiation alternative for preoperative assessment. Prospective investigations are warranted to confirm its clinical utility.
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