Patterns of Bone Density Change in L4-L5 Spondylolisthesis

Study Design. Retrospective analysis of medical imaging data. Objective. This study aimed to determine if there are changes in localized bone density of the L4-L5 vertebrae in patients with spondylolisthesis , with these changes hypothesized to be associated with increasing severity of spinal deformities. Summary of Background Data. Degenerative spondylolisthesis is a common spinal pathology resulting in pain and functional limitations. The condition may lead to changes in the bone density of the affected vertebrae and subsequent fracture risk and challenges for surgical interventions. However, the specific regions where these changes may occur have not been fully investigated. Methods. Sixty-eight sets of three-dimensional L4-L5 vertebrae models were created from clinical computed tomography (CT) scans, 38 from patients with spondylolisthesis and the remainder matched controls. A calibrated opportunistic quantitative CT approach was used to produce detailed bone density estimates across each vertebrae. The effects of age, sex, and associations with radiographic measures of spinal deformity on bone density patterns were assessed. Results. There was a significant association between diagnosis of spondylolisthesis and full bone density as well as age-related changes, however these overall changes were not found to be associated with any specific measure of deformity. The localized analysis showed that with increasing anterolisthesis, bone density was affected in the anterior, medial, and lateral regions of the L5 body, and the L4-L5 facet joints. Conclusions. These findings demonstrate that there are patterns of region change to L4-L5 bone density associated with spondylolisthesis , however there remains significant variability between patients. Future work will explore if surgical planning of spinal vertebrae correction and assessment of fracture risk may be assisted through detailed bone density mapping for L4-L5 and other vertebrae. Level of Evidence. Level 4.