• Ze-Ming Sun, Chao Jiang, Jia-Jing Xu, Ze-Xin Chen, Qiang Guo, Yan Lin, and Yao-Sen Wu.
• Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China; Second School of Medicine, Wenzhou Medical University, Wenzhou, China.
• World Neurosurg. 2019 Sep 1; 129: e393-e400.

ObjectiveThe aim of the present study was to investigate the relationship between vacuum facet phenomena and lumbar instability in patients with degenerative spondylolisthesis (DS) in L4-L5.MethodsPatients with L4-L5 DS who had both lumbosacral flexion-extension radiographs and computed tomography (CT) scans available for review from January 2016 to December 2017 were eligible for the present study. The dynamic motion index (DMI) of each patient was used to represent the percentage of slippage of L-L4 on the L5 vertebral disks on the flexion radiographs minus the percentage on the extension radiographs. The facet vacuum index refers to the average width of the facet vacuum on the left and right sides.ResultsA total of 67 patients with L4-L5 DS were included in the present study. Of the 67 patients, 35 had a vacuum facet phenomenon on their CT scan and 32 patients did not. The incidence of lumbar instability in the patients with a vacuum facet phenomenon was significantly greater than that in the patients without a vacuum facet phenomenon (P = 0.015). The mean DMI for the patients with a vacuum facet phenomenon was significantly greater than that for the patients without a vacuum facet phenomenon (P < 0.001). A positive linear correlation was found between the facet vacuum index and DMI for patients with a vacuum facet phenomenon (Pearson correlation coefficient, 0.597; P < 0.001).ConclusionsA linear correlation was found between the degree of segmental motion and the width of the vacuum facet phenomenon in patients with DS at L4-L5. Our study has shown that vacuum facet phenomena detected on the CT images of patients with DS are highly predictive of segmental instability.Copyright © 2019 Elsevier Inc. All rights reserved.

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