Spine - 2026-06-15 - Journal Article
Patterns of Bone Density Change in L4-5 Spondylolisthesis.
Khoo B, Cross NM, Telfer S
Topics
Key Takeaway
In 38 patients with L4-5 spondylolisthesis, increasing anterolisthesis was associated with localized bone density reduction specifically in the anterior, medial, and lateral regions of the L5 body and the L4-5 facet joints, while overall bone density changes did not correlate with any specific deformity measure.
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Summary
This study used calibrated opportunistic QCT on 3D CT-derived vertebral models to map regional bone density across L4-5 in 38 spondylolisthesis patients versus 30 matched controls, assessing associations with age, sex, and radiographic deformity parameters. Overall bone density differed by diagnosis and age but did not correlate with specific deformity measures. Localized analysis identified that greater anterolisthesis was associated with reduced bone density in the anterior, medial, and lateral L5 body and the L4-5 facet joints.
Key Limitation
The study does not report Meyerding grade distribution or slip percentage ranges within the spondylolisthesis cohort, preventing determination of whether the localized density changes are clinically meaningful at the grade I threshold where surgical decision-making is most contested.
Original Abstract
STUDY DESIGN
Retrospective analysis of medical imaging data.
OBJECTIVE
This study aimed to determine whether there are changes in localized bone density of the L4 to 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 to 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 to L5 facet joints.
CONCLUSIONS
These findings demonstrate that there are patterns of region change in L4 to 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 to L5 and other vertebrae.
LEVEL OF EVIDENCE
Level IV.