Lumbar spine listhesis in older African American women.
BACKGROUND
Degenerative changes in the lumbar spine may result in a loss of spinal stability and subluxation of one vertebra relative to another. Cadaveric studies and clinical case series have suggested that listhesis may be much more common in African Americans than in whites.


OBJECTIVE
To determine the prevalence of lumbar spine listhesis (anterolisthesis and retrolisthesis) among African American women aged 65 years and older and the relationship of listhesis to low back pain, physical function and quality of life.


METHODS
Cross-sectional study.


METHODS
A total of 481 African American women aged 65 years and older who were enrolled in the Study of Osteoporotic Fractures. These women were recruited from population-based listings in Baltimore, MD, Minneapolis, MN, Pittsburgh, PA, and Portland, OR.


METHODS
Not applicable.


METHODS
Lateral radiographs of the lumbar spine were digitized, and listhesis (anterolisthesis and retrolisthesis) was assessed at spinal levels L3-L4, L4-L5 and L5-S1. Usable data were obtained for 470 women. Listhesis was defined as present when the subluxation (antero or retro) was 3 mm or more.


RESULTS
The overall prevalence of anterolisthesis was 58.3% and varied by spinal level (13.2% at L3-L4, 36.5% at L4-L5 and 29.6% at L5-S1). The prevalence increased with age but was lower among oophorectomized women and those currently on estrogen replacement therapy. Anterolisthesis was not associated (p>.05) with disc height nor was it related to back function. Retrolisthesis occurred in 4% of women and was associated with decreased disc height and an increased prevalence of spinal problems and walking problems.


CONCLUSIONS
The prevalence of anterolisthesis among older African American women living in the community was two to three times greater than that found in white women of a similar age. This condition was not related to an increased frequency of back problems nor did it adversely affect general physical function. Retrolisthesis was relatively rare but was associated with decreased back function.
Department of Orthopaedic Surgery, University of Pittsburgh, PA 15213, USA. vogtm@msx.upmc.edu
Molly T
MT
Vogt
David A
DA
Rubin
Lisa
L
Palermo
Lisa
L
Christianson
James D
JD
Kang
Michael C
MC
Nevitt
Jane A
JA
Cauley
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D017116:Low Back Pain / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D010147:Pain Measurement; D015995:Prevalence; D011788:Quality of Life; D011859:Radiography; D013168:Spondylolisthesis / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology