Limited Usefulness of Traction-Compression Films in the Radiographic Diagnosis of Lumbar Spinal Instability

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Abstract
A prospective, within-patient comparison of two methods for functional radiography of lumbar spine with consecutive patients. To evaluate the usefulness of traction-compression radiography compared with conventional flexion-extension radiography in diagnosis of lumbar spinal instability. Flexion-extension radiography generally is used and widely recognized as an effective method for diagnosis of segmental lumbar spinal instability, but the usefulness and findings of traction-compression films are less well known. Flexion-extension and traction-compression radiography were performed on 306 consecutive patients (mean age, 43 years; range, 14-68 years) with clinically suspected lumbar spinal instability. Radiography was performed of each patient in an upright position. Axial traction was accomplished by letting the patient hang by his or her hands from a horizontal bar. Compression views were taken when the patient had sandbags of approximately 30% of the his or her weight on the shoulders. Main interest was translational forward and backward displacement of one vertebra on another. Signs of translational instability were present on the functional radiographs of 27% (84 of 306) of the patients. In diagnosis of instability, the overall agreement of flexion-extension and traction-compression films was only 0.786, and also statistic Kappa remained poor (0.05). Flexion-extension films more frequently revealed signs of instability than traction-compression films: 81 versus seven patients. Traction-compression films seem to be of questionable value in diagnosis of lumbar spinal instability.