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Ekşi MŞ, Özcan-Ekşi EE, Orhun Ö, Huet SE, Turgut VU, Pamir MN. Association between facet joint orientation/tropism and lumbar intervertebral disc degeneration. Br J Neurosurg 2024; 38:293-300. [PMID: 33356603 DOI: 10.1080/02688697.2020.1864289] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022]
Abstract
Background: The aim of this study was to understand how facet joint orientation (FJO) and facet joint tropism (FJT) affected severe intervertebral disc degeneration (IVDD) process at lower lumbar levels in patients with LBP.Methods: This study is a cross-sectional analysis of a retrospective database. Patients were evaluated in terms of IVDD, FJO, and FJT at all lumbar levels on magnetic resonance imaging.Results: In this study (n: 123) facet joints were aligned more coronal in men than in women at upper lumbar levels. Men had less FJT compared to women, significantly at L2-L3 and L3-L4 levels. Severe IVDD at L4-L5 was associated with more coronal aligned L1-L2 (29.0 ± 2.5° vs. 23.3 ± 2.3°, p = 0.006) and misaligned L5-S1 (8.3 ± 1.9° vs. 4.5 ± 1.7°, p = 0.008). Besides, severe IVDD at L3-L4 was associated with more coronal aligned L4-L5 (49.1 ± 3.2° vs. 41.4 ± 2.8°, p = 0.014).Conclusion: There is a close association between FJO/FJT with lumbar IVDD. Facet joint orientation and FJT do not affect the disc at only the corresponding level; the lumbar spine should be evaluated as a whole.
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Affiliation(s)
- Murat Şakir Ekşi
- Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, İstanbul, Turkey
| | - Ömer Orhun
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Sibel Emilie Huet
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Veli Umut Turgut
- Antalya Atatürk State Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - M Necmettin Pamir
- Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
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Tan L, Du X, Tang R, Rong L, Zhang L. Preoperative Adjacent Facet Joint Osteoarthritis Is Associated with the Incidence of Adjacent Segment Degeneration and Low Back Pain after Lumbar Interbody Fusion. Asian Spine J 2024; 18:21-31. [PMID: 38379146 PMCID: PMC10910148 DOI: 10.31616/asj.2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 02/22/2024] Open
Abstract
STUDY DESIGN A retrospective cohort study. PURPOSE To analyze the association between preoperative adjacent facet joint osteoarthritis (FJOA) and outcomes of lumbar interbody fusion (LIF). OVERVIEW OF LITERATURE Whether preoperative adjacent FJOA is associated with the incidence of radiological adjacent segment degeneration (RASD) and low back pain (LBP) relief after lumbar fusion remains unknown. METHODS The study included patients who underwent LIF. The demographic characteristics and radiographic and surgical data were collected and evaluated. The included patients were divided into control group and FJOA group based on the preoperative adjacent facet joint Pathria grade. Preoperative and last follow-up LBP Visual Analog Scale (VAS) score, leg pain (LP) VAS, Oswestry Disability Index (ODI) and RASD were evaluated and compared. The improvement rates in VAS and ODI were calculated and compared between the two groups. Logistic regression was used to analyze the risk factors of LBP relief and incidence of RASD. RESULTS In total, 197 patients (control group, 86; FJOA group, 111) were included, and the median follow-up was 46 months. The VAS and ODI in both groups significantly improved after surgery. At the last follow-up, the FJOA group had higher VAS and lower VAS improvement rates of LBP than the control group (p<0.05). However, no significant difference in the LP VAS and ODI was found between the two groups. The incidence of RASD in the FJOA group was significantly higher than that in the control group (48.6% vs. 30.2%, p=0.034). Multivariate logistic regression analysis showed that preoperative adjacent FJOA was significantly associated with LBP relief (odds ratio [OR], 0.691; 95% confidence interval [CI], 0.498-0.958) and the postoperative incidence of RASD (OR, 1.406; 95% CI, 1.020-1.939). CONCLUSIONS The preoperative FJOA in the adjacent segments was significantly associated with LBP following LIF. Patients with preoperative FJOA were more likely to have RASD following lumbar fusion surgery.
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Affiliation(s)
- Lixian Tan
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Xiaokang Du
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Runmin Tang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
| | - Liangming Zhang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
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Tuoheti A, Xiao Y, Wang Y, Maimaiti A, Zhang R, Kahaer A, Tuoheti A, Wu X, Rexiti P. Biomechanical evaluation of modified and traditional cortical bone trajectory technique on adjacent segment degeneration in transforaminal lumbar interbody fusion-finite element analysis. BMC Musculoskelet Disord 2024; 25:7. [PMID: 38166794 PMCID: PMC10759649 DOI: 10.1186/s12891-023-07103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Modified cortical bone trajectory (MCBT) technique was proposed by our team in previous studies, but its biomechanical properties at adjacent segments have not been discussed yet. Therefore, the purpose of this study is to investigate the biomechanical properties of modified cortical bone trajectory (MCBT) technique on adjacent segment degeneration (ASD) in transforaminal intradiscal lumbar disc fusion (TLIF) compare to traditional bone trajectory (TT) technique and cortical bone trajectory (CBT) technique. METHODS The four human cadaveric lumbar specimens were provided by the anatomy teaching and research department of Xinjiang Medical University and four intact finite element models of the L1-S1 segment were generated. For each of these, three transforaminal lumbar interbody fusion procedures with three different fixation techniques were reconstructed at the L4-L5 segment, as follows: TT-TT (TT at both L4 and L5 segments), CBT-CBT (CBT at both L4 and L5 segments), MCBT-MCBT (MCBT at both L4 and L5 segments). The range of motion and von Mises stress of the intervertebral disc of the L3-L4 and L5-S1 segments were recorded with a 400N compressive load and 7.5 Nm moments in flexion, extension, left-right bending, and left-right rotation. RESULTS The peak ROM of the L3-L4 segment in the MCBT-MCBT group was reduced by 10.5%, 6.1%, 12.2%, 4.1%, and 1.5% in flexion, extension, left-right bending, and left rotation compared to the TT-TT group and reduced by 1.8%, 5.5%, 10.0%, 12.8%, and 8.8% in flexion, left-right bending, and left-right rotation compared to the CBT-CBT group, respectively. The MCBT-MCBT group has the lowest peak ROM of the L3-L4 segment in flexion, left bending, and right rotation, the lowest peak ROM of the L5-S1 segment in extension and right rotation, and the lowest peak von Mises stress of the intervertebral disc at the L5-S1 segment in right rotation compared to the TT-TT and CBT-CBT group. In addition, the peak von Mises stress at the L3-L4 segment was lowest and more dispersed in all motions, the MCBT-MCBT group exhibited lower peak ROM of the L5-S1 segment in flexion, extension, and right rotation, and showed lower peak von Mises stress of the disc at the L5-S1 segment in flexion, extension, and right rotation compared with the TT-TT group. CONCLUSION The modified cortical bone trajectory technique may have a beneficial effect on reducing the incidence of ASD in the L4-L5 TLIF model compared to the traditional bone trajectory technique and cortical bone trajectory technique.
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Affiliation(s)
- Abudusalamu Tuoheti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yixi Wang
- Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Xianghui Wu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Ministrv of Education, Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China.
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Biryuchkov MY, Jubaeva BA, Boddapati V, Lehman RA, Riew KD. The Relationship of Radiographic Parameters and Morphological Changes at Various Stages of Degeneration of the Lumbar Facet Joints: Cadaver Study. Global Spine J 2024; 14:195-203. [PMID: 35499552 PMCID: PMC10676162 DOI: 10.1177/21925682221099471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cadaveric specimens. OBJECTIVE To perform a pathomorphological analysis of the degree of facet joint (FJ) degeneration utilizing fresh cadaveric models and correlating these structural changes with imaging findings. METHODS L1-L5 FSU including all tissue between the anterior longitudinal ligament to the posterior spinal structures were obtained on 28 patients at a mean of 5.7 hours post-mortem. The samples were fixed in an agar medium and CT and MRI were performed. The level of FJ degeneration was identified based on prior classifications Osteoarthritis Research Society International (OARSI), as was the facet angle and tropism. Pathomorphological assessment including articular cartilage cell density was performed according to prior established methodology. RESULTS Radiographically, a direct association was identified between FJ degeneration and patient age. Facet angle and tropism did not significantly vary by patient age. Pathomorphologically, there was a decrease in the cellular density of articular cartilage with increasing patient age. Similarly, there was a significant direct correlation between radiographic degree of degenerative changes in FJs with the age of cadavers and the degree of degeneration of FJs according to the morphological classification of OARSI, as well as a significant inverse correlation with cell density. CONCLUSION A comprehensive assessment of various signs of FJ degeneration using cadaveric material has established that, based on radiographic imaging, it is possible to assess the microstructural state of FJ, including at an early stage of the disease. This data may be useful for surgeons in guiding therapeutic strategies based on individual biometric parameters of the FJ.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
- Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Valerii V Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Yurii Ya Pestryakov
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Mikhail Y Biryuchkov
- Department of Neurosurgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Bagdat A Jubaeva
- Department of Neurosurgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Venkat Boddapati
- Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Ronald A Lehman
- Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical School
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Ren X, Liu H, Hui S, Wang X, Zhang H. Forecast of pain degree of lumbar disc herniation based on back propagation neural network. Open Life Sci 2023; 18:20220673. [PMID: 37724118 PMCID: PMC10505347 DOI: 10.1515/biol-2022-0673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 09/20/2023] Open
Abstract
To further explore the pathogenic mechanism of lumbar disc herniation (LDH) pain, this study screens important imaging features that are significantly correlated with the pain score of LDH. The features with significant correlation imaging were included into a back propagation (BP) neural network model for training, including Pfirrmann classification, Michigan State University (MSU) regional localization (MSU protrusion size classification and MSU protrusion location classification), sagittal diameter index, sagittal diameter/transverse diameter index, transverse diameter index, and AN angle (angle between nerve root and protrusion). The BP neural network training model results showed that the specificity was 95 ± 2%, sensitivity was 91 ± 2%, and accuracy was 91 ± 2% of the model. The results show that the degree of intraspinal occupation of the intervertebral disc herniation and the degree of intervertebral disc degeneration are related to LDH pain. The innovation of this study is that the BP neural network model constructed in this study shows good performance in the accuracy experiment and receiver operating characteristic experiment, which completes the prediction task of lumbar Magnetic Resonance Imaging features for the pain degree of LDH for the first time, and provides a basis for subsequent clinical diagnosis.
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Affiliation(s)
- Xinying Ren
- College of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huanwen Liu
- College of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shiji Hui
- College of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xi Wang
- College of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Honglai Zhang
- College of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China
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Aytekin K, Balta O. Dimple of Venus Is Associated with the Increased Pelvic Incidence Angle and More Sagittally Oriented Facet Joint. Med Princ Pract 2023; 32:209-216. [PMID: 37285829 PMCID: PMC10601671 DOI: 10.1159/000531413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES The present study aims to investigate whether the dimple of Venus affects the anatomy of spinopelvic junction. SUBJECTS AND METHODS Inclusion criteria were having a lumbar MRI examination in the last 1 year, being older than 18 years of age and being able to radiologically evaluate the whole vertebral colon and pelvic girdle. Exclusion criteria were having congenital diseases of the pelvic girdle/hip/vertebral column and history of fracture or previous surgery in the same anatomic regions. The patients' demographic data and low back pain were noted. At radiological examination, the pelvic incidence angle was measured by lateral lumbar X-ray. The facet joint angle, tropism, facet joint degeneration, intervertebral disc degeneration, and intervertebral disc herniation at the level of L5-S1 were examined on lumbar MRIs. RESULTS We included 134 male and 236 female patients with a mean age of 47.86 ± 14.50 years and 48.49 ± 13.49 years, respectively. We found that the patients with the dimple of Venus had higher pelvic incidence angle (p < 0.001) and more sagittally oriented facet joint (right facet joint p = 0.017, left facet joint p = 0.001) compared to those without the dimple of Venus. There was no statistically significant relationship between low back pain and the presence of the dimple of Venus. CONCLUSIONS The dimple of Venus affects the anatomy of the spinopelvic junction and is associated with an increased pelvic incidence angle and a more sagittally oriented facet joint angle.
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Affiliation(s)
- Kürşad Aytekin
- Department of Orthopedics and Traumatology, Department of Anatomy, School of Medicine, University of Giresun, Giresun, Turkey
| | - Orhan Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Hospital, Tokat, Turkey
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Özcan-Ekşi EE, Börekci A, Ekşi MŞ. Facet Joint Orientation/Tropism Could Be Associated with Fatty Infiltration in the Lumbar Paraspinal Muscles. World Neurosurg 2023; 173:e606-e615. [PMID: 36863453 DOI: 10.1016/j.wneu.2023.02.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the previous studies has evaluated the association of FJO/FJT with fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar levels. In the present study, we aimed to analyze whether FJO and FJT were associated with fatty infiltration in the paraspinal muscles at any lumbar level. METHODS Paraspinal muscles and FJO/FJT were evaluated from L1-L2 to L5-S1 intervertebral disc levels on T2-weighted axial lumbar spine magnetic resonance imaging. RESULTS Facet joints were more sagittally and coronally oriented at the upper and lower lumbar levels, respectively. FJT was more obvious at lower lumbar levels. The FJT/FJO ratio was higher at upper lumbar levels. Patients with sagittally oriented facet joints at the L3-L4 and L4-L5 levels had fattier erector spinae and psoas muscles at the L4-L5 level. Patients with increased FJT at upper lumbar levels had fattier erector spinae and multifidus at lower lumbar levels. Patients with increased FJT at the L4-L5 level had less fatty infiltration in the erector spinae and psoas at the L2-L3 and L5-S1 levels, respectively. CONCLUSIONS Sagittally oriented facet joints at lower lumbar levels could be associated with fattier erector spinae and psoas muscles at lower lumbar levels. The erector spinae at upper lumbar levels and psoas at lower lumbar levels might have become more active to compensate the FJT-induced instability at lower lumbar levels.
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Affiliation(s)
- Emel Ece Özcan-Ekşi
- Bahçeşehir University, School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
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Ke S, Sun T, Zhang W, Zhang J, Li Z. Are there correlations between facet joint parameters and lumbar disk herniation laterality in young adults? J Clin Neurosci 2023; 109:50-56. [PMID: 36731383 DOI: 10.1016/j.jocn.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/08/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We aimed to determine whether there is an association, in young adults, between the occurrence of lumbar disk herniation (LDH) at a given segment and the segment's facet joint parameters [facet orientation (FO) and tropism (FT)]. In addition, associations between facet joint parameters in the corresponding segment and LDH laterality were also investigated. METHODS We retrospectively analyzed data from 529 patients who were between 18 and 35 years old, who had experienced single-level LDH (L4-5 or L5-S1) between June 2017 and December 2019, and with<2 years of clinical history. We included an additional 122 patients with no history of LDH as an age-matched control group. LDH were classified by laterality (left-sided, right-sided, or central herniation). At each level, we investigated the relationship between facet joint parameters and herniation laterality. RESULTS FOA values at the L4-L5 level and the L5-S1 level were significantly lower and FT was higher for the LDH group compared with those for the control group. The level at which LDH occurred, FOL, FOR, and FT differed significantly among the three groups. There was a significant association between herniationlaterality and FO at the L4-L5 level but not at the L5-S1 level. CONCLUSIONS Abnormal facet joint parameters are significantly associated with LDH. Young adults with higher FT should be paid more attention, to prevent the occurrence of LDH. Compared with L5-S1 level, intervertebral disk herniation at the L4-L5 level tended to occur ipsilateral to the side with a lower facet joint angle when FT was present.
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Affiliation(s)
- Song Ke
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China; Department of Orthopaedics, The Second Hospital of Tangshan, Tangshan, People's Republic of China
| | - Tianze Sun
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Wentao Zhang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Jing Zhang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China.
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Aaen J, Banitalebi H, Austevoll IM, Hellum C, Storheim K, Myklebust TÅ, Anvar M, Weber C, Solberg T, Grundnes O, Brisby H, Indrekvam K, Hermansen E. The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2777-2785. [PMID: 35930062 DOI: 10.1007/s00586-022-07317-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/24/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS). METHODS The NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to ≥ 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients' gender, age, smoking status and BMI. RESULTS The primary analysis showed that severe disc degeneration (Pfirrmann score 4-5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations. CONCLUSION Severe disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.
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Affiliation(s)
- Jørn Aaen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | | | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Dept. of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Tore Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Oliver Grundnes
- Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway
| | - Helena Brisby
- Dept of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Dept. of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kari Indrekvam
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Yadav S, Arya R, Dakshinamoorthy R, Jha AA, Jain S, Kumar I. Facet Tropism/Inclination and Its Association with Intervertebral Disc Herniation in the Lumbar Spine - A Radiological Evaluation. Rev Bras Ortop 2022; 57:941-946. [PMID: 36540729 PMCID: PMC9757969 DOI: 10.1055/s-0042-1742338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/14/2021] [Indexed: 10/18/2022] Open
Abstract
Objective To assess the role of facet tropism (FT) in intervertebral disc prolapse. Methods A total 98 patients with lower back pain were included in the study. Magnetic resonance imaging scans were performed and analyzed. The angles of the right and left facets were measured on the axial section. Patients without disc prolapse at the L3-L4, L4-L5 and L5-S1 levels act as controls for those with disc prolapse at the same levels. A statistical analysis was also performed. Results The incidence of FT at the L3-L4 level was of 85.2% in patients with disc herniation ( n = 27), and of 56.3% in the control group, which was statistically significant ( p = 0.008). Similarly, at the L4-L5 level, incidence of FT among cases and controls was of 71.4% ( n = 35) and 52.4% respectively ( p = 0.066). At the L5-S1 the incidence was of 66% and 51% among cases and controls respectively ( p = 0.13). Conclusion We found a positive association between FT and disc herniation at the L3-L4 level, but no association at the L4-L5 and L5-S1 levels.
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Affiliation(s)
- Sanjay Yadav
- Departamento de Ortopedia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, Índia,Endereço para correspondência Sanjay Yadav, MS, DNB Department of Orthopedics, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005, Uttar PradeshIndia
| | - Rajkumar Arya
- Departamento de Ortopedia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, Índia
| | - Raghul Dakshinamoorthy
- Departamento de Ortopedia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, Índia
| | - Abhinav Anand Jha
- Departamento de Ortopedia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, Índia
| | - Shivi Jain
- Departamento de Radiodiagnóstico e Imagem, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, Índia
| | - Ishan Kumar
- Departamento de Radiodiagnóstico e Imagem, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, Índia
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Zhou Y, Wang B, Pei Z, Yang J, Jiang C, Tian X, Qu X, Li L. Facet tropism: Association between cervical disc degeneration and cervical spondylotic radiculopathy in middle-aged patients. J Clin Neurosci 2022; 99:89-93. [PMID: 35278934 DOI: 10.1016/j.jocn.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/25/2021] [Accepted: 01/13/2022] [Indexed: 12/19/2022]
Abstract
This study aimed to retrospectively explore the relationship between facet tropism (FT) and cervical disc degeneration in cervical spondylotic radiculopathy (CSR) patients on 3-dimensional views. A total of 180 middle-aged patients with single-level CSR at C4/5 who underwent cervical CT and MRI in our hospital were included. The incidence of FT (or called FT (+), defined as FT ≥ 7 degree) at C3/4, C4/5, C5/6 levels were measured and calculated by reconstructed CT images on 3-dimensional views. The grade of cervical disc degeneration at three levels was assessed by MRI images by the method of Miyazali. Univariate analysis was performed to compare their cervical disc degeneration grade and CSR incidence between two groups stratified by FT (+). Moreover, a logistic regression model was used to investigate the association between FT (+) and grade of cervical disc degeneration and incidence of CSR adjusting for age, gender, and BMI. Grade of cervical disc degeneration and incidence of CSR in axial FT (+) group were both significantly increased compared to axial FT (-) group, while sagittal and coronal FT (+) groups showed no difference. Axial FT (+) was significantly associated with the grade of cervical disc degeneration and incidence of CSR. in middle-aged patients with CSR, axial FT (+) might be the risk factor for cervical disc degeneration but not sagittal and coronal FT (+). Also, axial FT (+) was positively associated with CSR incidence. Therefore, axial FT might play a vital role in the progression of cervical disc degeneration and CSR occurrence.
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Affiliation(s)
- Yuanxing Zhou
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Bo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Zhongyu Pei
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Jun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Chang Jiang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Xiliang Tian
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Xiaochen Qu
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Linan Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China.
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Evaluation of the degenerative lumbar osseous morphology using zero echo time magnetic resonance imaging (ZTE-MRI). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:792-800. [PMID: 35015138 DOI: 10.1007/s00586-021-07099-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/16/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine and compare the performance of zero echo imaging (ZTE) with conventional MRI sequences on lumbar osseous morphology in patients suspected with lumbar degeneration with multi-slice computed tomography (MSCT) as standard reference. METHODS 22 subjects with concerned lumbar degeneration were recruited. All subjects were scanned with ZTE sequence after routine conventional MR sequences on a 3.0 T system and also received MSCT examination. Image quality was assessed. The quantitative and qualitative parameters of lumbar osseous morphology on MSCT, ZTE and MRI images were evaluated by three musculoskeletal radiologists independently. Inter-reader and inter-modality reliability and the difference between the modalities were calculated. RESULTS There was no difference for the osseous parameters between modalities, including axial orientation (p = 0.444), IAD (p = 0.381), lateral recess (p = 0.370), pedicle width (p = 0.067), pedicle height (p = 0.056), and osteophyte grade (p = 0.052). The measurement of the foramina diameter was statistically different between conventional MRI and MSCT (p < 0.05) but not between the MSCT and ZTE (p = 0.660). Conventional MRI was more likely to miss cortical bone abnormalities. ZTE appeared blurrier in cortical bone than MSCT, especially in cases with severe lumbar degeneration. The inter-reader agreement between MSCT and ZTE-MRI was higher than between MSCT and conventional MRI. CONCLUSIONS ZTE-MRI could offer more cortical bone details than conventional MRI images and might be a valid alternative to CT for lumbar osseous morphology assessment to some extent.
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Zheng Z, Wang Y, Wang T, Wu Y, Li Y. A Systematic Review and Meta-Analysis of the Facet Joint Orientation and Its Effect on the Lumbar. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2486745. [PMID: 35242295 PMCID: PMC8888088 DOI: 10.1155/2022/2486745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/21/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
Facet tropism is recognized as the difference in the positioning of the facet joints in association with each other in the sagittal plane. This guides to an imbalanced biomechanical force over the facet joints and the intervertebral disc during rotation and other physiological activities. A systematic review and meta-analysis of Web of Science, EMBASE, PubMed, Cochrane Library, SCOPUS, and CINHAL from 2004 to 2021 to recognize the related research studies was performed. The data for meta-analysis were obtained from multiple studies to get the combined effect of the facet tropism on the lumbar disc herniation (LDH) and the degenerative lumbar spondylolisthesis (LDS). 117 articles were incorporated in the systematic review, where 41 studies were selected for meta-analysis, out of which 7 studies were found eligible as per the inclusion criteria. When degenerative lumbar spondylolisthesis was compared with the normal group, 95% CI was observed at 1.94 (1.59, 2.28). There was a comparison of disc herniation with the normal group in L4/L5, with a 95% CI of 0.60 (0.05, 1.14). The L5/S1 disc herniation was compared with the normal group and was found to be 0.21 (-0.48, 0.90). Therefore, it was observed that facet tropism is related to lumbar disc herniation and degenerative lumbar spondylolisthesis. Our meta-analysis demonstrated a unique link between the facet tropism and the lumbar disk degeneration along with degenerative lumbar spondylolisthesis.
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Affiliation(s)
- Zhirui Zheng
- The Second Affiliated Hospital of Harbin Medical University Orthopedic Surgery Three Ward, Harbin, China
| | - Youqiang Wang
- The Second Affiliated Hospital of Harbin Medical University Orthopedic Surgery Three Ward, Harbin, China
| | - Tong Wang
- The Second Affiliated Hospital of Harbin Medical University Orthopedic Surgery Three Ward, Harbin, China
| | - Yue Wu
- The Second Affiliated Hospital of Harbin Medical University Orthopedic Surgery Three Ward, Harbin, China
| | - Yuhui Li
- The Second Affiliated Hospital of Harbin Medical University Orthopedic Surgery Three Ward, Harbin, China
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Huang Z, Zhang Y, Rong X, Zhang X, Liu H, Jin Z. Investigation on the biomechanical behavior of the lower cervical spine induced by facet tropism with respect to the sagittal plane. Med Eng Phys 2022; 102:103779. [DOI: 10.1016/j.medengphy.2022.103779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 12/24/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
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Tisot RA, Vieira JSL, Collares DDS, Sallet MB, Matos AGD, Buchner A, Klein BD, Rovadoscki CP, Polli F, Santos L, Viegas L, Bottega LM, Borelli N, Cavedon P, Silveira RMD, Milani T, Mecca V. EVALUATION OF SYMPTOMATIC DEGENERATIVE LUMBAR STENOSIS WITH PROBABLE DETERMINING FACTORS. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222104262001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACT Objective: To evaluate degenerative lumbar stenosis in symptomatic patients submitted to surgeryand the correlation between probable determining factors. Methods: A retrospective descriptive study in which themagnetic resonance images of 73 patients with degenerative stenosis,who underwent surgeries involving 141 levels performed by a single surgeon at the Hospital Ortopédico de Passo Fundo from 2015 to 2018, were evaluated. The patients were stratified by the degree of facet tropism, facet arthrosis, disc degeneration, and operated side, as well as by epidemiological data such as age, sex, etc. Tropism was measured using the Karacan method and evaluated numerically and categorically. Disc degeneration was classified by Pfirrmann and facet arthrosis by Weishaupt. To analyze and obtain the results, the Chi-square test and ANOVA were used with the SPSS statistical program, version 18.0. Results: Statistical significance was found in the relationship between facet tropism and disc degeneration (p=0.026) at the L4-L5 level. No correlation was found between tropism and facet arthrosis (p=0.161) or tropism and the operated side (p=0.573). Conclusion: The degree of tropism directly influences disc degeneration and greater asymmetries are related to more severe degenerations. Although tropism has not shown a statistically significant correlation with the operated side (p=0.573), it is believed that further studies should be carried out on this correlation. Level of evidence II; Retrospective study.
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Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:1391-1398. [PMID: 34797405 DOI: 10.1007/s00586-021-07051-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. METHODS The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. RESULTS The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2-4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. CONCLUSION In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. TRIAL REGISTRATION www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.
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The Correlation Between Facet Tropism and Intervertebral Disc Herniation in the Subaxial Cervical Spine. Spine (Phila Pa 1976) 2021; 46:E310-E317. [PMID: 33534441 DOI: 10.1097/brs.0000000000003788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVE Investigating the correlation between the facet tropism (FT) and subaxial cervical disc herniation (CDH). SUMMARY OF BACKGROUND DATA Although debatable, it was widely reported that FT was associated with lumbar disc herniation. However, the exact correlation between FT and subaxial CDH is still unclear. METHODS Two-hundred patients with any disc herniation at C3/4, C4/5, C5/6, or C6/7 and 50 normal participants without CDH (normal control group) were included in this study. For patients, the cervical levels with CDH and the levels without herniation were classified into the "herniation group" and "patient control group," respectively. Bilateral facet joint angles at C3/4, C4/5, C5/6, and C6/7 on sagittal, axial, and coronal planes were measured on computed tomography (CT). The disc degeneration at each level was assessed on magnetic resonance imaging (MRI). RESULTS Both the mean difference between left and right facet angles and tropism incidence in herniation group were significantly greater than those in two control groups whenever at C3/4, C4/5, C5/6, or C6/7 level and whenever on sagittal, axial, or coronal plane. The mean differences of angles and tropism incidences in most patient control groups were not significantly greater than those of corresponding normal control groups. The incidence of greater facet angle at the left or right side was not significantly different among the left, central, and right herniation groups. The mean disc degeneration grades in both herniation and patient control groups were significantly higher than those in normal control groups while no difference between herniation and patient control groups. CONCLUSION The FT on the sagittal, axial, and coronal planes are all associated with CDH in the subaxial cervical spine. The greater facet angle at the left or right side does not affect the side of herniation. The severity of cervical disc degeneration is not associated with FT.Level of Evidence: 3.
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Facet Tropism in Lumbar Spine and Cervical Spine: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 147:47-65. [PMID: 33309642 DOI: 10.1016/j.wneu.2020.11.171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Facet tropism (FT) refers to the difference in the orientation of facet joints with respect to each other in the sagittal plane. FT leads to unequal biomechanical forces on facet joint and intervertebral disc during rotation and other physiologic movements. Most of the studies have reported the incidence of FT in the lumbar spine to vary between 40% and 70%, with L4-5 level being the most commonly afflicted level. The objective of this study was to find the association between FT and various lumbar and cervical degenerative disorders. METHODS A systematic search of PubMed was performed with the keywords "facet tropism" and "facet asymmetry." Data for meta-analysis were extracted from the studies to obtain pooled impact of FT on lumbar disc herniation (LDH) and lumbar degenerative spondylolisthesis (LDS). RESULTS Eighty-two articles were included in the systematic review and 18 studies had the required data to be included in the meta-analysis. The pooled standard mean difference between FT angles in patients with or without LDH was 0.31 with (P = 0.04). The pooled odds ratio for FT in patients with LDH was 3.27 with (P = 0.02). Subgroup analysis showed that there is no significant difference in the L3/4, L4/5, and L5S1 subgroups. The pooled standard mean difference between FT angles in patients with or without LDS was 0.54 (P = 0.009). CONCLUSIONS FT is significantly associated with LDH and LDS along with various other lumbar and cervical degenerative diseases.
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Lumbar Facet Tropism on Different Facet Portions and Asymmetry Between Ipsilateral Cephalad and Caudad Portions: Their Correlations With L4/5 and L5/S1 Lumbar Disc Herniation. Spine (Phila Pa 1976) 2020; 45:E1312-E1318. [PMID: 32694484 DOI: 10.1097/brs.0000000000003614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVE To investigate the correlation between lumbar disc herniation (LDH) and lumbar facet tropism (FT) on cephalad and caudad facet portions, respectively; to investigate the asymmetry between ipsilateral cephalad and caudad facet portions and its correlation with LDH. SUMMARY OF BACKGROUND DATA There are still heavy debates on the exact correlation between lumbar FT and LDH. However, no study ever focused on the FT on different facet portions and asymmetry between ipsilateral cephalad and caudad portions in patients with LDH. METHODS One hundred patients with L4/5 LDH, 100 patients with L5/S1 LDH, and 100 participants without LDH (control group) were age and sex matched and included in this study. Participants in each group were further divided into two subgroups based on age (≥ or < 50 yr old). Bilateral facet joint angles on both cephalad and caudad portions were measured. FT and asymmetry between ipsilateral cephalad and caudad portions in each LDH group were compared with those in corresponding control group. RESULTS Comparing with control participants, the mean difference of bilateral facet angles in older patients with L4/5 LDH was significantly greater either on cephalad portion and caudad portion, whereas significantly higher frequency of FT was only exhibited on cephalad portion. In older patients with L4/5 LDH, the mean difference of facet angle between ipsilateral cephalad and caudad portions was significantly greater than that of control participants, the frequency of ipsilateral cephalad, and caudad facet asymmetry was also significantly higher. CONCLUSIONS Only the FT on cephalad portion but not caudad portion of facet joint is associated with L4/5 LDH of older patients. The measurement on different portions of facet joint may result in discrepancy on FT identification. Asymmetry between ipsilateral cephalad and caudad facet portions is also associated with L4/5 LDH in older patients. LEVEL OF EVIDENCE 3.
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Are facet joint parameters risk factors for recurrent lumbar disc herniation? A pilot study in a Chinese population. J Clin Neurosci 2020; 77:36-40. [DOI: 10.1016/j.jocn.2020.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/30/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022]
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Abbas J, Peled N, Hershkovitz I, Hamoud K. Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2453503. [PMID: 32685454 PMCID: PMC7341411 DOI: 10.1155/2020/2453503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.
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Affiliation(s)
- Janan Abbas
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Physical Therapy, Zefat Academic College, Zefat, 13206, Israel
| | - Natan Peled
- Department of Radiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Kamal Hamoud
- Department of Physical Therapy, Zefat Academic College, Zefat, 13206, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- Department of Orthopaedic Surgery, The Baruch Padeh Poriya Medical Center, Tiberias 1520800, Israel
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Yang M, Wang N, Xu X, Zhang Y, Xu G, Chang Y, Li Z. Facet joint parameters which may act as risk factors for chronic low back pain. J Orthop Surg Res 2020; 15:185. [PMID: 32448378 PMCID: PMC7245951 DOI: 10.1186/s13018-020-01706-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/13/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Facet orientation (FO) and facet tropism (FT) are two important structural parameters of lumbar facet joint. The purpose of this study was to evaluate the association between facet joint parameters and chronic low back pain (LBP). METHODS From June 2017 to January 2019, a total of 542 cases were enrolled in this study. There were 237 males and 305 females with a mean age of 35.8 years (range 18~59 years). All the cases were divided into a LBP group (LBP group) and a non-LBP group (N-LBP group) in this study. We compared their clinical parameters and facet joint parameters between two groups. RESULTS The LBP group was composed of 190 male and 252 female, whose ages ranged from 17 to 59 years (35.6 ±7.9 y). The N- LBP group was composed of 47 male and 53 female, whose ages ranged from 18 to 59 years (35.9 ± 7.5 y). Of these parameters, BMI (P = 0.008) and FT (P = 0.003) at all three levels were found to be significantly associated with incidence of chronic LBP (P < 0.05), but FO were only found to be significant at L3-L4 level and L5-S1 level (P < 0.05). Logistic regression analysis showed that high BMI and large FT were significant risk factors for chronic LBP (P < 0.05), and FT were found to might be independent risk factors for chronic LBP. CONCLUSION FT may play a more important role in the pathogenesis of chronic LBP.
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Affiliation(s)
- Ming Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Naiguo Wang
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Xiaoxin Xu
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Yu Zhang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Gang Xu
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Yvang Chang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China. .,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China.
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Song Q, Liu X, Chen DJ, Lai Q, Tang B, Zhang B, Dai M, Wan Z. Evaluation of MRI and CT parameters to analyze the correlation between disc and facet joint degeneration in the lumbar three-joint complex. Medicine (Baltimore) 2019; 98:e17336. [PMID: 31577728 PMCID: PMC6783151 DOI: 10.1097/md.0000000000017336] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters.A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured.Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1.Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.
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Affiliation(s)
- Quanwei Song
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Xuqiang Liu
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - De-jian Chen
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Qi Lai
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Benyu Tang
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Bin Zhang
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Min Dai
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Zongmiao Wan
- Department of Orthopedics, Multidisciplinary Therapy Center of Musculoskeletal Tumor
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
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Ko S, Chae S, Choi W, Kim JY, Kwon J, Doh J. The Prevalence of Facet Tropism and Its Correlation with Low Back Pain in Selected Community-Based Populations. Clin Orthop Surg 2019; 11:176-182. [PMID: 31156769 PMCID: PMC6526133 DOI: 10.4055/cios.2019.11.2.176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 01/25/2019] [Indexed: 11/06/2022] Open
Abstract
Background The incidence of facet tropism (FT) and its correlation with low back pain (LBP) have, to our knowledge, not yet been investigated among selected community-based populations who visited departments unrelated to LBP with their chief complaints unrelated to LBP. In this study, we aimed to evaluate the prevalence of FT among selected patients in whom LBP was not the chief complaint and the correlation between FT and LBP among these patients. Methods Among patients who underwent computed tomography during 2014 for reasons unrelated to LBP, we enrolled 462 patients who satisfied the inclusion and exclusion criteria. The degree of tropism was defined as grade 0, 1, and 2 for FT, FT+, and FT++, respectively. LBP was evaluated using a modified version of the Nordic low back pain questionnaire. For additional evaluation of dynamic LBP, the question, "Did your pain go away when lying down still or standing up straight, and did it also intensify when you bend or stretch your back?," was included in the questionnaire. Results The L4-5 intervertebral area was most frequently and severely affected by FT with an incidence rate of 46.3%, and severe FT was observed in 24.7% of the patients. FT increased with age at L2-3 and L5-S1 levels. FT at L2-3 level was correlated with LBP (p = 0.035) and dynamic LBP (p = 0.033). The FT grade at L2-3 level was correlated with dynamic LBP (p = 0.022) but not with LBP (p = 0.077). The relative risk of FT at L2-3 level was 1.614 for LBP and 1.724 for dynamic LBP. Conclusions The prevalence of FT among community-based populations was 46.3% and its severe form was more frequently observed at L4-5 level (24.7%). LBP was correlated with FT at L2-3 level. The relative FT-associated risk of LBP was 1.6 at L2-3 level, and the relative L2-3 FT-associated risk of dynamic LBP was 1.724.
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Affiliation(s)
- Sangbong Ko
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Seungbum Chae
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Wonkee Choi
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jun-Young Kim
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jaibum Kwon
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jeongseok Doh
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea
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Degulmadi D, Dave BR, Krishnan A. Age- and sex-related changes in facet orientation and tropism in lower lumbar spine: an MRI study of 600 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:961-966. [PMID: 30887218 DOI: 10.1007/s00586-019-05953-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/11/2019] [Accepted: 03/13/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE We aimed to determine the age- and sex-related changes in facet orientation and facet tropism in lower lumbar spine. METHODS Between June 2015 and December 2017, magnetic resonance imaging scans of the consecutive 600 patients performed in the outpatient department for low back pain were analyzed. The data were divided according to age into four groups: group A (< 30 years), group B (31-45 years), group C (46-60 years) and group D (> 60 years). The orientation of the facet angles at L3-4, L4-5 and L5-S1 was measured using the method described by Noren et al. Sagittal angles and tropism were determined at each level. RESULTS Average facet angle is noted to increase from L3-4 to L5-S1 level in all groups irrespective of age and sex. A positive correlation is noted between age and sagittal facet orientation at all levels across all groups. Tropism was noted to be statistically significant (p < 0.05) at L5-S1 level. L3-4 and L4-5 levels did not show a positive correlation with respect to age. Facet angle sagittalization was significantly associated in males at L5-S1 level (p < 0.05) and in females at L4-5 level (p < 0.05). CONCLUSIONS Predominant morphological changes in superior articular process are responsible for remodeling of facets that occur with increasing age, resulting in sagittalization. Even though the facet orientation changes over a period of time, differential changes within the facets at the same level might not be seen. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Devanand Degulmadi
- Stavya Spine Hospital and Research Institute Pvt. Ltd, Mithakali, Ahmedabad, India.
| | - Bharat R Dave
- Stavya Spine Hospital and Research Institute Pvt. Ltd, Mithakali, Ahmedabad, India
| | - Ajay Krishnan
- Stavya Spine Hospital and Research Institute Pvt. Ltd, Mithakali, Ahmedabad, India
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Relationship between facet joint tropism and degeneration of facet joints and intervertebral discs based on a histological study. J Orthop 2019; 16:123-127. [PMID: 30814826 DOI: 10.1016/j.jor.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/02/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose Evaluate the correlation between lumbar facet joint tropism, lumbar facet joint degeneration, and intervertebral disc degeneration. Methods Forty-two of facet joints were evaluated histologically and radiologically. Results The correlation between facet joint tropism and histologic, CT, and MRI grading was -0.159 (P = 0.339), 0.025 (P = 0.226) and -0.270 (P = 0.102), respectively. The correlation between facet joint tropism and intervertebral disc MRI grading was 0.346 (P = 0.033), and that between facet joint and intervertebral disc MRI grading was 0.208 (P = 0.210). Conclusions Facet joint tropism was correlated with intervertebral disc degeneration but not with facet joint degeneration.
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Kanhangad MP. Response to: Zygapophyseal Joint Orientation and Facet Tropism and Their Association with Lumbar Disc Prolapse. Asian Spine J 2019; 13:175. [PMID: 30703860 PMCID: PMC6365797 DOI: 10.31616/asj.2018.0267.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Madhava Pai Kanhangad
- Corresponding author: Madhava Pai Kanhangad Division of Spine Surgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576-104, Karnataka, India Tel: +91-820-2922754, Fax: +91-820-2571934, E-mail: ,
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Rustagi T, Chhabra HS, Das K. Zygapophyseal Joint Orientation and Facet Tropism and Their Association with Lumbar Disc Prolapse. Asian Spine J 2019; 13:173-174. [PMID: 30703859 PMCID: PMC6365783 DOI: 10.31616/asj.2018.0267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tarush Rustagi
- Department of Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India.,Ohio State University and Wexner Medical Center, Columbus, OH, USA
| | | | - Kalidutta Das
- Department of Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India
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Degulmadi D, Dave B, Krishnan A, Patel D. The Relationship of Facet Joint Orientation and Tropism with Lumbar Disc Herniation and Degenerative Spondylolisthesis in the Lower Lumbar Spine. Asian Spine J 2019; 13:22-28. [PMID: 30326694 PMCID: PMC6365798 DOI: 10.31616/asj.2018.0116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/17/2018] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Retrospective study. PURPOSE This study aimed to clarify the relationship of both facet tropism (FT) and the sagittally aligned facet (SAF) joint with lumbar disc herniation (LDH) and degenerative spondylolisthesis (DS). OVERVIEW OF LITERATURE Despite several studies conducted, there is no consensus on the association of the SAF joint and FT with DH and DS. METHODS Between June 2015 and December 2017, magnetic resonance imaging scans of 250 consecutive patients who underwent surgery for LDH and DS were analyzed. The facet angles at all the lower lumbar levels were calculated, and SAF and FT were noted. The relationship between the side of disc herniation and that of the SAF joint were also determined. Statistical analysis was performed, and the relation of SAF and FT to LDH and DS was noted. RESULTS We observed a positive relationship between SAF and LDH at L4-5 and L5-S1 with a p-value of 0.02 (<0.05). FT demonstrated a positive association with LDH at L4-5 (p=0.047) but not at L3-4 or L5-S1. SAF demonstrated a positive relationship with DS at L3-4 (p<0.001) but not at L3-4 or L5-S1. FT demonstrated a significant relation with DS at L4-5 (p<0.001), whereas no positive association was observed at L3-4 and L5-S1. CONCLUSIONS The L4-5 level demonstrated a significant association with SAF and FT in LDH and DS. Moreover, SAF at L5-S1 demonstrated a positive association with LDH. These findings provide useful information for future longitudinal studies to elucidate the possible causes for such phenomena.
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Affiliation(s)
- Devanand Degulmadi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute Private Limited, Ahmedabad, India
- Corresponding author: Devanand Degulmadi Stavya Spine Hospital and Research Institute Private Limited, Mithakhali, Ellisbridge, Ahmedabad, Gujarat 380006, India Tel: +91-79-26565757, +91-79-26565657, Fax: +91-7874444091, E-mail:
| | - Bharat Dave
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute Private Limited, Ahmedabad, India
| | - Ajay Krishnan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute Private Limited, Ahmedabad, India
| | - Denish Patel
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute Private Limited, Ahmedabad, India
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Fallah Arzpeyma S, Hajir P, Bahari Khorram P. The relationship between facet tropism and lumbar disc herniation in patients with low back pain. AIMS MEDICAL SCIENCE 2019. [DOI: 10.3934/medsci.2019.3.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Clinical Characteristics and Risk Factors of Recurrent Lumbar Disk Herniation: A Retrospective Analysis of Three Hundred Twenty-One Cases. Spine (Phila Pa 1976) 2018; 43:1463-1469. [PMID: 30325345 DOI: 10.1097/brs.0000000000002655] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical series. OBJECTIVE To investigate the clinical features and the risk factors for recurrent lumbar disc herniation (rLDH) in China. SUMMARY OF BACKGROUND DATA rLDH is a common cause of poor outcomes after lumbar microdiscectomy surgery. Risk factors for rLDH are increasingly being investigated. However, results in these previous studies were not always consistent. METHODS Between June 2005 and July 2012, 321 consecutive patients with single-level LDH, who underwent surgery, were enrolled in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group) and compared their clinical parameters and preoperative radiologic parameters. The relationships between the variables and rLDH were evaluated by univariate analysis and multiple logistic regression analysis. RESULTS There was significant difference between groups in sex (P = 0.003), age (P = 0.003), current smoking (P = 0.004), body mass index (BMI) (P = 0.04), occupational lifting (P < 0.001), trauma history (P = 0.04), procedures (P = 0.04), herniation type (P = 0.006), disc height index (DUI) (P = 0.04), facet orientation (FO) (P = 0.04), facet tropism (FT) (P = 0.04), and sagittal range of motion (from) (P = 0.04). By putting these differences in logistic regression analysis, it showed that being male, young age, current smoking, higher BMI, herniation type (transligamentous extrusion), surgical procedures (bilateral laminectomy or total laminectomy), heavy works, undergoing a traumatic event, a large from, a high DUI, a large FT, and a small FO significantly related with rLDH. CONCLUSION Based on our data, sex, age, current smoking, BMI, occupational lifting, trauma, surgical procedures, herniation type, DUI, FO, FT, and from showed a significant correlation with the incidence of rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. LEVEL OF EVIDENCE 3.
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Mohanty SP, Kanhangad MP, Kamath S, Kamath A. Zygapophyseal Joint Orientation and Facet Tropism and Their Association with Lumbar Disc Prolapse. Asian Spine J 2018; 12:902-909. [PMID: 30213174 PMCID: PMC6147874 DOI: 10.31616/asj.2018.12.5.902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/09/2018] [Indexed: 01/07/2023] Open
Abstract
Study Design Cross-sectional study. Purpose To evaluate the association between zygapophyseal joint angle (ZJA), facet tropism (FT), and lumbar intervertebral disc prolapse (IVDP). Overview of Literature Several studies have shown that FT increases the risk of IVDP and have postulated that a more sagittally oriented zygapophyseal joint provides less mechanical resistance to axial torque, thereby exerting excessive rotational strain on the intervertebral disc, resulting in an annular tear. In contrast, other studies have found no definitive association between FT and IVDP. Therefore, conclusive evidence regarding the role of FT in the pathogenesis of disc prolapse is currently lacking. Methods Magnetic resonance imaging scans of 426 patients with single-level lumbar IVDP were analyzed. Right and left ZJAs of the lumbar segments were measured on axial sections. The frequency and severity of FT were determined by calculating the absolute difference between the right and left ZJAs. Patients without IVDP at L4–L5 and L5–S1 served as controls for those with IVDP at L4–L5 and L5–S1, respectively. Chi-square test and t-test were used to compare the severity and frequency of FT between patients with and without IVDP. The receiver operating characteristic analysis was performed to determine the critical FT values that were predictive of IVDP. Results Patients with IVDP exhibited a higher frequency (L4–L5: 47% vs. 15.08%; L5–S1: 39.62% vs. 22.69%; p=0.001) and severity (L4–L5: 7.85°±3.5° vs. 4.05°±2.62°; L5–S1: 7.30°±3.07° vs. 4.82°±3.29°; p <0.001) of FT than those without IVDP. Critical FT values of 5.7° at L4–L5 and 6° at L5–S1 increased the likelihood of IVDP by a factor of 2.89 and 1.75, respectively. Conclusions Our results confirm the existence of a significant association between lumbar IVDP and FT; however, a causal relationship could not be ascertained.
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Affiliation(s)
- Simanchal Prosad Mohanty
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Madhava Pai Kanhangad
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Siddarth Kamath
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Is Facet Tropism Associated with Increased Risk of Disc Herniation in the Lumbar Spine? Asian Spine J 2018; 12:428-433. [PMID: 29879769 PMCID: PMC6002178 DOI: 10.4184/asj.2018.12.3.428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/24/2017] [Accepted: 09/16/2017] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective case control study. PURPOSE In current study, we compared the incidence of facet tropism (FT) in patients with lumbar disc herniation and normal controls. OVERVIEW OF LITERATURE It has been suggested that FT can be associated with increased risk of lumbar disc herniation. METHODS A total of 66 and 63 patients with L4/L5 and L5/S1 disc herniation, respectively, were evaluated in the present study. The control group comprised 61 normal subjects. Facet joint angle was measured using axial magnetic resonance images. The FT was defined as a difference of >10° between the right and left facet joints. The incidence of FT was compared between patients and controls. We also investigated the relationship between facet orientation (sagittal or coronal) and side of disc herniation. RESULTS The incidence of FT at the L4/L5 level was significantly higher in patients with disc herniation (48.5% vs. 26.2%, p =0.01), while it was found to be the same at the L5/S1 level in patients and controls (50.8% vs. 36%, p =0.098). Among the 64 patients with FT, intervertebral disc herniation occurred significantly toward the more sagittally oriented facet joint in 41 patients (p <0.05). CONCLUSIONS FT is associated with increased risk of L4/L5 intervertebral disc herniation, but not at the L5/S1 level. In addition, disc herniation occurred toward the more sagittally oriented facet joint.
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Mohanty SP, Pai Kanhangad M, Kamath S, Kamath A. Morphometric study of the orientation of lumbar zygapophyseal joints in a South Indian population. J Orthop Surg (Hong Kong) 2018; 25:2309499017739483. [PMID: 29121821 DOI: 10.1177/2309499017739483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine the orientation of lumbar zygapophyseal joints and prevalence of facet tropism (FT) identified by computerized tomographic (CT) scans. METHODS In a cross-sectional study, 124 CT scans of patients with spinal injuries, seen between 2011and 2015, were retrospectively studied. A total of 566 uninjured motion segments were analysed. The right and left zygapophyseal joint angles (ZJAs) from L1-L2 to L5-S1 were measured on axial sections at uninjured levels. The absolute difference between the right and left ZJA was calculated to determine the prevalence and severity of FT at each level. RESULTS The mean ZJA (mean ± SD) at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1 was 23.55 ± 7.21, 27.97 ± 6.95, 39.47 ± 6.07, 48.32 ± 6.38 and 53.45 ± 6.67, respectively. Prevalence of FT at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1 was 22.42%, 25%, 27.19%, 47.82% and 38.5%, respectively. One-way repeated analysis of variance test showed a statistically significant difference in mean ZJA ( p < 0.05) and prevalence of FT ( p < 0.05) at different levels of the lumbar spine. CONCLUSIONS This study confirms that ZJA is not the same at different levels of the lumbar spine. The mean ZJA progressively increases from L1-L2 to L5-S1. This could explain the greater range of movements in the lumbar spine at the lower levels. The higher prevalence of FT at L4-L5 and L5-S1 seen in this study could explain the greater incidence of disc prolapse and other degenerative disorders at these levels.
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Affiliation(s)
- S P Mohanty
- 1 Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Madhava Pai Kanhangad
- 1 Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Siddarth Kamath
- 1 Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Asha Kamath
- 2 Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Incidence and Risk Factors of Anterior Arch Fracture of the Atlas Following C1 Laminectomy Without Fusion. Spine (Phila Pa 1976) 2018; 43:667-674. [PMID: 28885292 DOI: 10.1097/brs.0000000000002402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter study. OBJECTIVE To identify the incidence of anterior arch fracture (AAF) of the atlas following C1 (first cervical vertebra) laminectomy without fusion, and its risk factors. SUMMARY OF BACKGROUND DATA C1 laminectomy without fusion is a widely accepted surgical procedure performed to decompress the spinal cord that is compromised at the C1/C2 level, but without instability. Several case series have reported spontaneous AAF following this procedure. However, the incidence of post-laminectomy AAF and its risk factors have not been studied. METHODS This retrospective study included patients who underwent C1 laminectomy without fusion in any of the four participating institutions between April 2002 and March 2016. The incidence of AAF following C1 laminectomy was determined, and the included patients were grouped into those who developed AAF (AAF group) and those who did not (non-AAF group). Patient demographics and radiographic parameters including subaxial cervical balance on x-ray (C2-7 sagittal vertical axis, C2-7 lordosis, C2-7 coronal cobb angle, and T1-slope), and morphology of the atlas on computed tomography (CT) scan were compared with the AAF and non-AAF groups. RESULTS Seventy patients who underwent C1 laminectomy without fusion were included in the study. The incidence of AAF was 14.2% (10/70). Multivariate analysis revealed that a large inferior facet angle (IFA, defined as the coronal inclination angle of the C1/2 facet as measured on CT) and the presence of subaxial ankylosis (bony ankylosis below C2 on CT) were independent risk factors for AAF. There were no significant differences in the subaxial cervical balance as measured on x-ray between the AAF and non-AAF groups (P > 0.05). CONCLUSION The incidence of AAF after C1 laminectomy without fusion is not uncommon. Preoperative assessment using CT may identify patients at high risk of AAF. LEVEL OF EVIDENCE 4.
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Abstract
Purpose:
To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine.
Methods:
A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type.
Results:
At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P > 0.05).
Conclusion:
Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.
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TISOT RODRIGOARNOLD, VIEIRA JULIANODASILVEIRA, COLLARES DIEGODASILVA, STUMM LEONARDODOMINGUES, FONTANA MARIANOFERABOLI, PASINI AUGUSTO, CORONEL EDUARDO, SCHARNOVSKI EDUARDO, AGOSTINI MAIARA, BORIN MATEUS, KASPER VICTOR, SÁNCHEZ VICTOR, ISERHARD WALTER. INFLUENCE OF FACET TROPISM ON THE LOCATION OF LUMBAR DISC HERNIATION. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181701179264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To correlate facet tropism with the side and location of the intervertebral disc in which the lumbar disc herniation occurred. Methods: A retrospective descriptive study that evaluated Magnetic Resonance Imaging of 255 patients with lumbar disc herniation undergoing surgical treatment with the Spine Group of the Hospital Ortopédico de Passo Fundo between 2002 and 2014. The total patient number was stratified according to the side affected by the herniated disc (right or left), location of the hernia in the intervertebral disc (central, centrolateral, foraminal and extraforaminal) and demographic data, such as age, gender etc. The degree of facet joint tropism was measured by the Karakan method and classified as mild (difference less than 7º); moderate (between 7º and 15º) and severe (difference greater than 15º). Results: A statistical significant relationship (p= 0.023) was observed between the facet joint tropism and the side where the lumbar disc herniation occurred. No correlation was found between facet joint tropism and location of the herniation on the intervertebral disc. Conclusions: The degree of facet tropism presents a statistical significant correlation with the side of the intervertebral disc in which the lumbar disc herniation will develop. Level of Evidence: II. Type of study: Retrospective study.
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Association of facet tropism and orientation with lumbar disc herniation in young patients. Neurol Sci 2018; 39:841-846. [DOI: 10.1007/s10072-018-3270-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
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Makino T, Honda H, Fujiwara H, Yoshikawa H, Yonenobu K, Kaito T. Low incidence of adjacent segment disease after posterior lumbar interbody fusion with minimum disc distraction: A preliminary report. Medicine (Baltimore) 2018; 97:e9631. [PMID: 29480873 PMCID: PMC5943881 DOI: 10.1097/md.0000000000009631] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN A retrospective review of prospectively collected data. OBJECTIVE To investigate the incidence of radiographic and symptomatic adjacent segment disease (ASD) and identify possible risk factors for ASD after posterior lumbar interbody fusion (PLIF) with minimum disc distraction by selecting low-height interbody cages. SUMMARY OF BACKGROUND DATA Excessive disc space distraction is reportedly 1 of the risk factors for ASD after PLIF; however, the incidence and other risk factors of ASD after PLIF with minimum disc distraction remain unclear. METHODS Forty-one consecutive patients who underwent PLIF at L4-L5 and were postoperatively followed up for a minimum of 2 years were included. The height and shape (box or bullet shape) of interbody cages was determined according to the disc height and morphology of the intervertebral space assessed on preoperative computed tomography scans to avoid excessive distraction. The incidence of radiographic and symptomatic ASD was evaluated and all demographic and radiographic parameters were compared between patients with and without ASD. Multivariate logistic regression analysis was performed to identify risk factors for ASD among the variables with P < .20 in univariate analysis. RESULTS The overall incidence of ASD was 12.2% (5/41 patients): radiographic ASD, 7.3% (3 patients); symptomatic ASD, 4.9% (2 patients). Multivariate analysis revealed preoperative retrolisthesis of L3 on extension as the sole risk factor for ASD after PLIF with minimum disc distraction (odds ratio, 2.13; 95% confidence interval, 1.00-4.05; P = .049). CONCLUSIONS The incidence of ASD in this study was lower than that of ASD in our previous study about PLIF with distraction of disc space (12.2% vs. 31.8%). Minimum disc distraction by selection of low-height interbody cages is a simple and effective method to prevent ASD at the surgeons' discretion, although preexisting retrolisthesis at the adjacent upper segment should be taken into consideration.
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Affiliation(s)
- Takahiro Makino
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita
| | - Hirotsugu Honda
- Department of Orthopedic Surgery, Japan Community Health care Organization Hoshigaoka Medical Center, Hirakata
| | - Hiroyasu Fujiwara
- Department of Orthopedic Surgery, National Hospital Organization Osaka Minami Medical Center, Kawachinagano
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita
| | | | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita
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The biomechanical impact of facet tropism on the intervertebral disc and facet joints in the cervical spine. Spine J 2017; 17:1926-1931. [PMID: 28713050 DOI: 10.1016/j.spinee.2017.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/22/2017] [Accepted: 07/06/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Facet tropism is defined as the angular difference between the left and the right facet orientation. Facet tropism was suggested to be associated with the disc degeneration and facet degeneration in the lumbar spine. However, little is known about the relationship between facet tropism and pathologic changes in the cervical spine and the mechanism behind. PURPOSE This study was conducted to investigate the biomechanical impact of facet tropism on the intervertebral disc and facet joints. STUDY DESIGN A finite element analysis study. METHODS The computed tomography (CT) scans of a 28-year-old male volunteer was used to construct the finite element model. First, a symmetrical cervical model from C2 to C7 was constructed. The facet orientations at each level were simulated using the data from our previously published study. Second, the facet orientations at the C5-C6 level were altered to simulate facet tropism with respect to the sagittal plane. The angular difference of the moderate facet tropism model was set to be 7 degrees, whereas the severe facet tropism model was set to be 14 degrees. The inferior of the C7 vertebra was fixed. A 75 N follower loading was applied to simulate the weight of the head. A 1.0 N⋅m moments was applied on the odontoid process of the C2 to simulate flexion, extension, lateral bending, and axial rotation. RESULTS The intradiscal pressure (IDP) at the C5-C6 level of the severe facet tropism model increased by 49.02%, 57.14%, 39.06%, and 30.67%, under flexion, extension, lateral bending, and axial rotation moments, in comparison with the symmetrical model. The contact force of the severe facet tropism model increased by 35.64%, 31.74%, 79.26%, and 59.47% from the symmetrical model under flexion, extension, lateral bending, and axial rotation, respectively. CONCLUSIONS Facet tropism with respect to the sagittal plane at the C5-C6 level increased the IDP and facet contact force under flexion, extension, lateral bending, and axial rotation. The results suggested that facet tropism might be the anatomic risk factor of the development of cervical disc degeneration or facet degeneration. Future clinical studies are in need to verify the biomechanical impact of facet tropism on the development of degenerative changes in the cervical spine.
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Correlation between facet tropism and lumbar degenerative disease: a retrospective analysis. BMC Musculoskelet Disord 2017; 18:483. [PMID: 29166933 PMCID: PMC5700519 DOI: 10.1186/s12891-017-1849-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate the correlation between facet tropism and spinal degenerative diseases, such as degenerative lumbar spondylolisthesis, degenerative lumbar scoliosis, and lumbar disc herniation. Methods This study retrospectively analysed clinical data from the Department of Orthopaedics at The First Affiliated Hospital of Nanchang University. Ninety-two patients were diagnosed with lumbar spondylolisthesis, 64 patients with degenerative scoliosis, and 86 patients with lumbar disc herniation between 1 October 2014 and 1 October 2016. All patients were diagnosed using 3.0 T magnetic resonance imaging and underwent conservative or operative treatment. Facet tropism was defined as greater than a ten degree between the facet joint angles on both sides. Results For L3-L4 degenerative lumbar spondylolisthesis, one out of six cases had tropism compared to seven out of the 86 controls (p = 0.474). At the L4-L5 level, 17/50 cases had tropism compared to 4/42 cases in the control group (p = 0.013). At the L5-S1 level, 18/36 cases had tropism compared to 7/56 controls (p = 0.000). For degenerative lumbar scoliosis at the L1-L5 level, 83/256 cases had tropism as compared to 36/256 controls (p = 0.000). For L3-L4 lumbar disc herniation two out of eight cases had tropism compared to 14/78 controls (p = 0.625). At the L4-L5 level, 19/44 cases had tropism compared to four out of 42 controls (p = 0.001). At the L5-S1 level, 24/34 cases had tropism compared to 10/52 controls (p = 0.000). Conclusion At the L4–5 and L5-S1 levels, facet tropism is associated with degenerative spondylolisthesis. In the degenerative lumbar scoliosis group, the number of case with facet tropism was significantly higher than that of the control group. Facet tropism was associated with lumbar disc herniation at the L4–5 and L5-S1 levels. Overall, in these three lumbar degenerative diseases, facet tropism is a common phenomenon. Electronic supplementary material The online version of this article (10.1186/s12891-017-1849-x) contains supplementary material, which is available to authorized users.
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Variation of facet joint orientation and tropism in lumbar degenerative spondylolisthesis and disc herniation at L4-L5: A systematic review and meta-analysis. Clin Neurol Neurosurg 2017; 161:41-47. [DOI: 10.1016/j.clineuro.2017.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/15/2017] [Accepted: 08/10/2017] [Indexed: 11/18/2022]
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Eroğlu A, Çarlı BA, Pusat S, Şimşek H. The Role of the Features of Facet Joint Angle in the Development of Isthmic Spondylolisthesis in Young Male Patients with L5-S1 Isthmic Spondylolisthesis. World Neurosurg 2017; 104:709-712. [PMID: 28549642 DOI: 10.1016/j.wneu.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate facet tropism and its role in development of lumbar isthmic spondylolisthesis (IS) in young men. METHODS From March 2013 to May 2016, bilateral facet joint angles were measured axially at L3-4, L4-5, and L5-S1 on lumbar computed tomography (CT) in 97 participants (46 patients with IS and 51 control subjects) 20-29 years old. A difference between the 2 corresponding facet angles of <6° was classified as no tropism; a difference of 6°-12°, moderate tropism; and a difference of >12°, severe tropism. RESULTS We measured 276 facet angles from 46 patients with IS and 306 facet angles from 51 control subjects. For patients with IS, there was no tropism in 43.5% (n = 20), moderate tropism in 50% (n = 23), and severe tropism in 6.5% (n = 3) at L3-4. For L4-5, there was no tropism in 28.3% (n = 13), moderate tropism in 60.9% (n = 28), and severe tropism in 10.9% (n = 5). For L5-S1, there was no tropism in 32.6% (n = 15), moderate tropism in 39.1% (n = 18), and severe tropism in 28.3% (n = 13). For the control group, there was no tropism in 86.3% (n = 44), moderate tropism in 13.7% (n = 7), and no severe tropism at L3-4. For L4-5, there was no tropism in 80.4% (n = 41), moderate tropism in 17.6% (n = 9), and severe tropism in 1.9% (n = 1). For L5-S1, there was no tropism in 68.6% (n = 35), moderate tropism in 29.4% (n = 15), and severe tropism in 1.9% (n = 1). CONCLUSIONS Facet angle tropism is seen in a high proportion of patients with IS and seems to be a predisposing factor in the etiology of IS.
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Affiliation(s)
- Ahmet Eroğlu
- Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul, Turkey.
| | - Bayram Alparslan Çarlı
- Department of Physical Medicine and Rehabilitation, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul, Turkey
| | - Serhat Pusat
- Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul, Turkey
| | - Hakan Şimşek
- Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul, Turkey
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Bredow J, Löhrer L, Oppermann J, Scheyerer MJ, Sobottke R, Eysel P, Siewe J. Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off? BIOMED RESEARCH INTERNATIONAL 2017; 2017:2964529. [PMID: 28831392 PMCID: PMC5554995 DOI: 10.1155/2017/2964529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 07/04/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. METHODS A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015. RESULTS Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi. CONCLUSION Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.
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Affiliation(s)
- J. Bredow
- Center for Spinal Surgery, Schön Klinik Düsseldorf SE & Co. KG, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - L. Löhrer
- Center for Spinal Surgery, Schön Klinik Düsseldorf SE & Co. KG, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
| | - J. Oppermann
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - M. J. Scheyerer
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - R. Sobottke
- Department of Orthopedics, Medical Center City Aachen GmBH, Wuerselen, Germany
| | - P. Eysel
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - J. Siewe
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
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Alonso F, Kirkpatrick CM, Jeong W, Fisahn C, Usman S, Rustagi T, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. Lumbar Facet Tropism: A Comprehensive Review. World Neurosurg 2017; 102:91-96. [DOI: 10.1016/j.wneu.2017.02.114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
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Eroğlu A, Sarı E, Cüce F, Tok F, Atabey C, Düz B. The investigation of the role of the facet joint angle in the development of L5-S1 spondylolysis in young men. Turk J Phys Med Rehabil 2017; 63:253-258. [PMID: 31453462 PMCID: PMC6648250 DOI: 10.5606/tftrd.2017.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/07/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This study aims to evaluate facet tropism in younger patients with lumbar spondylolysis and to investigate the role of facet tropism in the development of spondylolysis. PATIENTS AND METHODS Between February 2013 and December 2015, a total of 102 male patients with bilateral L5 pars defect including 53 with spondylolysis and 49 control subjects were included in this case-control study. The facet joint angles were measured bilaterally and axially at the level of L3-4, L4-5, L5-S1 using computed tomography (CT). The classification was made as follows: A difference between two reciprocal facet joint angles of <6° indicated no tropism, 6°-12° indicated moderate tropism, and >12° indicated severe tropism. RESULTS A total of 612 angles including 318 facet joint angles from 53 patients with spondylolysis and 294 facet joint angles from 49 control subjects were measured. L3-4 measurements in the control group showed no tropism in 87.8% (n=43), moderate tropism in 12.2% (n=6), and severe tropism in 0% (n=0). L4-5 measurements in control group showed no tropism in 79.6% (n=39), moderate tropism in 20.4% (n=10), and severe tropism in 0% (n=0). L5-S1 measurements in the control group showed no tropism in 69.4% (n=34), moderate tropism in 28.6% (n=14), and severe tropism in 2.0% (n=1). The mean facet joint angles in the spondylosis group were 32.9±5.1°, 37.5±5.4°, and 41.2±7.8° at the levels of L3-4, L4-5, and L5-S1, respectively. The mean facet joint angles of the control group were 33.2±5.7°, 39.7±4.9°, and 42.2±4.9° at the levels of L3-4, L4-5, and L5-S1, respectively, indicating no significant difference between the right and left mean facet joint angles between the groups (p>0.05). The frequency of facet tropism and the difference between right and left facet joint angles for all three levels were significantly higher in the spondylolysis group (p<0.05). Facet tropism at the level of L5-S1 was significantly more frequent than facet tropism at L3-4 level (p<0.05). CONCLUSION Our study results show that the rate of facet joint tropism is higher in the patients with spondylolysis, suggesting that facet tropism seems to play a role in the etiology of spondylolysis as a predisposing factor.
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Affiliation(s)
- Ahmet Eroğlu
- Department of Neurosurgery, Van Military Hospital, Van, Turkey
| | - Enes Sarı
- Department of Orthopedics and Traumatology, Aksaz Military Hospital, Muğla, Turkey
| | - Ferhat Cüce
- Department of Radiology, Mevki Military Hospital, Ankara, Turkey
| | - Fatih Tok
- Department of Physical Medicine and Rehabilitation, TSK Rehabilitation Center, Ankara, Turkey
| | - Cem Atabey
- Department of Neurosurgery, Mevki Military Hospital, Ankara, Turkey
| | - Bülent Düz
- Department of Neurosurgery, İstanbul Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Turkey
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Are Locked Facets a Contraindication for Extreme Lateral Interbody Fusion? World Neurosurg 2017; 100:607-618. [DOI: 10.1016/j.wneu.2016.11.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/09/2016] [Accepted: 11/12/2016] [Indexed: 12/17/2022]
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Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine. BMC Musculoskelet Disord 2017; 18:86. [PMID: 28219354 PMCID: PMC5319171 DOI: 10.1186/s12891-017-1448-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 02/09/2017] [Indexed: 02/05/2023] Open
Abstract
Background Facet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc degeneration, facet degeneration and degenerative spondylolisthesis in the lumbar spine. The purpose of this study was to explore the relationship between facet tropism and facet degeneration in the sub-axial cervical spine. Methods A total of 200 patients with cervical spondylosis were retrospectively analyzed. Facet degeneration was categorized into 4 grade: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes (<3 mm) without joint hypertrophy; grade III, joint hypertrophy secondary to large osteophytes (>3 mm) without fusion of the joint; grade IV, bony fusion of the facet joints. Facet orientations and facet tropisms with respect to the transverse, sagittal and coronal plane were calculated from the reconstructed cervical spine, which was based on the axial CT scan images. The paired facet joints were then categorized into three types: symmetric, moderated tropism and severe tropism. Univariate and multivariate analysis were performed to evaluate the relationship between any demographic and anatomical factor and facet degeneration. Results The mean age of enrolled patients was 46.23 years old (ranging from 30 to 64 years old). There were 114 males and 86 females. The degrees of facet degeneration varied according to cervical levels and ages. Degenerated facet joints were most common at C2-C3 level and more common in patients above 50 years old. The facet orientations were also different from level to level. By univariate analysis, genders, ages, cervical levels, facet orientations and facet tropisms were all significantly different between the normal facets and degenerated facets. However, results from multivariate logistic regression suggested only age and facet tropism with respect to the sagittal plane were related to facet degeneration. Conclusion Facet degeneration were more common at C2-C3 level. Older age and facet tropism with respect to the sagittal plane were associated with the facet degeneration. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1448-x) contains supplementary material, which is available to authorized users.
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Asymmetric Facet Joint Osteoarthritis and Its Relationships to Facet Orientation, Facet Tropism, and Ligamentum Flavum Thickening. Clin Spine Surg 2016; 29:394-398. [PMID: 23168391 DOI: 10.1097/bsd.0b013e31827ad875] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
STUDY DESIGN The degrees of osteoarthritis of the left and right facet joints were evaluated by using computerized tomography among elderly patients with low back or leg pain. OBJECTIVE To reveal the phenomenon of asymmetry regarding facet joint osteoarthritis (FJOA) in old patients and establish its relationships to spinal level, facet orientation, facet tropism and ligamentum flavum (LF) thickening. SUMMARY OF BACKGROUND DATA There were few reports regarding left-right asymmetry among severity of FJOA and its relationships to spinal level, facet orientation, facet tropism, and LF thickening remained unclear. METHODS The grade of bilateral FJOA was evaluated using 4-grade scale on computerized tomography images at the L3-4, L4-5, and L5-S1 levels of patients with age ranging from 60 to 80 years. All subjects were divided into 2 groups: symmetric FJOA group (FJOA I-II on both sides or FJOA III-IV on both sides) and asymmetric FJOA group (FJOA I-II on one side and FJOA III-IV on the other side). The relationships of FJOA to spinal level, facet orientation, facet tropism, and LF hypertrophy were evaluated. RESULTS No association between asymmetric FJOA and spinal level was noted (P>0.05). In asymmetric FJOA group, significant difference in facet orientation between 2 sides was observed at the L4-5 (P=0.018) and L5-S1 levels (P=0.033). Compared with symmetric FJOA, asymmetric FJOA showed significant difference in prevalence of facet tropism at the L5-S1 level (P<0.001). The LF showed significantly thicker on the side of FJOA III-IV than the side of FJOA I-II at each level in asymmetric FJOA group (P<0.05). However, no difference was found in thickness between 2 sides in symmetric FJOA group (P>0.05). CONCLUSIONS Asymmetric FJOA is associated with facet orientation and tropism, but not with spinal level. There is a close relationship between severity of FJOA and LF thickness.
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Radiographic Adjacent Segment Degeneration at 5 Years After L4/5 Posterior Lumbar Interbody Fusion With Pedicle Screw Instrumentation: Evaluation by Computed Tomography and Annual Screening With Magnetic Resonance Imaging. Clin Spine Surg 2016; 29:E442-E451. [PMID: 27755201 DOI: 10.1097/bsd.0b013e31828aec78] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE To investigate adjacent segment degeneration (ASD) at 5 years after L4/5 posterior lumbar interbody fusion with pedicle screw instrumentation and L4/5 decompression surgery using plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI), with the evaluation of annual changes on MRI. SUMMARY OF BACKGROUND DATA Methods of evaluation have been inconsistent among studies of ASD. There is no report that ASD in the lumbar spine after posterior lumbar interbody fusion at the same level is thoroughly evaluated on radiographs, CT, annual MRI changes, and the impact of decompression procedures. METHODS ASD was evaluated in 52 patients. Disk height, vertebral slip, intervertebral angle, and intervertebral range of motion were examined on plain radiographs. Facet joint degeneration on CT and disk degradation and spinal stenosis on MRI were classified into categories, and facet sagittalization and tropism were measured on CT. The incidence of ASD was compared between the decompression procedures. RESULTS The radiographic changes observed in the study were defined as radiographic ASD (R-ASD) without reoperation, as no patient required reoperation. R-ASD was rarely detected by radiography. The incidences of facet joint degeneration, MRI-detected disk degeneration, and spinal stenosis at the L3/4 and L5/S1 levels were 21% and 23%, 27% and 17%, and 35% and 4%, respectively. Progressive disk degeneration at L3/4 was found significantly more frequently in patients with aggravation of facet degeneration (P<0.01); however, the severities of preoperative facet degeneration, facet sagittalization, and tropism were not associated with progressive disk degeneration or spinal stenosis. In annual MRI, most R-ASD cases were detected within 3 years after surgery. Patients who underwent L4 total laminectomy had significantly more frequent R-ASD compared with those who received bilateral fenestration at L4/5 (P<0.01). CONCLUSIONS R-ASD was detected more frequently by CT and MRI compared with radiography. Preoperative facet joint degeneration and morphology were not always related to progressive disk degeneration or spinal stenosis. Annual MRI suggested that accelerated degeneration was due to lumbar spine fusion, rather than aging degeneration. Decompression with preservation of posterior connective components is recommended to prevent R-ASD.
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