Hyperlordosis is Associated With Facet Joint Pathology at the Lower Lumbar Spine

Jentzsch, Thorsten; Geiger, James D.; König, Matthias; Werner, Clément M. L.

doi:10.1097/bsd.0b013e3182aab266

Cited by 37 publications

(22 citation statements)

References 51 publications

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“…Hyperlordosis is considered to cause low back pain because of the increase in pressure on the posterior ligaments and facet joints 5,9 . In a CT analysis study, Jentzsch et al found that hyperlordosis of the lumbar spine was associated with facet joint arthritis in the lower lumbar spine 10 . Furthermore, Sorensen et al reported that lumbar lordosis in individuals who had low back pain when standing was greater than it was in individuals without low back pain 11 .…”

Section: Discussionmentioning

confidence: 99%

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

Okuzu

Goto

Okutani

et al. 2019

JBJS OA

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Background: Hip-spine syndrome was originally described by Offierski and MacNab, who argued that the flexion deformity of the hip rotated the pelvis forward, causing the spine symptoms. We additionally hypothesized that in patients who have osteoarthritis (OA) of the hip, the pelvis is tilted anteriorly to compensate for the anterior acetabular coverage defect. We investigated the hip factors associated with anterior pelvic tilt (PT) in patients who had OA of the hip due to acetabular dysplasia. Methods: We retrospectively reviewed the medical records of patients who had undergone total hip arthroplasty between January 2009 and December 2017 to identify those who had unilateral secondary OA due to acetabular dysplasia. Patients who had spinal imbalance, a history of spinal or lower limb fracture or surgery, bilateral OA of the hip, or a severely subluxated hip were excluded, leaving 100 eligible patients. We defined the indicators of an anterior acetabular coverage defect, flexion deformity of the hip, and anterior PT as the acetabular anteversion angle (AAA), extension range of motion (ROM), and anterior tilt of the pelvis, respectively. We measured hip factors and spinal parameters on radiographs and the standardized axial and coronal planes on 3-dimensional computed tomography with reference to the anterior pelvic plane. Hip factors associated with PT were investigated. Results: Univariate analysis showed a significant correlation between PT and both AAA (r = –0.389, p < 0.001) and combined anteversion angle (r = –0.272, p = 0.03). Multivariate regression analysis identified AAA (β = –0.385, p < 0.001) and extension ROM (β = 0.212, p = 0.0496) as independent factors associated with PT. Lumbar lordosis and pelvic incidence minus lumbar lordosis were significantly correlated with AAA, but sagittal vertical axis was not. Conclusions: When treating patients who have acetabular dysplasia, surgeons should recognize the relationship between the anterior acetabular coverage and anterior PT. Correcting hyperlordosis of the lumbar spine can induce progression of hip OA because it may decrease the acetabular anterior coverage.

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Section: Discussionmentioning

confidence: 99%

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

Okuzu

Goto

Okutani

et al. 2019

JBJS OA

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“…Beside these factors, and others related to the variability of the lumbar spine as subject of study—number of vertebrae used, pathological or nonpathological spines, presence or absence of lumbosacral transitional vertebrae, presence or absence of scoliosis, and so forth, discrepancies found among studies of sexual dimorphism and population variation could also stem from differences in the inclusion/exclusion criteria used by each author, which are often based on the sample's age range. Some consider age‐related degeneration to have an influence on the lumbar curvature—either increasing it (Jentzsch et al, ) or decreasing it (Dreischarf et al, ; Gelb, Lenke, Bridwell, Blanke, & McEnery, ; Korovessis et al, ; Merrill et al, ; Pries et al, )—and prefer to choose a younger‐aged sample in order to eliminate its effect in studies where age variation is not the main subject of study (Bailey et al, ). On the contrary, other authors do not find any relation between lordosis and age (Kalichman et al, ), and thus do not make any exclusions regarding age.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the degree of lumbar lordosis varies greatly throughout an individual's life history—during postnatal ontogeny, the lumbar lordosis is established and reaches its initial adult configuration shortly after puberty (Reichmann & Lewin, ; Shefi et al, ). During adulthood, the lumbar lordosis can change further with the senescence process (Dreischarf et al, ; Jentzsch, Geiger, König, & Werner, ; Korovessis, Stamatakis, & Baikousis, ; Pries, Dreischarf, Bashkuev, Putzier, & Schmidt, ). These changes are closely related to factors such as bone and soft tissue degeneration (Bogduk, ), genetic make‐up variability in different populations (i.e., inter‐population variation) and sexual dimorphism.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, there is a number of studies investigating different adult populations and applying different methodologies, which did not find sexual dimorphism neither in lordosis (Hasegawa et al, ; Jentzsch et al, ; Kalichman, Li, Hunter, & Been, ) nor in the wedging of the vertebral segments (Fazzalari, Manthey, & Parkinson, ). Legaye, Duval‐Beaupère, Hecquet, and Marty () even found a greater mean lordotic angle in males than in females.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, study populations vary in different aspects such as sample's size, posture, body mass index, mean age and age range, presence of lumbosacral transitional vertebrae, genetic differences, and so forth. These characteristics can have an influence on the degree of sexual dimorphism of the lumbar lordosis observed (Jentzsch et al, ; Korovessis et al, ; Pries et al, ).…”

Section: Introductionmentioning

confidence: 99%

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3D geometric morphometric analysis of variation in the human lumbar spine

Zlolniski

Torres-Tamayo

García‐Martínez

et al. 2019

American J Phys Anthropol

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Objectives: The shape of the human lumbar spine is considered to be a consequence of erect posture. In addition, several other factors such as sexual dimorphism and variation in genetic backgrounds also influence lumbar vertebral morphology. Here we use 3D geometric morphometrics (GM) to analyze the 3D morphology of the lumbar spine in different human populations, exploring those potential causes of variation.Material and methods: We collected 390 (semi) landmarks from 3D models of the CT scans of lumbar spines of seven males and nine females from a Mediterranean population (Spain, Israel) and seven males and either females from a South African population for geometric morphometric (GM) analysis. We carried out Generalized Procrustes Analysis, Principal Components, and Regression analyses to evaluate shape variation; and complemented these analyses with the Cobb Method.Results: The Mediterranean sample was considerably more lordotic than the South African sample. In both populations, female lumbar spines showed proportionally narrower and more craniocaudally elongated lumbar segments than in males. In addition, the point of maximum curvature in females tended to be located more inferiorly than in males. Discussion:Our results show that sexual dimorphism is an important factor of lumbar spine variation that mainly affects features of lumbar spine robustness (height proportions) and the structure-but not the degree-of its curvature. Differences in lordosis, however, are clearer at the inter-population level. This reflects previous conflicting studies casting doubts on pregnancy as an adaptive factor influencing lordosis. Other factors, for example, shape of the individual lumbar vertebrae and intervertebral discs and their relative proportions within the lumbar spine should be considered when exploring variation in vertebral column morphology. K E Y W O R D Slordosis, Mediterranean Caucasian, population variation, sexual dimorphism, South African

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Level dependent alterations in human facet cartilage mechanics and bone morphometry with spine degeneration

Gupta

Xiao

Fainor

et al. 2022

Journal Orthopaedic Research

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The zygapophyseal joints of the spine, also known as the facet joints, are paired diarthrodial joints posterior to the intervertebral disc and neural elements. The pathophysiology of facet osteoarthritis (OA), as well as crosstalk between the disc and facets, remains largely understudied compared to disc degeneration. The purpose of this study was to characterize alterations to human facet cartilage and subchondral bone across a spectrum of degeneration and to investigate correlations between disc and facet degeneration. Human lumbar facet articular surfaces from six independent donors were subject to creep indentation mechanical testing to quantify cartilage mechanical properties, followed by microcomputed tomography (µCT) analyses for subchondral bone morphometry.The degenerative state of each articular surface was assessed via macroscopic scoring and via Osteoarthritis Research Society International histopathology scoring. Our data suggest reduced facet cartilage compressive and tensile moduli and increased permeability with increasing degenerative grade, particularly at the lower levels of the spine. µCT analyses revealed spinal level-dependent alterations to the subchondral bone, with an increase in trabecular bone at the L4−L5 level, but a decrease at the upper levels of the lumbar spine with increasing degenerative grade. Cortical bone volume fraction was generally decreased with increasing degenerative grade across spinal levels. Correlation analysis revealed several associations between quantitative measures of disc degeneration and facet OA. This study showed that alterations in the mechanical properties of facet cartilage and in the structural properties of facet subchondral bone correlated with aspects of disc degeneration and were highly dependent on spinal level.

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Hyperlordosis is Associated With Facet Joint Pathology at the Lower Lumbar Spine

Cited by 37 publications

References 51 publications

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

3D geometric morphometric analysis of variation in the human lumbar spine

Level dependent alterations in human facet cartilage mechanics and bone morphometry with spine degeneration

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