The Pedicle-facet Angle and Tropism in the Sagittal Plane in Degenerative Spondylolisthesis

Gao, Fei; Hou, Dailun; Zhao, Bin; Sun, Xiaoli; Sun, Hongchang; Li, Ning; Guo, Linxin; Liu, Cheng

doi:10.1097/bsd.0b013e31823972d4

Cited by 19 publications

(13 citation statements)

References 22 publications

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“…It has been shown that increased angles might predispose to slippage and degeneration [8]. Our data show larger angles in symptomatic patients.…”

Section: Facet Joint Anglesupporting

confidence: 60%

“…Besides intervertebral disc degeneration, infection or fracture, degenerative changes in the posterior stabilizing column (facet joints, interspinous ligaments and paraspinal muscles) may be the cause of low back pain [7]. Degenerative spondylolisthesis is common and may become more important with aging populations [8]. The proportion of patients with low back pain in whom facet joints are causative has been estimated to be 5-15% [9] has been shown to increase with age [10] and may amount up to 50% in chronic pain cohorts [11].…”

Section: Introductionmentioning

confidence: 99%

“…The facet joints protect the intervertebral discs from forward motion [12] or excessive rotational strain [8] and are subjected to higher loads as the discs shrink with age. The form of the facet joints may predispose to mechanical instability.…”

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Imaging Can Detect Symptomatic Patients with Facet Joint Pain. A Retrospective Analysis

Freund¹,

Weber²,

Meier³

et al. 2017

J Clin Med Exp Images

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Background: Low back pain has recently been reported as the leading cause for disability worldwide. The diagnostic value of imaging has been estimated low. Led by own positive experience, however, we hypothesized that MRI can detect signs of facet joint pain.Methods: 15 patients and 15 controls were retrospectively assessed by two readers. They compared deidentifi ed T2 weighted lumbar spine MRI scans. Facet joint size, shape, angle, joint space signal and degeneration were rated. Pain aetiology was proven with the diagnostic gold standard of medial branch blocks.Results: Facet joint angles and joint diameters were signifi cantly larger in symptomatic patients, who also showed signifi cantly higher grades of degeneration but no difference in joint space distances or shape or signal intensity.The readers were able to correctly identify symptomatic patients with good interrater reliability (kappa 0.5, sensitivity and specifi city 0.87-0.93), positive (LR+= 6.7-7.2) and negative likelihood ratios (LR-=0.15). Conclusions:Contrary to recent publications, we could demonstrate differences between asymptomatic and symptomatic subjects showing the latter to have larger joints and more signs of degeneration.One can conclude from the strong LR+ and LR-values that MRI is a useful investigation to rule in or rule out facet pain.

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“…It has been shown that increased angles might predispose to slippage and degeneration [8]. Our data show larger angles in symptomatic patients.…”

Section: Facet Joint Anglesupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Magnetic Resonance Imaging Can Detect Symptomatic Patients with Facet Joint Pain. A Retrospective Analysis

Freund¹,

Weber²,

Meier³

et al. 2017

J Clin Med Exp Images

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show abstract

“…Gao et al [12] showed in their study in 2012 on 156 patients that facet joint tropism was significantly greater in these patients compared with control subjects. In one of the largest studies in asia-pacific region by Samartzis et al [13] in 2016, assessing facet joint orientation in patients with spondylolisthesis, it was concluded that greater sagittal facet joint angulation was associated with L4-L5 spondylolisthesis.…”

Section: Discussionmentioning

confidence: 92%

Facet joint malorientation as a cause of disc degeneration and prolapse in cases with backache: A radiological analysis

Rajamanickam¹,

Pillappan²,

Devadass³

et al. 2018

Int. J. Orthop. Sci.

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Background: Facet tropism is defined as asymmetry between the left and right vertebral facet-joint angles, with one joint having a more sagittal orientation than the other. The goals of the present investigation were to examine the association between facet tropism and disc degeneration as well as disc herniation to determine the relationship between increased sagittal orientation of the facet joint. It is postulated that non-coherent movements of facets on either side leads to an altered biomechanical stress which has to be borne by the anterior structure that is the disc this leading to disc degeneration and earlier prolapse. Methods: Axial and sagittal sections of MRI of the L4 L5 levels of 49 symptomatic adults aged between 20 to 60 years has been taken and their disc degeneration was classified from the T1 and T2 weighted MRI scans and facet tropism was graded as Mild (6-10 degrees), Moderate (11-15 degrees), Severe (>15 degrees). Results: It was observed from our study that the greater the grades of disc degeneration was found in patients with higher degrees of mal-orientation. There is a 5.893 times risk of dis degeneration in the cases of malorientation of the facet joint. There was no significant difference between the male and female population with regard to face tropism as a risk factor for disc degeneration. Conclusion: In our present study the association between the facet tropism as a risk factor for degeneration is positively established. The alteration in the biomechanical forces in the cases of facet tropism thus has led to faster disc degeneration. Keywords: Facet tropism, disc degeneration, facet malorientation IntroductionFacet tropism is defined as asymmetry between the left and right vertebral (apophyseal) facet joint angle, with one joint having a more sagittal orientation than the other. For years, it has been postulated that this could result in inter-vertebral disc degeneration and herniation. The results of several studies concerning the association between the facet tropism and disc degeneration had been conflicting each other [1,2,3] . With magnetic resonance imaging, it is possible to obtain data on tropism of facet joints and measure facet joint angles and disc degeneration at the corresponding level can be obtained in symptomatic volunteers without the risk of ionising radiation and also reducing the cost of the study [4,5] . The goals of the present study were to examine the association between facet tropism and disc degeneration as well as disc herniation and to determine the relationship between increased sagittal orientation of the facet joint at the level of L4-L5 with the help of the axial and sagittal sections of MRI of the L4 L5 levels.

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“…Individuals with sagitally oriented facet joints have therefore been regarded as prone for development of DS. 2,8 Facet tropism is defined as asymmetry between left and right facet joint orientation, a difference of 8° or more is considered as tropism. 9 Recently, there have been multicentre studies 9,10 on this topic, however, the scope of these studies was limited by the fact that they did not include any control group without DS at any level.…”

Section: Introductionmentioning

confidence: 99%

A Radiological Study of the Association of Facet Joint Tropism and Facet Angulation With Degenerative Spondylolisthesis

Rai

Shah

et al. 2019

Neurospine

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Objective: To study the association of facet joint angulation and joint tropism with degenerative spondylolisthesis (DS) through a comparison with a matched control group. Methods: This radiographic study was carried out in 2 groups of 45 patients each. Group A contained patients with single-level DS, while group B (control) contained non-DS patients with similar age and degeneration who underwent surgery for disc prolapse or lumbar stenosis. DS was diagnosed based on translation of ≥ 3 mm on standing lateral radiography. Axial magnetic resonance imaging from L3 to S1 was utilized to assess the angulation of facet joints in relation to the coronal plane; a difference of ≥ 8° was considered to indicate tropism. Results: Among 45 patients with DS, 15 were males and 30 females. Their mean age was 62.2 years. Facet tropism was identified in 20 of 45 patients at the level of DS, 12 patients at a level proximal to DS, and 15 patients at a level distal to DS. Facet tropism was found in 7 of the 45 patients in group B. At L3-4, facet tropism was observed in 13 patients (28.88%) in group A and 2 (4.44%) in group B. At L4-5, tropism was observed in 19 patients (42.22%) in group A and 5 (11.11%) in group B. At L5-S1, tropism was seen in 17 patients (37.77%) in group A and 2 (4.44%) in group B. Group A showed a significantly higher prevalence of multilevel facet tropism and tropism at levels adjacent to the DS level. A higher average angulation of facet joints was observed in the DS group, but the difference was not statistically significant at all levels. Conclusion: The present study documented a statistically significant relationship between facet tropism and DS. A higher prevalence of facet tropism was also found in DS patients at non-DS levels, which is a novel observation. This finding supports the argument that facet tropism is a pre-existing morphological variation contributing to the development of DS, not a result of secondary remodelling.

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The Pedicle-facet Angle and Tropism in the Sagittal Plane in Degenerative Spondylolisthesis

Cited by 19 publications

References 22 publications

Magnetic Resonance Imaging Can Detect Symptomatic Patients with Facet Joint Pain. A Retrospective Analysis

Magnetic Resonance Imaging Can Detect Symptomatic Patients with Facet Joint Pain. A Retrospective Analysis

Facet joint malorientation as a cause of disc degeneration and prolapse in cases with backache: A radiological analysis

A Radiological Study of the Association of Facet Joint Tropism and Facet Angulation With Degenerative Spondylolisthesis

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