The Value of Computerized Tomography in Determining Lumbar Facet Joint Orientation

Gunzburg, Robert; Sandhu, Avninder; Fraser, Robert D.

doi:10.1097/00002517-198909000-00004

Cited by 18 publications

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“…The measurement of facet joint orientation on axial CT scans has been shown to be accurate and can be reproduced [14]. Using this method, several investigators have assessed the orientation of lumbar facet joints in patients with DS [12,17,22,29].…”

Section: Discussionmentioning

confidence: 99%

Predisposing factors in degenerative spondylolisthesis

Cinotti¹,

Postacchini

Fassari

et al. 1997

International Orthopaedics

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Summary. We report a prospective study analysing whether possible factors predisposing to degenerative spondylolisthesis (DS) must be present concomitantly in order to cause vertebral slipping. Standard and flexion-extension radiographs were obtained from 27 patients with DS and 27 without spondylolisthesis. The level of the intercrestal line, the lumbosacral angle, the presence of sacralization of L5 and vertebral motion at the L4 ± L5 level were assessed. Facet joint orientations were measured on CT scans. Only facet joint orientation and vertebral motion at the spondylolisthetic level were significantly different in patients with DS compared with controls. Facet joints were oriented more sagittally both at the spondylolisthetic level and at the levels above and below. An inverse linear correlation was found between the sagittal orientation of facet joints and the mobility of the slipped vertebra. Abnormal sagittal orientation of facet joints and hypermobility of the spondylolisthetic vertebra appear to play major roles among possible factors predisposing to DS. Both factors should be considered in the planning of surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Predisposing factors in degenerative spondylolisthesis

Cinotti¹,

Postacchini

Fassari

et al. 1997

International Orthopaedics

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“…All measurements were taken twice by the principal author, and their average was used for further analysis. No attempt was made to assess intra-or interobserver variability, as these have been shown to be insignificant [11].…”

Section: Group Dmentioning

confidence: 99%

Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism

Berlemann

Jeszenszky

Bühler

et al. 1998

European Spine Journal

103

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IntroductionSeveral studies have attempted to define etiological factors for the development of degenerative spondylolisthesis (DS), and the orientation of lumbar facet angles relative to the transverse plane has been a major focus of interest. The facet joints play a critical role in maintaining stability of the lumbar spine by sharing load in compression and extension, and protecting the disc from excessive shear and rotational forces [1,13,24]. Determined by their spatial orientation, they also guide motion between two adjacent vertebrae. Their oblique orientation in the lumbar spine allows flexion, extension, and lateral bending, but only a small amount of axial rotation [27].It has been shown that in patients with DS, the facet joints are significantly more sagittally oriented, thus allowing the superior vertebra to glide anteriorly. Individuals with sagittally oriented facet joints have therefore been regarded as candidates for DS [23]. However, it is not clear whether this more pronounced sagittal orientation of the facet joint represents a pre-existing morphology or whether it has to be considered a result of secondary remodeling.Facet joint asymmetry (tropism) has been claimed to be related to disc herniation and degenerative disc disease due to rotational instability of the spinal segment [6,8,20]. Whether facet joint tropism plays a role in the development of DS, however, has not been investigated.The present study analyzed facet joint orientation in the transverse plane in patients with DS and compared this to patients with no evidence of ventrolisthesis from three different age groups. The working hypothesis was that if the more sagittal orientation in DS was a pre-existing anatomical feature, it then should be possible to identify a younger patient group being "at risk" for the development of DS later in life. The incidence of facet joint tropism in the different groups was also investigated.Abstract This study analyzed transverse facet joint angulations at the three lower lumbar levels in 132 patients assigned to one of four groups. Group A comprised 23 patients with degenerative spondylolisthesis (DS) at the level L4-5, group B comprised 40 patients above the age of 50 years, group C comprised 38 patients aged between 35 and 50 years, and group D comprised 31 patients under the age of 35 years. Groups B, C, and D had no evidence of DS. Measurements were taken from hard copies of axial MR or CT images. The transverse plane of facet joints was more sagittally oriented in group A than in any other group. This difference was highly significant at the L4-5 level. The incidence of more sagittally oriented L4-5 facet joints was also significantly higher only in group A. The incidence of facet joint tropism, however, was not different in group A. These results support the view that the pronounced sagittal alignment of facet joints in patients with DS represents a secondary remodeling rather than a pre-existing morphology. Facet joint asymmetry does not seem to play a major role in the development of DS.

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“…There was a statistically significant difference in mean facet joint angles for type 1 (27.2°) against types 2 (46.4°) and 3 (48.1°) at L5/S1 and for types 1 (33.3°) and 2 (33.5°) against type 3 (46.2°) at L4/L5, showing that a more frontal facet joint orientation (less than 45°) promotes flexion in the two lowest lumbar levels of the spine. Since one single examiner studied facet joint obliquity, we suppose there is sufficient reliability of the data, because Gunzburg et al found no significant difference in repeated measurements from lumbar spine computed tomography (CT) scans [2].…”

Section: Discussionmentioning

confidence: 99%

Functional MRI of the spine: different patterns of positions of the forward flexed lumbar spine in healthy subjects

König

Vitzthum

2001

Eur Spine J

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IntroductionImaging of the flexed and extended spine has been carried out since the first half of the 20th century using lateral radiographs [3,8]. With this technique, the examined subject is exposed to ionizing radiation with no assessment of soft tissues or axial plane imaging. Magnetic resonance imaging (MRI) provides excellent anatomical details in all planes without exposure to ionizing radiation. In the past, restrictions existed for functional lumbar spinal imaging, because of the systems' configuration. With the development of open MR scanners this problem has been partly overcome [4,6,9]. Because of ongoing developments and improvements in image quality, it is possible to reduce motion artifacts by decreasing acquisition time. Although functional MRI of the lumbar spine is not yet a standard diagnostic procedure, in the future it is likely to be used for diagnostic entities such as discoligamentous instability or position-dependent spinal stenosis.To assess pathological findings by a new diagnostic method, it is necessary first to investigate physiological conditions. The purpose of this study was to establish the best setup for MRI of the forward flexed lumbar spine, describe the findings in a group of asymptomatic subjects and correlate them with the orientation of the facet joints.Abstract Since the introduction of the technique of vertical open-configuration systems, efforts have been made to obtain functional lumbar spinal magnetic resonance (MR) images. The purpose of this study was to determine the relation between facet joint orientation and flexion patterns in the lower lumbar spine. Thirty-four normal subjects (18 women, 16 men) were examined in a vertical open 0.5-T MR scanner with T1-weighted gradient echo (GE) sequences. Flexion angles were digitally measured in the sagittal plane and facet joint orientation in the axial plane. The population showed three different functional flexion patterns: 17.6% (n=6) had kyphotic angles in all three lower lumbar levels during forward flexion (type 1), 50% (n=17) had a lordotic angle at L5/S1 but kyphotic angles at L4/L5 and L3/L4 (type 2), and 32.4% (n=11) showed lordotic angles at L5/S1 and L4/L5 but a kyphotic angle at L3/L4 (type 3). There were statistically significant differences between flexion patterns and mean facet joint orientation: at L4/L5 33.3°for type 1, 33.5°f or type 2 and 46.2°for type 3; at L5/S1 27.2°for type 1, 46.4°for type 2 and 48.1°for type 3. There were no significant differences between the three groups at L3/L4. The three different flexion patterns in normal subjects and their relation to facet joint orientation have not been described previously. Knowledge of these patterns may lead to a better understanding of physiological spinal movement as a base for future investigations in low back pain patients.

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The Value of Computerized Tomography in Determining Lumbar Facet Joint Orientation

Cited by 18 publications

References 0 publications

Predisposing factors in degenerative spondylolisthesis

Predisposing factors in degenerative spondylolisthesis

Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism

Functional MRI of the spine: different patterns of positions of the forward flexed lumbar spine in healthy subjects

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