Lumbar Facet Orientation in Spondylolysis: A Skeletal Study

Spinal Research Laboratory, Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
Spine (Impact Factor: 2.3). 04/2007; 32(6):E176-80. DOI: 10.1097/01.brs.0000257565.41856.0f
Source: PubMed


Orientation of the lumbar articular facets at the L1-L5 level was measured and analyzed.
To characterize the relationship between lumbar facet orientation and isthmic spondylolysis.
Whereas many studies have explored the relationship between facet orientation in the transverse plane and various spinal pathologies, there is insufficient data regarding this relationship and isthmic spondylolysis.
A 3-dimensional digitizer was used to measure the transverse orientation of the lumbar facet joints at the L1-L5 level in 115 male individuals with bilateral isthmic spondylolysis (at L5) and 120 age and sex-matched normal control subjects from the Hamann-Todd Human Osteological Collection (Cleveland Museum of Natural History, Cleveland, OH). Statistical analysis included paired t tests and analysis of variance.
In both isthmic spondylolysis and control groups, considerable shifts were noticed from sagittally oriented articular facets at L1 to frontally oriented facets at L5. The change in orientation was significantly greater (up to 13 degrees at L4) in the isthmic spondylolysis group (right inferior facets). Three of the 4 articular facets of L5 (right and left inferior and right superior) were significantly more frontally oriented in isthmic spondylolysis compared to the control group. A greater tendency of asymmetry in facet orientation was noticed in the isthmic spondylolysis group.
Individuals with more frontally oriented facets in the lower lumbar vertebrae incorporated with facet tropism are at a greater risk for developing isthmic spondylolysis at L5.

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Available from: Deborah Alperovitch-Najenson, Sep 03, 2014
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    • "This indicates that FJ asymmetry is less common in sagittally oriented and more common in coronally oriented FJs, namely, the lower lumbar levels. Accordingly, Cassidy et al. [8] and Masharawi et al. [44] stated that FJ asymmetry is more commonly found in coronally oriented FJs. This may be explained by the increased load and degenerative changes at the lower lumbar spine [66], which may lead to uncontrolled changes of the FJs. "
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    ABSTRACT: We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years (P < 0.0001) as well as in 52% of females and 49% of males (P = 0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated with more coronal (increased degree) FJ orientation at L2/3 (P = 0.03) with a cutoff point at ≥32°. FJs were more coronally oriented (48.8°) in individuals ≤40 years and more sagittally oriented (45.6°) in individuals ≥41 years at L5/S1 (P = 0.01). Mean FJ asymmetry was 4.89° at L2/3, 6.01° at L3/4, 6.67° at L4/5, and 7.27° at L5/S1, without a significant difference for FJ arthritis. FJ arthritis is common, increases with age, and affects both genders equally. More coronally oriented FJs (≥32°) in the upper lumbar spine may be an individual risk factor for development of FJ arthritis.
    Full-text · Article · Oct 2013
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    • "[Color figure can be viewed in the online issue, which is available at] ertson and by Masharawi et al. (Masharawi et al., 2007b; Don and Robertson, 2008), but the significance of lumbar segmental lordosis, especially in lumbosacral spine, on spondylolysis had been set aside. As described by Ward and Latimer, human lumbar lordosis is closely related to facet configuration . "
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    ABSTRACT: The aim of this study is to reveal the association between lumbar spondylolysis and several radiologic parameters, which had been suggested to be significant. The authors examine interfacet distance (IFD), facet joint orientation (FJO), and lumbar segmental lordosis (LSL) all together on the basis of lumbar computed tomography (CT) scan of 35 patients with L5 spondylolysis and 36 unaffected control groups. Thirty-five Korean military recruits, aged 19-23 (mean 20.9 years), were diagnosed as L5 spondylolysis by lumber CT scans. As a control group, 36 male Korean military recruits, aged 18-25 (mean 21.3 years), were reconfirmed as not affected by lumbar spondylolysis by CT scan when they visited our hospital complaining of back pain. This study compares IFD, FJO, and LSL for each lumbar segment between the spondylolytic and unaffected groups. We also propose the use of normal mean data of IFD, FJO, and LSL of lumbar vertebrae from 36 Korean young military recruits because each measurement has power as an absolute value, like data from an osteologic collection in other studies. Comparison of IFD between spondylolytic and unaffected individuals reveals significant differences at the L3, L4, and L5 level (P = 0.0384, P = 0.0219, and P < 0.0001, respectively). In the group of spondylolysis, the increase of IFD from L4 to S1 was less pronounced (P < 0.0001) and the LSL at L5-S1 was more lordotic (P = 0.0203). Interfacet distance and lumbar lordosis were significantly different between patients with L5 spondylolysis and individuals without pars defect on L5. In the spondylolysis group, and the increase of IFD from L4 to S1 was less pronounced and the LSL at L5-S1 was more lordotic.
    Full-text · Article · Apr 2012 · Clinical Anatomy
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    • "These data are also unconfirmed by others as no gender effect on facet orientation has been found[5]. Furthermore, frontally oriented lumbar facets in females may be of an evolutionary disadvantage as it would increase the shearing stress on the pars interarticularis area[7]. If zygoapophyseal facets in females are more frontally oriented, a lower prevalence of spondylolisthesis would be expected in females than in males. "
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Full-text · Article · Sep 2010
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