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Global Spine J. 2016 Aug;6(5):414-21. doi: 10.1055/s-0035-1564417. Epub 2015 Oct 26.

Critical Values of Facet Joint Angulation and Tropism in the Development of Lumbar Degenerative Spondylolisthesis: An International, Large-Scale Multicenter Study by the AOSpine Asia Pacific Research Collaboration Consortium.

Author information

1
Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.
2
Department of Orthopaedics, Ganga Hospital, Coimbatore, India.
3
Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan.
4
Department of Orthopedics, Sir Gangaram Hospital, New Delhi, India.
5
Spine Center, Wakayama Medical University, Kihoku Hospital, Ito-gun, Japan.
6
Department of Spine Surgery, Eniwa Hospital, Hokkaido Japan.
7
Orthopaedic Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
8
Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea.
9
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
10
Department of Orthopaedic Surgery, Khonkaen Regional Hospital, Khonkean, Thailand.
11
Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
12
Department of Neurosurgery, Gangnam Severance Hospital, Seoul, South Korea.
13
Department of Spine Surgery, The First Hospital Affiliated of Zhongshan University, Guangzhou, China.
14
Department of Orthopedics, Cebu Orthopaedic Institute, Cebu, Philippines.
15
Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
16
Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
17
Department of Neurosurgery, College of Medicine, Soon Chun Hyang Unviersity Bucheon Hospital, Bucheon, South Korea.
18
Department of Orthopaedic and Traumatology, Faculty of Medicine Airlargga University, Dr. Soetomo Teaching Hospital, Surabaya, Indonesia.
19
Department of Orthopaedics, Deenanath Mangeshkar Hospital, Jehangir Hospital, Pune, India.
20
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
21
Department of Orthopaedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
22
Department of Orthopedics, Phramongkuthklao Army Hospital, Bangkok, Thailand.
23
Dwaraka Institute of Spine Care, Bellary, India.
24
Department of Orthopedics and Trauma Surgery, Spine Unit, Tribhuvan University, Teaching Hospital, Kathmandu, Nepal.
25
Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
26
Department of Orthopaedic Surgery, Niigata City General Hospital, Niigata, Japan.
27
Department of Orthopaedic Surgery, Beijing 361 Hospital (Aviation General Hospital), Beijing, China.
28
Department of Orthopedics, Kasturba Medical College, Manipal University, Mangalore, India.
29
Department of Neurosurgery, Fortis Hospital, Kolkata, India.
30
Orthopaedic and Traumatology Department, University of Indonesia/RS Ciptomangunkusumo, Jakarta, Indonesia.
31
Neurosciences Division, Park Clinic, Kolkata, India.
32
Department of Orthopedic, Punjab Institute of Medical Sciences Jalandhar, Jalandhar, India.
33
Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia.

Abstract

STUDY DESIGN:

An international, multicenter cross-sectional image-based study performed in 33 institutions in the Asia Pacific region.

OBJECTIVE:

The study addressed the role of facet joint angulation and tropism in relation to L4-L5 degenerative spondylolisthesis (DS).

METHODS:

The study included 349 patients (63% females; mean age: 61.8 years) with single-level DS; 82 had no L4-L5 DS (group A) and 267 had L4-L5 DS (group B). Axial computed tomography and magnetic resonance imaging were utilized to assess facet joint angulations and tropism (i.e., asymmetry between facet joint angulations) between groups.

RESULTS:

There was a statistically significant difference between group A (left mean: 46.1 degrees; right mean: 48.2 degrees) and group B (left mean: 55.4 degrees; right mean: 57.5 degrees) in relation to bilateral L4-L5 facet joint angulations (p < 0.001). The mean bilateral angulation difference was 7.4 and 9.6 degrees in groups A and B, respectively (p = 0.025). A critical value of 58 degrees or greater significantly increased the likelihood of DS if unilateral (adjusted OR: 2.5; 95% CI: 1.2 to 5.5; p = 0.021) or bilateral facets (adjusted OR: 5.9; 95% CI: 2.7 to 13.2; p < 0.001) were involved. Facet joint tropism was found to be relevant between 16 and 24 degrees angulation difference (adjusted OR: 5.6; 95% CI: 1.2 to 26.1; p = 0.027).

CONCLUSIONS:

In one of the largest studies assessing facet joint orientation in patients with DS, greater sagittal facet joint angulation was associated with L4-L5 DS, with a critical value of 58 degrees or greater increasing the likelihood of the condition for unilateral and bilateral facet joint involvement. Specific facet joint tropism categories were noted to be associated with DS.

KEYWORDS:

AOSpine; angulation; degenerative; facet; joints; orientation; spondylolisthesis; tropism

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