Prevalence of Facet Effusion and Its Relationship with Lumbar Spondylolisthesis and Low Back Pain: The Wakayama Spine Study

Kazunori Shinto; Akihito Minamide; Hiroshi Hashizume; Hiroyuki Oka; Ko Matsudaira; Hiroki Iwahashi; Yuyu Ishimoto; Masatoshi Teraguchi; Ryohei Kagotani; Yoshiki Asai; Shigeyuki Muraki; Toru Akune; Sakae Tanaka; Hiroshi Kawaguchi; Kozo Nakamura; Munehito Yoshida; Noriko Yoshimura; Hiroshi Yamada

doi:10.2147/JPR.S227153

Prevalence of Facet Effusion and Its Relationship with Lumbar Spondylolisthesis and Low Back Pain: The Wakayama Spine Study

J Pain Res. 2019 Dec 31:12:3521-3528. doi: 10.2147/JPR.S227153. eCollection 2019.

Authors

Kazunori Shinto¹, Akihito Minamide¹, Hiroshi Hashizume¹, Hiroyuki Oka², Ko Matsudaira², Hiroki Iwahashi¹, Yuyu Ishimoto¹, Masatoshi Teraguchi¹, Ryohei Kagotani¹, Yoshiki Asai¹, Shigeyuki Muraki³, Toru Akune⁴, Sakae Tanaka⁵, Hiroshi Kawaguchi⁶, Kozo Nakamura⁷, Munehito Yoshida^{1

8}, Noriko Yoshimura^#³, Hiroshi Yamada^#¹

Affiliations

¹ Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan.
² Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
³ Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
⁴ National Rehabilitation Center for Persons with Disabilities, Tokorozawa City, Saitama, Japan.
⁵ Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
⁶ Tokyo Neurological Center, Minato-ku, Tokyo, Japan.
⁷ Towa Hospital, Adachi-ku, Tokyo, Japan.
⁸ Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama City, Wakayama, Japan.

^# Contributed equally.

Abstract

Introduction: Facet effusion represents a magnetic resonance imaging finding suggesting accumulation of fluid in the facet joint, potentially predictive of lumbar spondylolisthesis and low back pain. However, its prevalence and epidemiological characteristics in the general population remain unclear, because previous studies only included patients or volunteers. The aim of the present study was to investigate the prevalence of facet effusion in the general population and to describe its potential relationship with spondylolisthesis and low back pain.

Material and methods: Our study enrolled 808 participants from the Wakayama Spine Study who underwent magnetic resonance imaging investigations in supine position. Facet effusion was defined as a measurable, curvilinear, high-intensity signal within the facet joint, closely matching that of cerebrospinal fluid on the axial T2 images. We used standing lateral radiographs to diagnose L4 spondylolisthesis.

Results: We found that the prevalence of facet effusion in the lumbar spine was 34.3%, which did not differ significantly between men and women (p=0.13) and did not tend to increase with age, either in men (p=0.81) or in women (p=0.65). Additionally, we found no significant association between facet effusion and low back pain (odds ratio, 1.04-1.49; 95% confidence interval, 0.57-2.64; p=0.17-0.85), or between facet effusion and L4 spondylolisthesis (odds ratio, 1.55; 95% confidence interval, 0.80-2.86; p=0.17). In a subset of participants with L4 spondylolisthesis, we also noted that facet effusion was not significantly associated with low back pain (odds ratio, 1.26; 95% confidence interval, 0.37-4.27; p=0.70).

Discussion: This is the first study of facet effusion employing a population-based cohort, and the findings are thus expected to accurately describe the relationship between facet effusion and low back pain in the general population. We are planning a follow-up survey of the Wakayama Spine Study cohort to clarify the natural history of facet effusion and its relationship with clinical symptoms.

Keywords: epidemiology; facet effusion; low back pain; lumbar spine; spondylolisthesis.

Grants and funding

This study was supported by H23-Choujyu-002 (Director, TA), H-25-Choujyu-007 (Director, NY), H25-Nanchitou (Men)-005 (Director, ST), 201417014A (Director, NY), and H22-Choujyu-Wakate-007 (Director, SM) from the Ministry of Health, Labour and Welfare, URL:http://www.mhlw.go.jp/; a Grant-in-Aid for Scientific Research (B26293139, B23390172 to NY, B2629333, C20591774 to SM, C26462249 to HH, C25462305 to HY) and a Grant-in-Aid for Young Researcher (B25860448 to YI, B26861286 to MT, B26860419 to RK), and Grant-in-Aid for Challenging Exploratory Research (15K15219 to NY, 26670307 to SM, 24659666 to HO, 25670293 to TA) of JSPS KAKENHI grant, URL:https://www.jsps.go.jp/j-grantsinaid/; a Grant from the Japanese Orthopaedics and Traumatology Foundation, Inc. (No. 287) to MT, URL:http://jotf.jp/invitation.html; and Collaborating Research with NSF 08033011-00262 (Director, NY) from the Ministry of Education, Culture, Sports, Science and Technology in Japan, URL:http://www.mext.go.jp/english/. This study also was supported by grants from the Japan Osteoporosis Society (NY, SM, HO, and TA), URL:http://www.josteo.com/ja/index.html, a grant from JA Kyosai Research Institute (HO), URL:http://www.jkri.or.jp/, grants from Mitsui Sumitomo Insurance Welfare Foundation (SM), URL:http://www.ms-ins.com/welfare/index.htm, and research aid from the Japanese Orthopaedic Association (JOA-Subsidized Science Project Research 2006-1 & 2010-2; Director, HK), URL:https://www.joa.or.jp/english/english_frame.html. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.