CORRELATION OF LUMBAR FACET JOINT DEGENERATION AND SPINE-PELVIC SAGITTAL BALANCE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LÜXin ¹ , ZHANGBin ² , LIUYuan ² ,  DAIMin ^1,2

1. Medical Department of Nanchang University, Nanchang Jiangxi, 330006, P. R. China;
2. Department of Orthopedics, the First Affiliated Hospital of Nanchang University Nanchang Jiangxi, 330006, P. R. China;

Corresponding author：

DAIMin, Email: daimin@medmail.com

Keywords：

Spinepelvic sagittal balance; Facet joint degeneration; Lumbar vertebrae; Pelvic incidence

DOI：

10.7507/1002-1892.20150208

Video：

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Objective To investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. Methods A retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3, 4 in 32 cases, L4, 5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was 1ess than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared;according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. Results At L4, 5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P<0.05), more serious facet joint degeneration was observed in group C;no significant difference was found in facet joint degeneration at L3, 4 (P>0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P>0.05) except for PT (P<0.05). Conclusion PI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4, 5 and L5, S1;PT and PI are significantly associated with facet joint degeneration at the lower lumbar spine.

Citation： LÜXin, ZHANGBin, LIUYuan, DAIMin. CORRELATION OF LUMBAR FACET JOINT DEGENERATION AND SPINE-PELVIC SAGITTAL BALANCE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 964-968. doi: 10.7507/1002-1892.20150208 Copy

1.	Barrey C,Jund J,Noseda O,et al.Sagittal balance of the pelvisspine complex and lumbar degenerative diseases.A comparative study about 85 cases.Eur Spine J,2007,16(9):1459-1467.
2.	Kirkaldy-Willis WH,Farfan FH.Instability of the lumbar spine.Clin Orthop Relat Res,1982,(165):110-123.
3.	刘辉,希腊本大,郑召民,等.腰椎间盘退变与脊柱-骨盆矢状面平衡的相关性.中华医学杂志,2013,93(15):1123-1128.
4.	Pathria M,Sartoris DJ,Resnick D.Osteoarthritis of the facet joints:accuracy of oblique radiographic assessment.Radiology,1987,164(1):227-230.
5.	李危石,孙卓然,陈仲强.正常脊柱-骨盆矢状位参数的影像学研究.中华骨科杂志,2013,33(5):447-453.
6.	Newman PH.Spondylolisthesis,its cause and effect.Ann R Coll Surg Engl,1955,16(5):305-323.
7.	Robertson PA,Grobler LJ,Novotny JE,et al.Postoperative spondylolisthesis at L4-5.The role of facet joint morphology.Spine (Phila Pa 1976),1993,18(11):1483-1490.
8.	Boden SD,Riew KD,Yamaguchi K,et al.Orientation of the lumbar facet joints:association with degenerative disc disease.J Bone Joint Surg (Am),1996,78(3):403-411.
9.	Tanno I,Murakami G,Oguma H,et al.Morphometry of the lumbar zygapophyseal facet cap sule and cartilage with special reference to degenerative osteoarthritic changes:an anatomical study using fresh cadavers of elderly Japanese and Korean subjects.J Orthop Sci,2004,9(5):468-477.
10.	Barrey C,Roussouly P,Perrin G,et al.Sagittal balance disorders in severe degenerative spine.Can we identify the compensatory mechanisms? Eur Spine J,2011,20 Suppl 5:626-633.
11.	Roussouly P,Nnadi C.Sagittal plane deformity:an overview of interpretation and management.Eur Spine J,2011,19(11):1824-1836.
12.	Legaye J,Duval-Beaupère G.Sagittal plane alignment of the spine and gravity:a radiological and clinical evaluation.Acta Orthop Belg,2005,71(2):213-220.
13.	Boulay C,Tardieu C,Hecquet J,et al.Sagittal alignment of spine and pelvis regulated by pelvic incidence:standard values and prediction of lordosis.Eur Spine J,2006,15(4):415-422.
14.	Mangione P,Gomez D,Senegas J.Study of the course of the incidence angle during growth.Eur Spine J,1997,6(3):163-167.
15.	Jentzsch T,Geiger J,Bouaicha S,et al.Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine.BMC Med Imaging,2013,13:34.
16.	Jentzsch T,Geiger J,König MA,et al.Hyperlordosis is associated with facet joint pathology at the lower lumbar spine.J Spinal Disord Tech,2013.[Epub ahead of print].
17.	郭世绂.临床骨科解剖学.天津:天津科技出版社,1984:185-212.
18.	赵耀,李淳德,孙浩林.脊柱矢状位平衡的影像学参数及分型的研究进展.中国脊柱脊髓杂志,2012,22(7):651-655.
19.	Peleg S,Dar G,Steinberg N,et al.Sacral orientation and spondylolysis.Spine (Phila Pa 1976),2009,34(25):E906-910.
20.	Natarajan RN,Lavender SA,An HA,et al.Biomechanical response of a lumbar intervertebral disc to manual lifting activities:a poroelastic finite element model study.Spine (Phila Pa 1976),2008,33(18):1958-1965.
21.	Nagaosa Y,Kikuchi S,Hasue M,et al.Pathoanatomic mechanisms of degenerative spondylolisthesis:a radiographic study.Spine (Phila Pa 1976),1998,23(13):1447-1451.
22.	Margulies JY,Payzer A,Nyska M,et al.The relationship between degenerative changes and osteoporosis in the lumbar spine.Clin Orthop Relat Res,1996,(324):145-152.
23.	Dunlop RB,Adams MA,Hutton WC.Disc space narrowing and the lumbar facet joints.J Bone Joint Surg (Br),1984,66(5):706-710.
24.	Haher TR,O'Brien M,Dryer JW,et al.The role of the lumbar facet joints in spinal stability.Identification of alternative paths of loading.Spine (Phila Pa 1976),1994,19(23):2667-2670.
25.	Schwarzer AC,Wang SC,Bogduk N,et al.Prevalence and clinical features of lumbar zygapphysial joint pain:a study in Australian population with chronic low back.Ann Rheum Dis,1995,54(2):100-106.
26.	van Schaik JP.Lumbar facet joint morphology.Spinal Disord,2000,13(1):88-89.
27.	Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a quantitative radiographic and clinical analysis.Spine (Phila Pa 1976),2002,27(4):387-392.

1. Barrey C,Jund J,Noseda O,et al.Sagittal balance of the pelvisspine complex and lumbar degenerative diseases.A comparative study about 85 cases.Eur Spine J,2007,16(9):1459-1467.
2. Kirkaldy-Willis WH,Farfan FH.Instability of the lumbar spine.Clin Orthop Relat Res,1982,(165):110-123.
3. 刘辉,希腊本大,郑召民,等.腰椎间盘退变与脊柱-骨盆矢状面平衡的相关性.中华医学杂志,2013,93(15):1123-1128.
4. Pathria M,Sartoris DJ,Resnick D.Osteoarthritis of the facet joints:accuracy of oblique radiographic assessment.Radiology,1987,164(1):227-230.
5. 李危石,孙卓然,陈仲强.正常脊柱-骨盆矢状位参数的影像学研究.中华骨科杂志,2013,33(5):447-453.
6. Newman PH.Spondylolisthesis,its cause and effect.Ann R Coll Surg Engl,1955,16(5):305-323.
7. Robertson PA,Grobler LJ,Novotny JE,et al.Postoperative spondylolisthesis at L4-5.The role of facet joint morphology.Spine (Phila Pa 1976),1993,18(11):1483-1490.
8. Boden SD,Riew KD,Yamaguchi K,et al.Orientation of the lumbar facet joints:association with degenerative disc disease.J Bone Joint Surg (Am),1996,78(3):403-411.
9. Tanno I,Murakami G,Oguma H,et al.Morphometry of the lumbar zygapophyseal facet cap sule and cartilage with special reference to degenerative osteoarthritic changes:an anatomical study using fresh cadavers of elderly Japanese and Korean subjects.J Orthop Sci,2004,9(5):468-477.
10. Barrey C,Roussouly P,Perrin G,et al.Sagittal balance disorders in severe degenerative spine.Can we identify the compensatory mechanisms? Eur Spine J,2011,20 Suppl 5:626-633.
11. Roussouly P,Nnadi C.Sagittal plane deformity:an overview of interpretation and management.Eur Spine J,2011,19(11):1824-1836.
12. Legaye J,Duval-Beaupère G.Sagittal plane alignment of the spine and gravity:a radiological and clinical evaluation.Acta Orthop Belg,2005,71(2):213-220.
13. Boulay C,Tardieu C,Hecquet J,et al.Sagittal alignment of spine and pelvis regulated by pelvic incidence:standard values and prediction of lordosis.Eur Spine J,2006,15(4):415-422.
14. Mangione P,Gomez D,Senegas J.Study of the course of the incidence angle during growth.Eur Spine J,1997,6(3):163-167.
15. Jentzsch T,Geiger J,Bouaicha S,et al.Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine.BMC Med Imaging,2013,13:34.
16. Jentzsch T,Geiger J,König MA,et al.Hyperlordosis is associated with facet joint pathology at the lower lumbar spine.J Spinal Disord Tech,2013.[Epub ahead of print].
17. 郭世绂.临床骨科解剖学.天津:天津科技出版社,1984:185-212.
18. 赵耀,李淳德,孙浩林.脊柱矢状位平衡的影像学参数及分型的研究进展.中国脊柱脊髓杂志,2012,22(7):651-655.
19. Peleg S,Dar G,Steinberg N,et al.Sacral orientation and spondylolysis.Spine (Phila Pa 1976),2009,34(25):E906-910.
20. Natarajan RN,Lavender SA,An HA,et al.Biomechanical response of a lumbar intervertebral disc to manual lifting activities:a poroelastic finite element model study.Spine (Phila Pa 1976),2008,33(18):1958-1965.
21. Nagaosa Y,Kikuchi S,Hasue M,et al.Pathoanatomic mechanisms of degenerative spondylolisthesis:a radiographic study.Spine (Phila Pa 1976),1998,23(13):1447-1451.
22. Margulies JY,Payzer A,Nyska M,et al.The relationship between degenerative changes and osteoporosis in the lumbar spine.Clin Orthop Relat Res,1996,(324):145-152.
23. Dunlop RB,Adams MA,Hutton WC.Disc space narrowing and the lumbar facet joints.J Bone Joint Surg (Br),1984,66(5):706-710.
24. Haher TR,O'Brien M,Dryer JW,et al.The role of the lumbar facet joints in spinal stability.Identification of alternative paths of loading.Spine (Phila Pa 1976),1994,19(23):2667-2670.
25. Schwarzer AC,Wang SC,Bogduk N,et al.Prevalence and clinical features of lumbar zygapphysial joint pain:a study in Australian population with chronic low back.Ann Rheum Dis,1995,54(2):100-106.
26. van Schaik JP.Lumbar facet joint morphology.Spinal Disord,2000,13(1):88-89.
27. Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a quantitative radiographic and clinical analysis.Spine (Phila Pa 1976),2002,27(4):387-392.

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CORRELATION OF LUMBAR FACET JOINT DEGENERATION AND SPINE-PELVIC SAGITTAL BALANCE

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