The investigation of the role of the facet joint angle in the development of L5-S1 spondylolysis in young men

Characteristics of lumbar spondylolysis: L5 versus non-L5

BACKGROUND

Fifth lumbar vertebra (L5) spondylolysis has a lower bone union rate than non-L5 spondylolysis, but the reason for this is unknown. This study aimed to evaluate the differences in patient and lesion characteristics between L5 and non-L5 spondylolysis.

METHODS

A total of 410 patients with lumbar spondylolysis aged 18 years or younger who were treated conservatively were enrolled. Patients and lesions were divided into L5 and non-L5 (L2-L4) spondylolysis. Factors, including sex, age, presence of spina bifida occulta, stage of the main side lesion, whether the lesion was unilateral or bilateral, presence and stage of the contralateral side lesion and treatment duration, were evaluated at the first visit and compared between the two groups.

RESULTS

A total of 250 patients with 349 lesions were included. The bone union rate of L5 lesions was lower than that of non-L5 lesions (75% vs. 86%, p = 0.015). Patients with L5 spondylolysis were more likely to be male (86% vs. 66%) and younger (14.0 vs. 14.6 years) than patients with non-L5 spondylolysis. Lesions of L5 spondylolysis were more likely to be in a progressive stage (28% vs. 15%), less likely to be in a pre-lysis stage (28% vs. 43%) and more likely to be in a contralateral terminal stage (14% vs. 5.3%, p = 0.013) compared with lesions of non-L5 spondylolysis.

CONCLUSIONS

L5 spondylolysis was characterised by a lower bone union rate, more males, younger age, more progressive stage and more contralateral pseudarthrosis than non-L5 spondylolysis.

Evaluation the association of facet tropism in multi-sports athletes with cervical disc hernia

Background

Facet tropism (FT) can be defined as the angular difference between the orientation of the right and left facet joints in axial or sagittal planes. Most studies discuss about the relationship with lumbar disc hernia and facet joint angle. However, little is known about the association of facet tropism with disc herniation in the cervical spine in multisports athletes. In this study, We aimed to investigate the relationship between cervical facet tropism and disc hernia in athletes of different branches between the ages of 20–40 from the cervical MR images of the cases.

Methods

This is a retrospective study performed on athletes who applied our hospital between January 2014–2019 with neck pain and have MR imaging of the cervical spine. Cervical MR images of the patients were evaluated by an experienced radiologist from the hospital system database and archives. 79 cases (52 men and 27 women) were included in the study.

Results

No statistically significant difference was found between the facet joint angles of both groups at all levels (p˃0.05). Only left C6-7 disc angles of CDH group were measured as 92.99° ± 10.77⁰ (62⁰–113⁰) and 88.58° ± 7.65° (67°-110°) for the normal group and this difference was found statistically significant (p = 0.007).

Conclusion

In this study, we did not predict that cervical facet tropism may be a factor associated with cervical disc hernia in young athletes with CDH.

Impact of Concomitant Spinal Canal Stenosis on Clinical Presentation of Adult Onset Degenerative Lumbar Spondylolisthesis: A Study Combining Clinical and Imaging Spectrum

Aim Degenerative lumbar spondylolisthesis (DSL) is one of the reasons behind adult-onset backache due to degenerative spinal pathology. Clinical manifestations of this can range from asymptomatic patients to widely variable clinical signs and symptoms. Spinal canal stenosis (SCS) is the most common associated degenerative condition in the MRI of DSL. Moreover, other associated degenerative conditions may contribute significantly towards the clinical presentation. We have tried to assess the impact of SCS on the clinical symptomatology and presentation of the DSL by correlating the clinical and imaging findings. Methods This single-center prospective observational study has analysed 48 patients who were symptomatic due to DSL. The data was collected over a period of 18 months from January 2015 to June 2016 by screening through the adult patients presenting at the orthopaedic or spinal clinics with features suggestive of degenerative lumbar spine disease. Particular inclusion and exclusion criteria were developed as a screening tool and selected patients underwent imaging investigations. Patients had lumbar spine radiographs, both standing and flexion-extension view, and MRI of the lumbar spine. The presenting clinical features were documented. Their clinical and neurological assessment was done thoroughly by two qualified clinicians independently. Results The study population included 29 female (60.5%) and 19 male (39.5%) patients. The mean age of the study population was 49.5 years (SD 9.2 years). As per the radiological diagnostic criteria, 28 patients (58.3%) had features of SCS together with DSL and the rest of the 20 patients (41.7%) had DSL without SCS. Axial back pain and claudication had a statistically significant association with imaging findings. Similarly, patients with associated canal stenosis had statistically significant sensory and motor deficits, altered deep tendon reflexes. Facet joint angle more than 45 degrees at the level of the slip had a higher incidence of indicative presenting symptoms. However, this was not statistically proven. Conclusion DSL is a heterogeneous condition with the simultaneous presence of different degenerative processes in the lumbar spine at various stages. Hence, clinical presentations are widely variable. The concomitant presence of SCS significantly influences the clinical symptomatology with correlation to the MRI findings. Therefore, a judicious weighing of the clinical and imaging findings is crucial for prudent management planning for cases of DSL.

Facet Tropism in Lumbar Spine and Cervical Spine: A Systematic Review and Meta-Analysis

BACKGROUND

Facet tropism (FT) refers to the difference in the orientation of facet joints with respect to each other in the sagittal plane. FT leads to unequal biomechanical forces on facet joint and intervertebral disc during rotation and other physiologic movements. Most of the studies have reported the incidence of FT in the lumbar spine to vary between 40% and 70%, with L4-5 level being the most commonly afflicted level. The objective of this study was to find the association between FT and various lumbar and cervical degenerative disorders.

METHODS

A systematic search of PubMed was performed with the keywords "facet tropism" and "facet asymmetry." Data for meta-analysis were extracted from the studies to obtain pooled impact of FT on lumbar disc herniation (LDH) and lumbar degenerative spondylolisthesis (LDS).

RESULTS

Eighty-two articles were included in the systematic review and 18 studies had the required data to be included in the meta-analysis. The pooled standard mean difference between FT angles in patients with or without LDH was 0.31 with (P = 0.04). The pooled odds ratio for FT in patients with LDH was 3.27 with (P = 0.02). Subgroup analysis showed that there is no significant difference in the L3/4, L4/5, and L5S1 subgroups. The pooled standard mean difference between FT angles in patients with or without LDS was 0.54 (P = 0.009).

CONCLUSIONS

FT is significantly associated with LDH and LDS along with various other lumbar and cervical degenerative diseases.