Abstract
ABSTRACT Objective To evaluate facet joint degeneration following surgical treatment in patients with lumbar disc herniation, seeking to correlate it with possible determining factors. Methods Cross-sectional observational study, which analyzed medical records, radiographs and magnetic resonance images of 287 patients with lumbar disc herniation treated surgically at the Spine Surgery Service of the Hospital Ortopédico de Passo Fundo. Information about age and sex was collected. In the imaging exams, the following variables were evaluated: facet joint angulation and its tropism, measured by the Karacan method, sacral slope and lumbar lordosis, measured by the Cobb method, arthrosis of the interfacetary joints, measured by the Weishaupt classification, and intervertebral disc degeneration, measured by the Pfirrmann classification. Results A statistically significant relationship was observed between facet joint degeneration and age (p = 0.002), and also between facet joint degeneration and sacral slope (p = 0.038). No correlation was found between facet joint degeneration and lumbar lordosis (p = 0.934). It was found that the most degenerated facet joints were those that had the greatest facet joint asymmetry (tropism). However, the mean degree of facet tropism did not increase homogeneously with the progression of the joint degeneration score (p = 0.380). Conclusion It was verified that there are, in fact, a multiplicity of factors related to the degree of facet joint degeneration in the low lumbar spine. Additional studies, correlated with the asymmetry of the facet joints, would be important to elucidate better preventive management of this degeneration, aiming to avert secondary low back pain and sciatica with advancing age. Level of evidence II; Retrospective study.
Highlights
Low back pain is a frequent symptom, affecting 80% of adults at some time during their lives
It was verified that there are, a multiplicity of factors related to the degree of facet joint degeneration in the low lumbar spine
Sacral slope and lumbar lordosis are factors that vary from individual to individual and cause biomechanical changes in the load axis of the lumbar spine.[9]
Summary
Low back pain is a frequent symptom, affecting 80% of adults at some time during their lives It is one of the ten main causes for consultations and each year is the reason that 5 to 10% of workers are absent from their jobs for more than seven days.[1] Disc herniation is the degenerative disease that leads to the highest number of spinal surgeries in adults.[2] This lesion can occur in any age group, but is most prevalent between 40 and 50 years of age. The spine is the main body support axis for the trunk and appendicular limbs, resisting the forces of compression, anteriorly, and tension, posteriorly While this structure, formed by a complex group of osseous and discoligamentary structures, is axially very resistant, it enables important mobility for the execution of multiple movements of flexion-extension, lateralization, and rotation.[4,5] Each vertebral segment contains a triarticular complex, composed of the intervertebral disc and the paired, bilateral facet joints. Sacral slope and lumbar lordosis are factors that vary from individual to individual and cause biomechanical changes in the load axis of the lumbar spine.[9]
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