Abstract
We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years (P < 0.0001) as well as in 52% of females and 49% of males (P = 0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated with more coronal (increased degree) FJ orientation at L2/3 (P = 0.03) with a cutoff point at ≥32°. FJs were more coronally oriented (48.8°) in individuals ≤40 years and more sagittally oriented (45.6°) in individuals ≥41 years at L5/S1 (P = 0.01). Mean FJ asymmetry was 4.89° at L2/3, 6.01° at L3/4, 6.67° at L4/5, and 7.27° at L5/S1, without a significant difference for FJ arthritis. FJ arthritis is common, increases with age, and affects both genders equally. More coronally oriented FJs (≥32°) in the upper lumbar spine may be an individual risk factor for development of FJ arthritis.
Highlights
A functional spinal unit consists of anteriorly located adjacent vertebrae separated by an intervertebral disc and posteriorly located facet joints (FJ) [1]
Our study investigated one of the largest samples of CT scans with regard to facet (zygapophyseal) joints (FJ) arthritis in the literature
As hypothesized we were able to show that (1) radiological appearance of FJ arthritis is a very common entity, affecting nearly half of all individuals, (2) increases with age, (3) does not display gender predilection, (4) was significantly associated with coronal, that is, increased degree of FJ orientation at L2/3, and (5) is not correlated with FJ asymmetry
Summary
A functional spinal unit consists of anteriorly located adjacent vertebrae separated by an intervertebral disc and posteriorly located facet (zygapophyseal) joints (FJ) [1]. Being synovial-lined, diarthrodial, and freely moveable functional units, they transmit shear forces and help the intervertebral discs in carrying about 16% of the vertical load [3, 4]. Even though etiologies of low back pain are multifactorial [11], FJ arthritis is common and affects at least 50% of the population [12]. After Ghormley [13] first described a facet syndrome in 1933, there has been an ongoing debate [14, 15] about the possible association low back pain and FJ pathology [16]. There is convincing evidence that FJ pain plays an important role in low back pain [26, 27] and occurs in up to 45% of individuals [25]
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