An Evaluation of the Facet Joint Angle Characteristics on the Development of Lumbar Disc Hernia in Young Patients

Yıl 2018, , 229 - 235, 28.09.2018

Ahmet Eroglu , İlhan Yılmaz Metehan Eseoğlu

https://doi.org/10.31362/patd.408161

Öz

Background: The aim of the current study was to
investigate facet tropism in young patients with lumbar disc hernia (LDH) and the
role of facet tropism in the development of LDH.

 

Methods: The study included 57 patients aged
20-32 years with a diagnosis of LDH and bilateral facet joint angles at L3-4,
L4-5 and L5-S1 levels measured on lumbar magnetic resonance imaging (MRI)
tests. In the comparison of the two facet joint angles, a difference of <7°
was classified as no tropism, 7°-14° as moderate tropism and >14° as severe
tropism. A control group was formed of 46 age-matched healthy individuals with
no lumbar disc hernia.

Results: A total of 618 facet facet angles were
measured, comprising 342 in the 57 patients in the LDH group and 276 in the 46
subjects of the control group. In the LDH group, at the L3-4 level, no tropism
was determined in 46 (80.7%), moderate tropism in 9 (15.7%) and severe tropism
in 2 (3.5%). At the L4-5 level, no tropism was determined in 36 (63.1%),
moderate tropism in 17 (29.8%) and severe tropism in 4 (7%). At the L5-S1
level, no tropism was determined in 33 (57.9%), moderate tropism in 17 (29.8%)
and severe tropism in 7 (12.2%).In the control group, at the L3-4 level, no
tropism was determined in 40 (87%), moderate tropism in 5 (10.9%) and severe
tropism in 1 (2.2%). At the L4-5 level, no tropism was determined in 37
(80.4%), moderate tropism in 8 (17.3%) and severe tropism in 1 (2.1%). At the
L5-S1 level, no tropism was determined in 34 (73.9%), moderate tropism in 7
(15.2%) and severe tropism in 5 (10.9%).

In the
LDH group, the mean facet angle values were 40.4° at L3-4, 42.7° at L4-5 and
45.9° at L5-S1 levels. In the control group, the mean facet angle values were
39.2° at L3-4, 41.4° at L4-5 and 43.9° at L5-S1 levels.

Conclusion: Although facet joint tropism was
seen at a higher rate in the LDH patients than in the control group, the
difference was not statistically significant (p>0.05). The results of the
study did not suggest that facet tropism is a factor in the etiology of LDH.

Anahtar Kelimeler

ldh, fac

Kaynakça

• 1. Postacchini F, Postacchini R. Operative management of lumbar disc herniation: the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl 2011;108:17–21.2. Haidar R, Ghanem I, Saad S, Uthman. Lumbar disc herniation in young children. Acta Pediatr 2010;99:19-23.3. Duc HD, Cyrus ET, Winston F. The relationship between degree of facet tropism and amount of dynamic disc bulge in lumbar spine of patients symptomatic for low back pain. Eur Spine J 2011;20:71–78.4. O’Neill C, Owens DK. Lumbar facet joint pain: time to hit the reset button. Spine 2009;9:619-622.5. Karacan I, Aydin T, Sahin Z, Cidem M, Koyuncu H, Aktas I, et al. Facet angles in lumbar disc herniation: their relation to anthropometirc features. Spine (Phila Pa 1976) 2004;29:1132-1136.6. Farfan H, Sullivan J. The relation of facet orientation to intervertebral disc failure. Can J Surg 1967;10:179–185.7. Don AS, Robertson PA. Facet joint orientation in spondylolysis and isthmic spondylolisthesis. J.Spinal Disord Tech. 2008; 21:112–115.8. Grogan J, Nowicki BH, Schmidt TA, Haughton VM. Lumbar facet joint tropism does not accelerate degeneration of the facet joints. AJNR Am J Neuroradiol 1997;18:1325-1329.9. Ishihara H, Matsui H, Osada R, Ohshima H, Tsuji H. Facet joint asymmetry as a radiologic feature of lumbar intervertebral disc herniation in children and adolescents. Spine (Phila Pa 1976) 1997;22:2001-2004.10. Noren R, Trafimow J, Andersson GB, Huckman MS. The role of facet joint tropism and facet angle in disc degeneration. Spine (Phila Pa 1976) 1991;16:530-532.11. Matsuo Y, Kaito T, Iwasaki M, Sugiura T, Fujimori T, Nagamoto Y, et al. 3D morphometric analysis of laminae and facet joints in patients with degenerative spondylolisthesis. Mod Rheumatol 2015;25:756-760.12. Poussa M, Schlenzka D, Seitsalo S, Ylikoski M, Hurri H, Österman K. Surgical treatment of severe isthmic spondylolisthesis in adolescents. Spine 1993;18: 894-901.13. Kong MH, He W, Tsai Y, Chen NF, Keorochana G, Do DH. Relationship of Facet Tropism with Degeneration and Stability of Functional Spinal Unit Yonsei Med J 2009;50: 624-629.14. Vanharanta H, Floyd T, Ohnmeiss DD, Hochschuler SH, Guyer RD. The relationship of facet tropism to degenerative disc disease. Spine (Phila Pa 1976) 1993;15;18:1000-1005. 15. Donahue D, Whetsell W. Pathological considerations of the herniated nucleus pulposus. In : Camins and P . Oleary Lumbar Spine. New York: Raven Press, 1987;427-437.16. Hagg O, Wallner A. Facet joint asymmetry and protrusion of intervertebral disc. Spine 1990;15:356–359.17. Lee DY, Ahn Y, Lee SH. The influence of facet tropism on herniation of the lumbar disc in adolescents and adults. J Bone Joint Surg Br.2006; 88:520-523.18. Schleich C, Müller-Lutz A, Blum K, Boos J, Bittersohl B, Schmitt B. Facet tropism and facet joint orientation: risk factors for the development of early biochemical alterations of lumbar intervertebral discs. Osteoarthritis Cartilage 2016;24:1761-1768.19. Wang H, Zhou Y. Facet tropism: possible role in the pathology of lumbar disc herniation in adolescents. Journal of Neurosurgery. Pediatrics 2016;4:1-5.20. Adams MA, Hutton WC. The relevance of torsion to the mechanical derangement of the lumbar spine. Spine 1981;6:241–248.21. Kim HJ, Kang KT, Son J, Lee CK, Chang BS, Yeom JS. The influence of facet joint orientation and tropism on the stress at the adjacent segment after lumbar fusion surgery: a biomechanical analysis. Spine J 2015;15(8):1841-1847.22. Park JB, Chang H, Kim KW, Park SJ. Facet tropism: a comparison between far lateral and posterolateral lumbar disc herniations. Spine 2001;26:677-679.23. Wang H, Zhang Z, Zhou Y. Irregular Alteration of Facet Orientation in Lumbar Segments: Possible Role in Pathology of Lumbar Disc Herniation in Adolescents. World Neurosurg 2016; 86: 321-327.24. Cassidy JD, Loback D, Yong-Hing K, Tchang S. Lumbar facet joint asymmetry: intervertebral disc herniation. Spine 1992;17:570-574.25. Dai LY. Orientation and tropism of lumbar facet joints in degenerative spondylolisthesis. International Orthopaedics 2001;25:40–42.26. Pichaisak W, Chotiyarnwong C, Chotiyarnwong P. Facet joint orientation and tropism in lumbar degenerative disc disease and spondylolisthesis. J Med Assoc Thai; 2015;98:373-379.27. Richard W, Jason C, Ben G, et al. An International Multicenter Study Assessing the Role of Ethnicity on Variation of Lumbar Facet Joint Orientation and the Occurrence of Degenerative Spondylolisthesis in Asia Pacific: A Study from the AOSpine Asia Pacific Research Collaboration Consortium. Global Spine J 2016;6:35.28. Chadha M, Sharma G, Arora SS, Kochar V. Association of facet tropism with lumbar disc herniation. Eur Spine J. 2013;22:1045-1052.29. Kenesi C, Lesur E. Orientation of the articular processes at L4, L5 and S1. Possible role in pathology of the intervertebral disc. Anat Clin 1985;7:43-47. 30. Cyron BM, Hutton WC. Articular tropism and stability of the lumbar spine. Spine 1982;5:168-172.31. Van Schaik JP, Van Pinxteren B. Curvature of the lower lumbar facet joints: variations at different levels and relationship with orientation. J Spinal Disord. 1999;12:341-347.