Effect of the Increase in the Height of Lumbar Disc Space on Facet Joint Articulation Area in Sagittal Plane (original) (raw)
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Journal of Bone and Joint Surgery - British Volume, 2010
In a study on ten fresh human cadavers we examined the change in the height of the intervertebral disc space, the angle of lordosis and the geometry of the facet joints after insertion of intervertebral total disc replacements. SB III Charité prostheses were inserted at L3-4, L4-5, and L5-S1. The changes studied were measured using computer navigation sofware applied to CT scans before and after instrumentation. After disc replacement the mean lumbar disc height was doubled (p < 0.001). The mean angle of lordosis and the facet joint space increased by a statistically significant extent (p < 0.005 and p = 0.006, respectively). By contrast, the mean facet joint overlap was significantly reduced (p < 0.001). Our study indicates that the increase in the intervertebral disc height after disc replacement changes the geometry at the facet joints. This may have clinical relevance.
The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading
Skeletal Radiology, 2010
We present a two-part review article on the current state of knowledge of lumbar facet joint pathology. This first article discusses the functional anatomy, biomechanics, and radiological grading systems currently in use in clinical practice and academic medicine. Facet joint degeneration is presented within the larger context of degenerative disc disease to enable the reader to better understand the anatomical changes underlying facetmediated lower back pain. Other less-common, but equally important etiologies of lumbar facet joint degeneration are reviewed. The existing grading systems are discussed with specific reference to the reliability of CT and MR imaging in the diagnosis of lumbar facet osteoarthritis. It is hoped that this discussion will stimulate debate on how best to improve the diagnostic reliability of these tests so as to improve both operative and non-operative treatment outcomes.
Morphometric Analysis of Lumbar Intervertebral Disc Height: An Imaging Study
World Neurosurgery, 2019
BACKGROUND: Little published data exist regarding normal values of disc height. Current literature relies on plain radiographs making accurate measurements of individual lumbar disc height difficult.-OBJECTIVE: We seek to establish normal values for lumbar intervertebral discs in different age groups using computed tomography scans in healthy individuals.-METHODS: Two hundred forty anonymized abdominal computed tomography scans (131 women) were prospectively collected once institutional review board approval was obtained. Individuals with spinal pathologies were excluded. Disc height measurements were obtained at the anterior edge, center, and posterior edge of each vertebra in the midsagittal plane, averaged, and compared against age and sex.-RESULTS: Average age was 45 (14e83) years for women and 48 (14e89) years for men. Average lumbar disc height was 5.6 AE 1.1 mm for men and 4.8 AE 0.8 mm for women at T12/L1, 6.9 AE 1.3 mm for men and 5.8 AE 0.9 mm for women at L1/2, 8.1 AE 1.4 mm for men and 6.9 AE 1.1 mm for women at L2/ 3, 8.7 AE 1.5 mm for men and 7.6 AE 1.2 mm for women at L3/4, 9.2 AE 1.6 mm for men and 8.5 AE 1.6 mm for women at L4/5, and 8.8 AE 1.6 mm for men and 8.6 AE 1.8 mm for women at L5/ S1. Disc height was significantly smaller for women than men (P < 0.001), except at L5/S1.-CONCLUSIONS: Variation in disc height is determined much more by sex than age. The maximum height of the interbody space in the adult lumbar spine was at the L4/5 level (8.9 AE 1.7 mm [men], 8.6 AE 1.8 mm [women]). Based on our findings, >10 mm cage height will result in supraphysiologic interbody space restoration and potentially predispose to complications.
Facet Angles in Lumbar Disc Herniation: Their Relation to Anthropometric Features
Spine, 2004
Study Design. Cross-sectional study. Objective. To investigate the alteration of facet joint angle and its relation to anthropometric features in lumbar disc herniation. Summary of Background Data. In the previous studies, the facet tropism and its relation to the level, type, side, and development of lumbar disc herniation were reported. This study was the first to correlate anthropometric feature, facet angle, and asymmetry in patients with lumbar disc herniation. Methods. Sixty-one patients with lumbar disc herniation were included in this study. The body height, vertexto-spina iliaca posterior superior distance, spina iliaca posterior superior-to-floor distance, and net weight were measured and body mass index calculated. The facet angles were measured for each facet joint using computed tomography. The intraobserver error was found to be Ϯ 1.66°. We defined facet tropism as the bilateral angle difference greater than 2 intraobserver errors. The asymmetry rate was a ratio of degree of angles of the more coronally oriented facet joint to the more sagittally oriented facet joint at the same intervertebral level. Results. The facet asymmetry was observed at the herniation level in 70.5% of the patients. There was a correlation between the degree of the more sagittally oriented facet joint angle and facet asymmetry rate at the herniation level (R ϭ Ϫ0.684, P ϭ 0.0001 for L4-L5 lumbar disc herniation; R ϭ Ϫ0.509, P ϭ 0.008 for L5-S1 lumbar disc herniation). The body height correlated with the degree of the more sagittally oriented facet joint angle, the degree of more coronally oriented facet joint angle, and asymmetry rate, respectively (R ϭ Ϫ0.571, P ϭ 0.0001; R ϭ Ϫ0.474, P ϭ 0.002; R ϭ 0.314, P ϭ 0.045, respectively). There was no correlation between the degree of these angles and the vertex-to-spina iliaca posterior superior distance. The spina iliaca posterior superior-to-floor distance was correlated with the degree of the more sagittally oriented facet joint angle (R ϭ Ϫ0.457, P ϭ 0.0001) and more coronally oriented facet joint angle (R ϭ Ϫ0.435, P ϭ 0.004) but not with the asymmetry rate. The degree of facet angles was not correlated with body weight and body mass index. Conclusion. This study revealed that patients with lumbar disc herniation had the asymmetry and sagittalization of facet joints, and these alterations were more evident in the taller patients.
European Spine Journal, 2011
Facet tropism has been investigated as a predisposing factor for degenerative changes in the lumbar spine; however, no prior study has evaluated the relationship between disc bulge and facet tropism. In this study, we used kinetic magnetic resonance imaging (kMRI) to investigate the association between degree of facet tropism and amount of disc bulge in the lumbar spine in relation to age. kMRIs in the flexion, neutral, and extension positions were performed on 410 consecutive patients with low back pain. T2-weighted midsagittal and axial mid-disc cuts were analyzed to measure disc bulge and facet angle. Facet asymmetry was calculated and classified as: no facet tropism, \6°; mild facet tropism, 6-11°; or severe facet tropism, C11°. Maximal static bulge (MSB), maximal dynamic bulge (MDB), and age in the facet tropism groups were compared by age subpopulations and MDB categories, defined by the positions between which the largest change in disc bulge occurs. We found the severe facet tropism group to be associated with a nearly significant increase in MSB and MDB over the no facet tropism group in the older subpopulation at the L4-L5 level only, and a larger MDB in the L4-L5 MDB category [E-N], where the greatest change in disc bulge occurs between neutral and extension positions (p = 0.013). Our findings suggest that severe facet tropism is associated with increased disc bulge at L4-L5 in only a subset of older age patients, but may in large part be due to biomechanical factors that define the [E-N] category.
Influence of Facet Tropism on the Location of Lumbar Disc Herniation
Coluna/Columna
Objective: To correlate facet tropism with the side and location of the intervertebral disc in which the lumbar disc herniation occurred. Methods: A retrospective descriptive study that evaluated Magnetic Resonance Imaging of 255 patients with lumbar disc herniation undergoing surgical treatment with the Spine Group of the Hospital Ortopédico de Passo Fundo between 2002 and 2014. The total patient number was stratified according to the side affected by the herniated disc (right or left), location of the hernia in the intervertebral disc (central, centrolateral, foraminal and extraforaminal) and demographic data, such as age, gender etc. The degree of facet joint tropism was measured by the Karakan method and classified as mild (difference less than 7º); moderate (between 7º and 15º) and severe (difference greater than 15º). Results: A statistical significant relationship (p= 0.023) was observed between the facet joint tropism and the side where the lumbar disc herniation occurred. N...
Journal of Orthopaedic Surgery and Research
Background: Studies have shown that lumbar disc herniation, degenerative lumbar instability, and other degenerative lumbar spinal diseases are often secondary to disc degeneration. By studying the intervertebral disc, researchers have clarified the pathological changes involved in intervertebral disc degeneration but have ignored the roles of biomechanical factors in the development of disc degeneration. This study aims to investigate the relationships among the location, scope, and extent of lumbar disc degeneration and sagittal spinal-pelvic parameters. Methods: A retrospective analysis was performed on the clinical data of 284 patients with lumbar degenerative disc diseases (lumbar disc herniation and degenerative lumbar instability) from January 2013 to December 2016. Statistics were calculated for the following: (1.) patients' general information: name, sex, age, height, and weight. (2.) Measurements of sagittal parameters from total spinal radiographs: thoracic kyphosis (TK), Lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), T1 tilt angle (TA), and T1 pelvic angle (TPA). (3.) Location, scope, extent, and overall degree of lumbar disc degeneration. Parameters were analyzed in groups by sex, PI, and SVA, and a correlation analysis was performed for the location, scope, extent, and overall degree of lumbar intervertebral disc degeneration with 8 spinal-pelvic sagittal parameters. Results: The mean ages of the male and female patient groups were 59.00 and 53.28 years old, respectively (P < 0.05). The PT, location, scope, and overall degree of degradation were significantly different between the sexes (P < 0.05). Linear correlation analysis results showed that the overall degree and extent of degradation (r = 0.788, P < 0.01), LL and SS (r = 0.737, P < 0.01), PI and PT (r = 0.607, P < 0.01), and TPA and PT (r = 0.899, P < 0.01) were strongly correlated. The location values were 4.08 ± 0.72 in patients with PI≤50°and 3.62 ± 0.94 in patients with PI> 50°(P = 0.018). Different SVASVA groups differed in their overall degree of degeneration (P = 0.002). Conclusions: The location of lumbar intervertebral disc degeneration is affected by spinal-pelvic sagittal morphology. Populations with small PI values tend to exhibit degeneration at the L4/5 and L5/S1 discs, and populations with large PI values tend to exhibit degeneration at the L3/4 and L4/5 discs. The SVA value and the overall degree of lumbar disc degeneration are positively correlated.
Sagittal balance parameters influence indications for lumbar disc arthroplasty or ALIF
European Spine Journal, 2011
Chronic lower back pain is a potentially incapacitating condition associated with disc degeneration. Although therapy is primarily pharmaceutical, surgery comprising arthrodesis constitutes an alternative. Anterior intersomatic lumbar arthrodesis (ALIF, anterior interbody lumbar fusion) is the reference approach, although total disc arthroplasty may also be undertaken. Analysis of pelvic and spinal parameters provides the best indication of sagittal balance. Materials and methods This was a prospective study in a continuous series of 99 patients presenting chronic lower back pain due to disc disease. Pelvic incidence, sacral slope, pelvic tilt, spino-sacral angle (SSA) and the four back types in the Roussouly classification were studied in radiographs of the whole spine under load using an EOS imaging system. Results The pre-operative SSA value for the study population was 126.09°± 8.45°and the mean spine tilt angle was 90°compared with 95°in healthy subjects. Following surgery, the SSA was considerably increased in the discal arthroplasty, resulting in a significantly more balanced spinal position. In the group of patients undergoing arthrodesis using the ALIF technique, no such significant improvement was found despite the use of a lordosis cage. We showed that in cases of low pelvic incidence, it was necessary to maintain a Roussouly type 1 or 2 back without increasing lordosis. The results demonstrated the value of L4-L5 disc prostheses in these subjects. L5-S1 arthrodesis seemed a more suitable approach for treating patients with elevated sacral slope (back type 3 or 4). This new type of analysis of sagittal parameters should be performed prior to all surgical procedures involving lumbar prostheses.