Liu Jiayong, Ebraheim Nabil A, Haman Steven P, Shafiq Qaiser, Karkare Nakul, Biyani Ashok, Goel Vijay K, Woldenberg Lee
Department of Orthopaedic Surgery, Medical University of Ohio, Toledo, OH 43614, USA.
Spine (Phila Pa 1976). 2006 Apr 1;31(7):E198-202. doi: 10.1097/01.brs.0000206387.67098.a0.
Computerized tomography (CT) of the lumbar spine cadaveric specimens was used to evaluate the effect of increasing the height of the disc space in the lumbar spine to the facet joint articulation in the sagittal plane.
To show how the facet joint articulation is affected by increasing the height of the disc space in the lumbar spine.
The Charité Artificial Disc (DePuy Spine, Inc., Raynham, MA) was successful in relieving low back pain in the majority of patients, yet there was still a significant number of patients who did not obtain pain relief, or their pain even worsened. The etiology of their pain is still not known. To our knowledge, no study has addressed the effect on the facet joints when the disc height is increased.
CT images passing through the center of the L3-S1 facet joints (sagittal plane) were obtained from 15 cadaveric lumbar spine specimens. The articulation overlap of facet joints in sagittal plane from the L3 to S1 was measured. A 1-mm incremental increase to a total 5 mm in disc space height was performed to simulate the changes seen in disc replacement. The change in the facet joint articulation overlap in sagittal plane at normal and each displacement was then measured. There were 5 lumbar spine specimens dissected to validate the technique and standardize the measurements. Mean, percentages, and standard deviation values were calculated for all measured dimensions.
No significant difference was found between the measurements on CT and gross specimens (P > 0.05). In 15 specimens, the mean facet joint articulation overlap on the sagittal plane was: 16.29 +/- 1.20 mm (left) and 16.22 +/- 1.16 (right) at the L3-L4 level; 17.81 +/- 1.18 mm (left) and 17.74 +/- 1.18 mm (right) at the L4-L5 level; and 18.18 +/- 1.18 mm (left) and 18.23 +/- 1.15 mm (right) at the L5-S1 level. There is no significant difference between the measured values on left and right sides (P > 0.05). Each 1-mm incremental increase in disc space at the L3-L4 level translated to a decrease in the facet joint articulation overlap in the sagittal plane by 6%, and the mean facet joint space increased 0.4 mm. At the L4-L5 level, the articulation overlap decreased by 6%, and the facet joint space increased 0.5 mm. At the L5-S1 level, the articulation overlap decreased by 4%, and the facet joint space increased 0.7 mm.
There is a significant decrease of the facet joint articulation overlap in sagittal plane and an increase in the facet joint space following an increase in the lumbar disc space. The inappropriate increase of the height of disc space will result in facet joint subluxation.
使用腰椎尸体标本的计算机断层扫描（CT）来评估腰椎椎间盘间隙高度增加对矢状面小关节关节面的影响。
展示腰椎椎间盘间隙高度增加如何影响小关节关节面。
Charité人工椎间盘（DePuy Spine公司，马萨诸塞州雷纳姆）在大多数患者中成功缓解了腰痛，但仍有相当数量的患者未获得疼痛缓解，甚至疼痛加剧。其疼痛病因仍不清楚。据我们所知，尚无研究探讨椎间盘高度增加对小关节的影响。
从15个尸体腰椎标本获取通过L3 - S1小关节中心（矢状面）的CT图像。测量L3至S1矢状面小关节的关节面重叠情况。椎间盘间隙高度以1毫米的增量总共增加5毫米，以模拟椎间盘置换时的变化。然后测量正常及每次移位时矢状面小关节关节面重叠的变化。解剖5个腰椎标本以验证技术并规范测量。计算所有测量维度的平均值、百分比和标准差。
CT测量值与大体标本测量值之间未发现显著差异（P > 0.05）。在15个标本中，矢状面上小关节关节面平均重叠情况为：L3 - L4水平，左侧为16.29 +/- 1.20毫米，右侧为16.22 +/- 1.16毫米；L4 - L5水平，左侧为17.81 +/- 1.18毫米，右侧为17.74 +/- 1.18毫米；L5 - S1水平，左侧为18.18 +/- 1.18毫米，右侧为18.23 +/- 1.15毫米。左右两侧测量值之间无显著差异（P > 0.05）。L3 - L4水平椎间盘间隙每增加1毫米，矢状面小关节关节面重叠减少6%，小关节平均间隙增加0.4毫米。在L4 - L5水平，关节面重叠减少6%，小关节间隙增加0.5毫米。在L5 - S1水平，关节面重叠减少4%，小关节间隙增加0.7毫米。
腰椎椎间盘间隙增加后，矢状面小关节关节面重叠显著减少，小关节间隙增加。椎间盘间隙高度的不适当增加将导致小关节半脱位。
