Eubanks Jason David, Lee Michael J, Cassinelli Ezequiel, Ahn Nicholas U
Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA.
Clin Orthop Relat Res. 2007 Nov;464:184-9. doi: 10.1097/BLO.0b013e3181583d4e.
It is believed lumbar degeneration begins in the disc, where desiccation and collapse lead to instability and compensatory facet arthrosis. We explored the contrary contention that facet degeneration precedes disc degeneration by examining 647 skeletal lumbar spines. Using facet osteophytosis as a measure of facet degeneration and vertebral rim osteophytosis as a measure of disc degeneration, we assumed bone degeneration in both locations equally reflected the progression of those in the soft tissues. We graded arthrosis Grade 0 to 4 on a continuum from no arthritis to ankylosis. The data were analyzed for different age groups to examine patterns of degeneration with age. Specimens younger than 30 years of age had a higher prevalence of facet osteophytosis compared with vertebral rim osteophotosis at L1-L2 and L2-L3. Specimens aged 30 to 39 years showed more facet osteophytosis than vertebral rim osteophytosis at L4-L5. Specimens older than 40 years, however, showed more vertebral rim osteophytosis compared with facet osteophytosis at all levels except L4-L5 and L5-S1. This skeletal study suggests facet osteophytosis appears early in the degenerative process, preceding vertebral rim osteophytosis of degenerating intervertebral discs. However, once facets begin deteriorating with age, vertebral rim osteophytosis overtakes continued facet osteophytosis. These data challenge the belief that facet osteophytosis follows vertebral rim osteophytosis; rather, it appears vertebral rim osteophytosis progresses more rapidly in later years, but facet osteophotosis occurs early, predominating in younger individuals.
人们认为腰椎退变始于椎间盘，椎间盘的干燥和塌陷会导致不稳定以及代偿性小关节骨关节炎。我们通过检查647具腰椎骨骼，探讨了相反的观点，即小关节退变先于椎间盘退变。以小关节骨赘形成作为小关节退变的指标，以椎体边缘骨赘形成作为椎间盘退变的指标，我们假定这两个部位的骨质退变同样反映了软组织退变的进程。我们将骨关节炎从无关节炎到关节强直分为0至4级。对不同年龄组的数据进行分析，以研究退变随年龄的模式。与L1-L2和L2-L3椎体边缘骨赘形成相比，30岁以下的标本小关节骨赘形成的患病率更高。30至39岁的标本在L4-L5处显示出更多的小关节骨赘形成，而非椎体边缘骨赘形成。然而，40岁以上的标本，除L4-L5和L5-S1外，在所有节段均显示出更多的椎体边缘骨赘形成，而非小关节骨赘形成。这项骨骼研究表明，小关节骨赘形成在退变过程中出现较早，先于退变椎间盘的椎体边缘骨赘形成。然而，一旦小关节随着年龄开始退变，椎体边缘骨赘形成就会超过持续的小关节骨赘形成。这些数据挑战了小关节骨赘形成继发于椎体边缘骨赘形成的观点；相反，似乎椎体边缘骨赘形成在晚年进展更快，但小关节骨赘形成出现较早，在年轻人中占主导地位。
