Rai Ravi Ranjan, Shah Yash, Shah Siddharth, Palliyil Nigil Sadanandan, Dalvie Samir
Department of Orthopaedics, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India.
Neurospine. 2019 Dec;16(4):742-747. doi: 10.14245/ns.1836232.116. Epub 2019 Jan 16.
To study the association of facet joint angulation and joint tropism with degenerative spondylolisthesis (DS) through a comparison with a matched control group.
This radiographic study was carried out in 2 groups of 45 patients each. Group A contained patients with single-level DS, while group B (control) contained non-DS patients with similar age and degeneration who underwent surgery for disc prolapse or lumbar stenosis. DS was diagnosed based on translation of ≥ 3 mm on standing lateral radiography. Axial magnetic resonance imaging from L3 to S1 was utilized to assess the angulation of facet joints in relation to the coronal plane; a difference of ≥ 8° was considered to indicate tropism.
Among 45 patients with DS, 15 were males and 30 females. Their mean age was 62.2 years. Facet tropism was identified in 20 of 45 patients at the level of DS, 12 patients at a level proximal to DS, and 15 patients at a level distal to DS. Facet tropism was found in 7 of the 45 patients in group B. At L3-4, facet tropism was observed in 13 patients (28.88%) in group A and 2 (4.44%) in group B. At L4-5, tropism was observed in 19 patients (42.22%) in group A and 5 (11.11%) in group B. At L5-S1, tropism was seen in 17 patients (37.77%) in group A and 2 (4.44%) in group B. Group A showed a significantly higher prevalence of multilevel facet tropism and tropism at levels adjacent to the DS level. A higher average angulation of facet joints was observed in the DS group, but the difference was not statistically significant at all levels.
The present study documented a statistically significant relationship between facet tropism and DS. A higher prevalence of facet tropism was also found in DS patients at non-DS levels, which is a novel observation. This finding supports the argument that facet tropism is a pre-existing morphological variation contributing to the development of DS, not a result of secondary remodelling.
通过与匹配的对照组进行比较，研究小关节角和关节不对称性与退变性腰椎滑脱（DS）的关联。
这项影像学研究在两组患者中进行，每组45例。A组为单节段DS患者，而B组（对照组）为年龄和退变程度相似、因椎间盘突出或腰椎管狭窄接受手术的非DS患者。根据站立位侧位X线片上移位≥3mm诊断DS。利用L3至S1的轴向磁共振成像评估小关节相对于冠状面的角度；角度差异≥8°被认为提示不对称性。
45例DS患者中，男性15例，女性30例。他们的平均年龄为62.2岁。45例DS患者中，20例在DS节段、12例在DS节段近端、15例在DS节段远端发现小关节不对称性。B组45例患者中有七例发现小关节不对称性。在L3 - 4，A组13例患者（28.88%）和B组2例患者（4.44%）观察到小关节不对称性。在L4 - 5，A组19例患者（42.22%）和B组5例患者（11.11%）观察到不对称性。在L5 - S1，A组17例患者（37.77%）和B组2例患者（4.44%）观察到不对称性。A组显示多节段小关节不对称性以及DS节段相邻节段不对称性的患病率显著更高。DS组观察到小关节平均角度更高，但在所有节段差异均无统计学意义。
本研究记录了小关节不对称性与DS之间具有统计学意义的关系。在非DS节段的DS患者中也发现小关节不对称性患病率更高，这是一项新的观察结果。这一发现支持了小关节不对称性是导致DS发生的一种预先存在的形态学变异，而非继发重塑结果的观点。
