Lumbar Facet Tropism on Different Facet Portions and Asymmetry Between Ipsilateral Cephalad and Caudad Portions Their Correlations With L4/5 and L5/S1 Lumbar Disc Herniation
Lumbar Facet Tropism on Different Facet Portions and Asymmetry Between Ipsilateral Cephalad and Caudad Portions Their Correlations With L4/5 and L5/S1 Lumbar Disc Herniation
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腰椎小关节不同部位的向性及同侧头尾部分的不对称性与L4/5、L5/S1腰椎间盘突出症的相关性
DOI：
10.1097/brs.0000000000003614
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发表时间：
2020
期刊：
影响因子：
3
通讯作者：
Teng Honglin
中科院分区：
文献类型：
--
作者：
Wang Yu;Li Daoyou;Zhu Minyu;Wang Jing;Li Chi;Lin Chaowei;Wang Jianhong;Teng Honglin
研究设计：回顾性病例对照研究。目的：探讨腰椎间盘突出症（LDH）与腰椎小关节向性（FT）分别在头侧和尾侧小关节部分的相关性；研究同侧头侧和尾侧小关节部分的不对称性及其与 LDH 的相关性。背景数据摘要。关于腰椎 FT 和 LDH 之间的确切相关性仍存在激烈争论。然而，还没有研究关注 LDH 患者不同小关节部分的 FT 以及同侧头侧和尾侧部分的不对称性。 方法。 100 名 L4/5 LDH 患者、100 名 L5/S1 LDH 患者和 100 名无 LDH 参与者（对照组）进行年龄和性别匹配并纳入本研究。每组参与者根据年龄（≥或< 50岁）进一步分为两个亚组。测量头侧和尾侧的双侧小关节角度。将各LDH组的同侧头侧和尾部的FT和不对称性与相应对照组进行比较。结果。与对照组相比，老年L4/5 LDH患者双侧小关节角度的平均差异在头侧和尾侧显着更大，而FT频率仅在头侧表现出显着较高。在老年L4/5 LDH患者中，同侧头侧和尾侧小关节角度的平均差值显着大于对照组，同侧头侧和尾侧小关节不对称的频率也显着较高。结论：只有头侧FT与老年患者L4/5 LDH相关，而尾侧小关节不对称。小关节不同部位的测量可能会导致 FT 识别的差异。同侧头侧和尾侧小关节部分之间的不对称也与老年患者的 L4/5 LDH 相关。证据级别：3 腰椎小关节向性 (FT) 最初由 Brailsford 1 定义为左右腰椎小关节角度之间的不对称（一个小关节比另一个关节具有更多的矢状方向）。 FT 与退行性脊柱滑脱、小关节骨关节炎、椎间盘退变和椎间盘突出等腰椎退行性疾病之间的相关性已得到广泛研究。 2-10 然而，这些问题仍然存在争议，特别是 FT 与腰椎间盘退变或突出之间的关联。最近，进行了系统回顾和荟萃分析，以确定 FT 在腰椎退行性疾病中的作用。 11 结论是，退行性脊柱滑脱患者中 FT 更为常见，但未观察到 FT 与腰椎间盘突出症 (LDH) 之间存在显着关联。 FT 和 LDH 结果存在争议的原因可能很复杂。 1) 没有商定的标准来详细说明腰椎 FT。在不同的研究中，定义 FT 的双侧小面角度之间的差异是多种多样的。在一些研究中，通过比较两组双侧小关节角度的平均差异来识别 FT。 2）参加这些研究的受试者可能在种族、年龄、脊柱退化等方面存在多样性。据报道，FT 并未将青少年或年轻患者的 LDH 关联起来。 12, 13 3) 更重要的是，腰椎小关节是三维的。研究表明，退行性腰椎滑脱患者的小关节头侧部分比尾侧更加矢状取向。 14 然而，通常没有具体指出是面的哪一部分……
Study Design.A retrospective case-control study.Objective.To investigate the correlation between lumbar disc herniation (LDH) and lumbar facet tropism (FT) on cephalad and caudad facet portions, respectively; to investigate the asymmetry between ipsilateral cephalad and caudad facet portions and its correlation with LDH.Summary of Background Data.There are still heavy debates on the exact correlation between lumbar FT and LDH. However, no study ever focused on the FT on different facet portions and asymmetry between ipsilateral cephalad and caudad portions in patients with LDH.Methods.One hundred patients with L4/5 LDH, 100 patients with L5/S1 LDH, and 100 participants without LDH (control group) were age and sex matched and included in this study. Participants in each group were further divided into two subgroups based on age (≥ or< 50 yr old). Bilateral facet joint angles on both cephalad and caudad portions were measured. FT and asymmetry between ipsilateral cephalad and caudad portions in each LDH group were compared with those in corresponding control group.Results.Comparing with control participants, the mean difference of bilateral facet angles in older patients with L4/5 LDH was significantly greater either on cephalad portion and caudad portion, whereas significantly higher frequency of FT was only exhibited on cephalad portion. In older patients with L4/5 LDH, the mean difference of facet angle between ipsilateral cephalad and caudad portions was significantly greater than that of control participants, the frequency of ipsilateral cephalad, and caudad facet asymmetry was also significantly higher.Conclusions.Only the FT on cephalad portion but not caudad portion of facet joint is associated with L4/5 LDH of older patients. The measurement on different portions of facet joint may result in discrepancy on FT identification. Asymmetry between ipsilateral cephalad and caudad facet portions is also associated with L4/5 LDH in older patients.Level of Evidence: 3Lumbar facet tropism (FT) was first defined by Brailsford 1 as an asymmetry between the left and right lumbar facet joint angles (one facet joint has a more sagittal orientation than the other). The correlations between FT and lumbar degenerative diseases such as degenerative spondylolisthesis, facet joint osteoarthritis, disc degeneration, and disc herniation have been widely investigated. 2–10 However, there is still controversy on these issues, especially for the association between FT and lumbar disc degeneration or herniation. Lately, a systematic review and meta-analysis was conducted to identify the role of FT on lumbar degenerative diseases. 11 It concluded that FT was more common in patients with degenerative spondylolisthesis, whereas no significant association between FT and lumbar disc herniation (LDH) was observed. The causes for the controversial results on FT and LDH may be complicated. 1) There is no agreed standard to detail the lumbar FT. The difference between bilateral facet angles which defined the FT was diversified in different studies. The mean differences of bilateral facet angles in two groups were compared to identify FT in some studies. 2) The subjects enrolled in these studies might be diversified in race, age, spinal degeneration, and so on. It has been reported that the FT did not correlate LDH in the adolescents or younger patients. 12, 13 3) More importantly, the lumbar facet joint is three-dimensional. It was proved that the cephalad portion of facet joint was more sagittally oriented than the caudad portion in patients with degenerative spondylolisthesis. 14 However, it was usually not specifically indicated which portion of facet …