Lumbar Facet Joint Motion in Patients With Degenerative Spondylolisthesis

Study Design: Controlled laboratory study. Objective: To investigate the in vivo biomechanical effect of degenerative lumbar spondylolisthesis (DLS) on the motion of the facet joint during various functional weight-bearing activities. Summary of Background Data: Although the morphologic changes of the facet joints in patients with DLS have been reported in a few studies, no data have been reported on the kinematics of these facet joints. Methods: Ten patients with DLS at L4–L5 were studied. Each patient underwent a magnetic resonance imaging scan to obtain 3-dimensional models of the lumbar vertebrae from L2–L5 and a dual fluoroscopic imaging scan in different postures: flexion-extension, left-right bending, and left-right torsion. The positions of the vertebrae were reproduced by matching the magnetic resonance imaging–based vertebral models to the fluoroscopic images. The kinematics of the facet joint and the ranges of motion were compared with those of healthy subjects and those of patients with degenerative disk diseases (DDD) previously published. Results: In DLS patients, the range of rotation of the facet joints was significantly less at the DLS level (L4–L5) than that at the adjacent levels (L2–L3 and L3–L4), whereas the range of translation was similar at all levels. The range of rotation at the facet joints of the DLS level decreased compared with those of both the DDD patients and healthy subjects at the corresponding vertebral level (L4–L5), whereas no significant difference was found in the range of translation. The range of motion of facet joints in DLS and in DDD patients was similar at the adjacent levels (L2–L3 and L3–L4). Conclusions: The range of rotation decreased at the facet joints at the DLS level (L4–L5) in patients compared with those in healthy subjects and DDD patients. This decrease in range of rotation implies that the DLS disease may cause restabilization of the joint. The data may help the selection of conservative treatment or different surgical techniques for the DLS patients.

[1]  Ali Guermazi,et al.  Facet Orientation and Tropism: Associations With Facet Joint Osteoarthritis and Degeneratives , 2009, Spine.

[2]  M. Rahm,et al.  The Significance of Increased Fluid Signal on Magnetic Resonance Imaging in Lumbar Facets in Relationship to Degenerative Spondylolisthesis , 2007, Spine.

[3]  D. Sengupta,et al.  Degenerative Spondylolisthesis: Review of Current Trends and Controversies , 2005, Spine.

[4]  Qun Xia,et al.  Lumbar Facet Joint Motion in Patients with Degenerative Disc Disease at Affected and Adjacent Levels: An In Vivo Biomechanical Study , 2011, Spine.

[5]  June Ho Lee,et al.  Spinopelvic Alignment After Interspinous Soft Stabilization With a Tension Band System in Grade 1 Degenerative Lumbar Spondylolisthesis , 2010, Spine.

[6]  A. Mannion,et al.  Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis? , 2012, European Spine Journal.

[7]  Leonid Kalichman,et al.  Lumbar facet joint osteoarthritis: a review. , 2007, Seminars in arthritis and rheumatism.

[8]  D. W. Bühler,et al.  The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. , 1999, Journal of spinal disorders.

[9]  M. Pope,et al.  Etiology of Spondylolisthesis: Assessment of the Role Played by Lumbar Facet Joint Morphology , 1993, Spine.

[10]  S. Jacobsen,et al.  Degenerative Lumbar Spondylolisthesis: An Epidemiological Perspective: The Copenhagen Osteoarthritis Study , 2007, Spine.

[11]  D. Weishaupt,et al.  MR imaging of inflammatory joint diseases of the foot and ankle , 1999, Skeletal Radiology.

[12]  Gang Li,et al.  Measurement of Vertebral Kinematics Using Noninvasive Image Matching Method–Validation and Application , 2008, Spine.

[13]  Serena S. Hu,et al.  Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondylolisthesis. , 1999, Spine.

[14]  L. Weidenhielm,et al.  Three-dimensional movements of the lumbar spine facet joints and segmental movements: in vivo examinations of normal subjects with a new non-invasive method , 2012, European Spine Journal.

[15]  C. Pfirrmann,et al.  Magnetic Resonance Classification of Lumbar Intervertebral Disc Degeneration , 2001, Spine.

[16]  Brett Hanscom,et al.  Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. , 2007, The New England journal of medicine.

[17]  Gang Li,et al.  Range of Motion and Orientation of the Lumbar Facet Joints In Vivo , 2009, Spine.

[18]  H. An,et al.  Orientation and Osteoarthritis of the Lumbar Facet Joint , 2001, Clinical orthopaedics and related research.

[19]  A. Ganju.  Isthmic spondylolisthesis. , 2002, Neurosurgical focus.

[20]  H. Farfan,et al.  Instability of the lumbar spine. , 1982, Clinical orthopaedics and related research.

[21]  K. Yamaguchi,et al.  Orientation of the Lumbar Facet Joints: Association with Degenerative Disc Disease* , 1996, The Journal of bone and joint surgery. American volume.

[22]  N. Sut,et al.  Synovial cysts of the lumbar facet joints: a retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis. , 2009, Prague medical report.

[23]  Guoan Li,et al.  Segmental in vivo vertebral motion during functional human lumbar spine activities , 2009, European Spine Journal.

[24]  D. Bradford,et al.  In Vivo Analysis of Canine Intervertebral and Facet Motion , 1992, Spine.

[25]  A. Saifuddin,et al.  Dynamic Degenerative Lumbar Spondylolisthesis: Diagnosis With Axial Loaded Magnetic Resonance Imaging , 2006, Spine.

[26]  Health Related Quality of Life Following Decompression Compared to Decompression and Fusion for Degenerative Spondylolisthesis: A Canadian Multicenter Study , 2010 .

[27]  A. Guermazi,et al.  Spondylolysis and Spondylolisthesis: Prevalence and Association With Low Back Pain in the Adult Community-Based Population , 2009, Spine.

[28]  M M Panjabi,et al.  Human Lumbar Vertebrae: Quantitative Three-Dimensional Anatomy , 1992, Spine.

[29]  N. Rosenberg.  Degenerative spondylolisthesis. Predisposing factors. , 1975, The Journal of bone and joint surgery. American volume.

[30]  Adam S. Kanter,et al.  Characterization of articulation of the lumbar facets in the human cadaveric spine using a facet-based coordinate system. , 2011, The spine journal : official journal of the North American Spine Society.

[31]  K. Bridwell,et al.  Degenerative Spondylolisthesis Versus Spinal Stenosis: Does a Slip Matter? Comparison of Baseline Characteristics and Outcomes (SPORT) , 2010, Spine.

[32]  G B Andersson,et al.  The Effect of Disc Degeneration and Facet Joint Osteoarthritis on the Segmental Flexibility of the Lumbar Spine , 2000, Spine.

[33]  K. Nishida,et al.  Lumbar Multilevel Degenerative Spondylolisthesis: Radiological Evaluation and Factors Related to Anterolisthesis and Retrolisthesis , 2002, Journal of spinal disorders & techniques.

[34]  Sang-Ho Lee,et al.  Interspinous ligamentoplasty in the treatment of degenerative spondylolisthesis: midterm clinical results. , 2010, Journal of neurosurgery. Spine.

[35]  M. Adams,et al.  The Mechanical Function of the Lumbar Apophyseal Joints , 1983, Spine.

[36]  S. Peleg,et al.  Facet Orientation in the Thoracolumbar Spine: Three-dimensional Anatomic and Biomechanical Analysis , 2004, Spine.

[37]  Guizhong Wu,et al.  Lumbar Segmental Mobility According to the Grade of the Disc, the Facet Joint, the Muscle, and the Ligament Pathology by Using Kinetic Magnetic Resonance Imaging , 2009, Spine.

[38]  H N Herkowitz,et al.  Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. , 1991, The Journal of bone and joint surgery. American volume.