Critical Values of Facet Joint Angulation and Tropism in the Development of Lumbar Degenerative Spondylolisthesis: An International, Large-Scale Multicenter Study by the AOSpine Asia Pacific Research Collaboration Consortium

Author:

Samartzis Dino1,Cheung Jason Pui Yin1,Rajasekaran Shanmuganathan2,Kawaguchi Yoshiharu3,Acharya Shankar4,Kawakami Mamoru5,Satoh Shigenobu6,Chen Wen-Jer7,Park Chun-Kun8,Lee Chong-Suh9,Foocharoen Thanit10,Nagashima Hideki11,Kuh Sunguk12,Zheng Zhaomin13,Condor Richard14,Ito Manabu15,Iwasaki Motoki16,Jeong Je Hoon17,Luk Keith D. K.1,Prijambodo Bambang18,Rege Amol19,Jahng Tae-Ahn20,Luo Zhuojing21,Tassanawipas Warat22,Acharya Narayana23,Pokharel Rohit24,Shen Yong25,Ito Takui26,Zhang Zhihai27,Aithala P Janardhana28,Kumar Gomatam Vijay29,Jabir Rahyussalim Ahmad30,Basu Saumyajit31,Li Baojun25,Moudgil Vishal32,Goss Ben33,Sham Phoebe1,Williams Richard33

Affiliation:

1. Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China

2. Department of Orthopaedics, Ganga Hospital, Coimbatore, India

3. Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan

4. Department of Orthopedics, Sir Gangaram Hospital, New Delhi, India

5. Spine Center, Wakayama Medical University, Kihoku Hospital, Ito-gun, Japan

6. Department of Spine Surgery, Eniwa Hospital, Hokkaido Japan

7. Orthopaedic Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan

8. Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea

9. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

10. Department of Orthopaedic Surgery, Khonkaen Regional Hospital, Khonkean, Thailand

11. Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Japan

12. Department of Neurosurgery, Gangnam Severance Hospital, Seoul, South Korea

13. Department of Spine Surgery, The First Hospital Affiliated of Zhongshan University, Guangzhou, China

14. Department of Orthopedics, Cebu Orthopaedic Institute, Cebu, Philippines

15. Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan

16. Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan

17. Department of Neurosurgery, College of Medicine, Soon Chun Hyang Unviersity Bucheon Hospital, Bucheon, South Korea

18. Department of Orthopaedic and Traumatology, Faculty of Medicine Airlargga University, Dr. Soetomo Teaching Hospital, Surabaya, Indonesia

19. Department of Orthopaedics, Deenanath Mangeshkar Hospital, Jehangir Hospital, Pune, India

20. Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, South Korea

21. Department of Orthopaedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China

22. Department of Orthopedics, Phramongkuthklao Army Hospital, Bangkok, Thailand

23. Dwaraka Institute of Spine Care, Bellary, India

24. Department of Orthopedics and Trauma Surgery, Spine Unit, Tribhuvan University, Teaching Hospital, Kathmandu, Nepal

25. Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China

26. Department of Orthopaedic Surgery, Niigata City General Hospital, Niigata, Japan

27. Department of Orthopaedic Surgery, Beijing 361 Hospital (Aviation General Hospital), Beijing, China

28. Department of Orthopedics, Kasturba Medical College, Manipal University, Mangalore, India

29. Department of Neurosurgery, Fortis Hospital, Kolkata, India

30. Orthopaedic and Traumatology Department, University of Indonesia/RS Ciptomangunkusumo, Jakarta, Indonesia

31. Neurosciences Division, Park Clinic, Kolkata, India

32. Department of Orthopedic, Punjab Institute of Medical Sciences Jalandhar, Jalandhar, India

33. Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia

Abstract

Study Design An international, multicenter cross-sectional image-based study performed in 33 institutions in the Asia Pacific region. Objective The study addressed the role of facet joint angulation and tropism in relation to L4–L5 degenerative spondylolisthesis (DS). Methods The study included 349 patients (63% females; mean age: 61.8 years) with single-level DS; 82 had no L4–L5 DS (group A) and 267 had L4–L5 DS (group B). Axial computed tomography and magnetic resonance imaging were utilized to assess facet joint angulations and tropism (i.e., asymmetry between facet joint angulations) between groups. Results There was a statistically significant difference between group A (left mean: 46.1 degrees; right mean: 48.2 degrees) and group B (left mean: 55.4 degrees; right mean: 57.5 degrees) in relation to bilateral L4–L5 facet joint angulations ( p < 0.001). The mean bilateral angulation difference was 7.4 and 9.6 degrees in groups A and B, respectively ( p = 0.025). A critical value of 58 degrees or greater significantly increased the likelihood of DS if unilateral (adjusted OR: 2.5; 95% CI: 1.2 to 5.5; p = 0.021) or bilateral facets (adjusted OR: 5.9; 95% CI: 2.7 to 13.2; p < 0.001) were involved. Facet joint tropism was found to be relevant between 16 and 24 degrees angulation difference (adjusted OR: 5.6; 95% CI: 1.2 to 26.1; p = 0.027). Conclusions In one of the largest studies assessing facet joint orientation in patients with DS, greater sagittal facet joint angulation was associated with L4-L5 DS, with a critical value of 58 degrees or greater increasing the likelihood of the condition for unilateral and bilateral facet joint involvement. Specific facet joint tropism categories were noted to be associated with DS.

Publisher

SAGE Publications

Subject

Neurology (clinical),Orthopedics and Sports Medicine,Surgery

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