Rahmi ÇUBUK, Meral KOZAKÇIOĞLU, Nuri TASALI, Ayşe ATALAY, Levent ÇELİK

Lumbar disc and facet degeneration: Correlation with age and facet orientation

Amaç: Yaşın faset eklem oryantasyonu üzerindeki etkisi tam olarak aydınlatılmamıştır. Bu çalışmada faset eklemlerin dejenerasyonu, oryantasyonu ve disk dejenerasyonu ile ilişkisini farklı yaş gruplarındaki hastalarda incelemeyi amaçladık. Hastalar ve Yöntemler: Bel ve/veya bacak ağrısı bulunan, L1-S1 lomber segmentler arasında manyetik rezonans görüntülemesi uygulanan 106 hasta çalışmaya alındı. Faset eklem dejenerasyonunun değerlendirilmesi için Weishaupt ve ark., disk dejenerasyonlarının değerlendirilmesi için Pfirmann ve ark. tarafından tanımlamış olan evrelendirmeler kullanıldı. Bulgular: Yaş grupları arasında faset eklem oryantasyonları benzer bulundu. Faset eklem oryantasyon ve yaş arasında korelasyon saptanmadı. Erkek ve kadın hastalarda faset eklem oryantasyonunun faset eklem veya disk dejenerasyonu ile ilişkisi saptanmadı. Yaş tüm spinal seviyelerde faset dejenerasyonu ile korelasyon gösterdi. L3-4 düzeyi dışında tüm seviyelerde erkek hastalarda faset dejenerasyonu daha belirgindi. Sonuç: Bu çalışmada faset oryantasyonunun farklı yaş gruplarında benzer olduğu gösterilmiştir. Erkeklerde faset artrozunun daha belirgin oluşu yakın tarihli bazı çalışmalarla uyumludur. Bu çalışma disk dejenerasyonunun faset artrozuna göre daha erken başladığı görüşünü desteklemektedir.

Anahtar Kelimeler:

Manyetik rezonans görüntüleme, Yaş faktörü, Oryantasyon, Osteoartrit, Zigapofiseal eklem, Bel ağrısı

Lomber disk ve faset dejenerasyonu: Yaş ve faset oryantasyonunun korelasyonu

Objectives: The influence of age on orientation of the facet joint remains controversial. We aimed to examine facet joint degeneration, orientation and their relationships with disc degeneration in a group of patients in different age groups. Patients and Methods: The study included 106 patients with low back pain and/or leg symptoms who had undergone magnetic resonance imaging of L1-S1 lumbar segments. For evaluation of osteoarthritis of the facet joints grading described by Weishaupt et al. and for evaluation of disc degenerations grading by Pfirmann et al. were used. Results: Orientation of the facet joints were similar among age groups. Age was not correlated with facet joint orientation. Facet joint orientation was not correlated with facet or disc degeneration in neither female nor male patients. Age was positively correlated with facet degeneration at all spinal levels. At all levels except L3-4 level, facet joint degeneration was more prominent in male subjects. Conclusion: This study have demonstrated that facet joint orientation is similar among different age groups. The finding of greater prevalence and degree of facet arthrosis in men at all lumbar levels is in accordance with some recent studies. Our study supported the notion that disc degeneration precedes facet arthrosis.

Keywords:

Magnetic Resonance Imaging, Age Factors, Orientation, Osteoarthritis, Zygapophyseal Joint, Low Back Pain,

PDF

___

1) Niosi CA, Oxland TR. Degenerative mechanics of the lumbar spine. Spine J 2004;4(6 Suppl):202S-208S.
2) Eubanks JD, Lee MJ, Cassinelli E, Ahn NU. Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: an anatomic study of cadaveric specimens. Spine 2007;32:2058-62.
3) Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum 2007;37:69-80.
4) Fujiwara A, Tamai K, An HS, Lim TH, Yoshida H, Kurihashi A, et al. Orientation and osteoarthritis of the lumbar facet joint. Clin Orthop Relat Res 2001;(385):88-94.
5) Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J 2006;15:705-18.
6) Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 1999;8:396-401.
7) Noren R, Trafimow J, Andersson GB, Huckman MS. The role of facet joint tropism and facet angle in disc degeneration. Spine 1991;16:530-2.
8) Park JB, Chang H, Kim KW, Park SJ. Facet tropism: a comparison between far lateral and posterolateral lumbar disc herniations. Spine 2001;26:677-9.
9) Eubanks JD, Lee MJ, Cassinelli E, Ahn NU. Does lumbar facet arthrosis precede disc degeneration? A postmortem study. Clin Orthop Relat Res 2007;464:184-9.
10) Tischer T, Aktas T, Milz S, Putz RV. Detailed pathological changes of human lumbar facet joints L1-L5 in elderly individuals. Eur Spine J 2006;15:308-15.
11) Gries NC, Berlemann U, Moore RJ, Vernon-Roberts B. Early histologic changes in lower lumbar discs and facet joints and their correlation. Eur Spine J 2000;9:23-9.
12) Lewin T. Osteoarthrıtıs ın lumbar synovıal joınts. a morphologıc study. Acta Orthop Scand 1964; 73 (Suppl):1-112.
13) Wang ZL, Yu S, Haughton VM. Age-related changes in the lumbar facet joints. Clin Anat 1989;2:55-62.
14) Ha KY, Chang CH, Kim KW, Kim YS, Na KH, Lee JS. Expression of estrogen receptor of the facet joints in degenerative spondylolisthesis. Spine 2005;30:562-6.
15) Rosner IA, Goldberg VM, Moskowitz RW. Estrogens and osteoarthritis. Clin Orthop Relat Res 1986;(213):77-83.
16) Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS. Discs degenerate before facets. Spine 1990;15:111-3.
17) Dunlop RB, Adams MA, Hutton WC. Disc space narrowing and the lumbar facet joints. J Bone Joint Surg [Br] 1984;66:706-10.
18) Lipson SJ, Muir H. Experimental intervertebral disc degeneration: morphologic and proteoglycan changes over time. Arthritis Rheum 1981;24:12-21.
19) Kapandji IA, editor. The physiology of the joints; the trunk and the vertebral column. Vol. 3, 2nd ed. Edinburgh: Churchill Livingstone; 1974.
20) Masharawi YM, Alperovitch-Najenson D, Steinberg N, Dar G, Peleg S, Rothschild B, et al. Lumbar facet orientation in spondylolysis: a skeletal study. Spine 2007;32:E176-80.
21) Masharawi Y, Rothschild B, Dar G, Peleg S, Robinson D, Been E, et al. Facet orientation in the thoracolumbar spine: three-dimensional anatomic and biomechanical analysis. Spine 2004;29:1755-63.
22) Love TW, Fagan AB, Fraser RD. Degenerative spondylolisthesis. Developmental or acquired? J Bone Joint Surg [Br] 1999;81:670-4.
23) Grogan J, Nowicki BH, Schmidt TA, Haughton VM. Lumbar facet joint tropism does not accelerate degeneration of the facet joints. AJNR Am J Neuroradiol 1997;18:1325-9.
24) Karacan I, Aydin T, Sahin Z, Cidem M, Koyuncu H, Aktas I, et al. Facet angles in lumbar disc herniation: their relation to anthropometric features. Spine 2004;29:1132-6.
25) Cyron BM, Hutton WC. Articular tropism and stability of the lumbar spine. Spine 1980;5:168-72.
26) Grenier N, Kressel HY, Schiebler ML, Grossman RI, Dalinka MK. Normal and degenerative posterior spinal structures: MR imaging. Radiology 1987;165:517-25.
27) Leone A, Aulisa L, Tamburrelli F, Lupparelli S, Tartaglione T. The role of computed tomography and magnetic resonance in assessing degenerative arthropathy of the lumbar articular facets. Radiol Med 1994;88:547-52. [Abstract]
28) Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001;26:1873-8.