Clin Orthop Surg.  2019 Jun;11(2):176-182. 10.4055/cios.2019.11.2.176.

The Prevalence of Facet Tropism and Its Correlation with Low Back Pain in Selected Community-Based Populations

• Ko S
• Chae S
• Choi W
• Kim JY
• Kwon J
• Doh J

• KMID: 2445052
• DOI: http://doi.org/10.4055/cios.2019.11.2.176

Abstract

BACKGROUND
The incidence of facet tropism (FT) and its correlation with low back pain (LBP) have, to our knowledge, not yet been investigated among selected community-based populations who visited departments unrelated to LBP with their chief complaints unrelated to LBP. In this study, we aimed to evaluate the prevalence of FT among selected patients in whom LBP was not the chief complaint and the correlation between FT and LBP among these patients.
METHODS
Among patients who underwent computed tomography during 2014 for reasons unrelated to LBP, we enrolled 462 patients who satisfied the inclusion and exclusion criteria. The degree of tropism was defined as grade 0, 1, and 2 for FT, FT+, and FT++, respectively. LBP was evaluated using a modified version of the Nordic low back pain questionnaire. For additional evaluation of dynamic LBP, the question, "Did your pain go away when lying down still or standing up straight, and did it also intensify when you bend or stretch your back?," was included in the questionnaire.
RESULTS
The L4-5 intervertebral area was most frequently and severely affected by FT with an incidence rate of 46.3%, and severe FT was observed in 24.7% of the patients. FT increased with age at L2-3 and L5-S1 levels. FT at L2-3 level was correlated with LBP (p = 0.035) and dynamic LBP (p = 0.033). The FT grade at L2-3 level was correlated with dynamic LBP (p = 0.022) but not with LBP (p = 0.077). The relative risk of FT at L2-3 level was 1.614 for LBP and 1.724 for dynamic LBP.
CONCLUSIONS
The prevalence of FT among community-based populations was 46.3% and its severe form was more frequently observed at L4-5 level (24.7%). LBP was correlated with FT at L2-3 level. The relative FT-associated risk of LBP was 1.6 at L2-3 level, and the relative L2-3 FT-associated risk of dynamic LBP was 1.724.

Keyword

Low back pain; Lumbar vertebrae; Zygapophyseal joint; Tropism

Figure

• 

  Fig. 1 After setting the rear portion of the vertebral body as a datum point, we drew a vertical line through the middle of the spinous process. The angle between this “facet line” and the coronal plane of each facet joint was defined as the facet angle.

Reference

1. Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum. 2007; 37(2):69–80. PMID: 17379279.

2. Liu HX, Shen Y, Shang P, Ma YX, Cheng XJ, Xu HZ. Asymmetric facet joint osteoarthritis and its relationships to facet orientation, facet tropism, and ligamentum flavum thickening. Clin Spine Surg. 2016; 29(9):394–398. PMID: 23168391.

3. Boden SD, Riew KD, Yamaguchi K, Branch TP, Schellinger D, Wiesel SW. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am. 1996; 78(3):403–411. PMID: 8613448.

4. Karacan I, Aydin T, Sahin Z, et al. Facet angles in lumbar disc herniation: their relation to anthropometric features. Spine (Phila Pa 1976). 2004; 29(10):1132–1136. PMID: 15131443.

5. Van Schaik JP, Verbiest H, Van Schaik FD. The orientation of laminae and facet joints in the lower lumbar spine. Spine (Phila Pa 1976). 1985; 10(1):59–63. PMID: 3983702.

6. Yang KH, King AI. Mechanism of facet load transmission as a hypothesis for low-back pain. Spine (Phila Pa 1976). 1984; 9(6):557–565. PMID: 6238423.

7. Fujiwara A, Tamai K, An HS, et al. Orientation and osteoarthritis of the lumbar facet joint. Clin Orthop Relat Res. 2001; (385):88–94.

8. Abbas J, Hamoud K, Peleg S, et al. Facet joints arthrosis in normal and stenotic lumbar spines. Spine (Phila Pa 1976). 2011; 36(24):E1541–E1546. PMID: 21270684.

9. Vanharanta H, Floyd T, Ohnmeiss DD, Hochschuler SH, Guyer RD. The relationship of facet tropism to degenerative disc disease. Spine (Phila Pa 1976). 1993; 18(8):1000–1005. PMID: 8367766.

10. Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987; 18(3):233–237. PMID: 15676628.

11. Noren R, Trafimow J, Andersson GB, Huckman MS. The role of facet joint tropism and facet angle in disc degeneration. Spine (Phila Pa 1976). 1991; 16(5):530–532. PMID: 2052995.

12. Prabhoo TR, Joshi NN, Kothari J, Nene AM. 2016 SpineWeek: the role of facet tropism in the Indian population [Internet]. Singapore: SpineWeek;2016. cited 2019 Mar 30. Available from: http://www.spineweek2016.org/sites/default/files/files/Final_Prog_Spineweek2016_ONLINE_finaal.pdf.

13. Do DH, Taghavi CE, Fong W, Kong MH, Morishita Y, Wang JC. The relationship between degree of facet tropism and amount of dynamic disc bulge in lumbar spine of patients symptomatic for low back pain. Eur Spine J. 2011; 20(1):71–78. PMID: 20734211.

14. Kalichman L, Suri P, Guermazi A, Li L, Hunter DJ. Facet orientation and tropism: associations with facet joint osteoarthritis and degeneratives. Spine (Phila Pa 1976). 2009; 34(16):E579–E585. PMID: 19770601.

15. Holmstrom E, Moritz U. Low back pain: correspondence between questionnaire, interview and clinical examination. Scand J Rehabil Med. 1991; 23(3):119–125. PMID: 1835797.

16. Wang J, Yang X. Age-related changes in the orientation of lumbar facet joints. Spine (Phila Pa 1976). 2009; 34(17):E596–E598. PMID: 19644318.

17. Masharawi Y, Rothschild B, Dar G, et al. Facet orientation in the thoracolumbar spine: three-dimensional anatomic and biomechanical analysis. Spine (Phila Pa 1976). 2004; 29(16):1755–1763. PMID: 15303019.

18. Williams R, Cheung JP, Goss B, et al. An international multicenter study assessing the role of ethnicity on variation of lumbar facet joint orientation and the occurrence of degenerative spondylolisthesis in Asia Pacific: a study from the AOSpine Asia Pacific Research Collaboration Consortium. Global Spine J. 2016; 6(1):35–45. PMID: 26835200.

19. 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(7):1325–1329. PMID: 9282864.

20. Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine J. 2003; 3(6):460–465. PMID: 14609690.

21. Cyron BM, Hutton WC. Articular tropism and stability of the lumbar spine. Spine (Phila Pa 1976). 1980; 5(2):168–172. PMID: 7384910.

22. Berlemann U, Jeszenszky DJ, Buhler DW, Harms J. Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism. Eur Spine J. 1998; 7(5):376–380. PMID: 9840470.

23. Dai LY. Orientation and tropism of lumbar facet joints in degenerative spondylolisthesis. Int Orthop. 2001; 25(1):40–42. PMID: 11374266.

24. Grobler LJ, Robertson PA, Novotny JE, Pope MH. Etiology of spondylolisthesis: assessment of the role played by lumbar facet joint morphology. Spine (Phila Pa 1976). 1993; 18(1):80–91. PMID: 8434330.

25. Farfan HF, Sullivan JD. The relation of facet orientation to intervertebral disc failure. Can J Surg. 1967; 10(2):179–185. PMID: 4225346.

26. Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976). 1983; 8(3):286–293. PMID: 6226119.

27. El-Mahdi MA, Abdel Latif FY, Janko M. The spinal nerve root “innervation”, and a new concept of the clinicopathological interrelations in back pain and sciatica. Neurochirurgia (Stuttg). 1981; 24(4):137–141. PMID: 6211633.

28. Murata Y, Takahashi K, Ohtori S, Moriya H. Innervation of the sacroiliac joint in rats by calcitonin gene-related peptide-immunoreactive nerve fibers and dorsal root ganglion neurons. Clin Anat. 2007; 20(1):82–88. PMID: 16506235.

29. Suseki K, Takahashi Y, Takahashi K, Chiba T, Tanaka K, Moriya H. CGRP-immunoreactive nerve fibers projecting to lumbar facet joints through the paravertebral sympathetic trunk in rats. Neurosci Lett. 1996; 221(1):41–44. PMID: 9014176.