FACET JOINT DEGENERATION IN PATIENTS WITH LUMBAR DISC HERNIATION AND PROBABLE DETERMINING FACTORS

ABSTRACT Objective To evaluate facet joint degeneration following surgical treatment in patients with lumbar disc herniation, seeking to correlate it with possible determining factors. Methods Cross-sectional observational study, which analyzed medical records, radiographs and magnetic resonance images of 287 patients with lumbar disc herniation treated surgically at the Spine Surgery Service of the Hospital Ortopédico de Passo Fundo. Information about age and sex was collected. In the imaging exams, the following variables were evaluated: facet joint angulation and its tropism, measured by the Karacan method, sacral slope and lumbar lordosis, measured by the Cobb method, arthrosis of the interfacetary joints, measured by the Weishaupt classification, and intervertebral disc degeneration, measured by the Pfirrmann classification. Results A statistically significant relationship was observed between facet joint degeneration and age (p = 0.002), and also between facet joint degeneration and sacral slope (p = 0.038). No correlation was found between facet joint degeneration and lumbar lordosis (p = 0.934). It was found that the most degenerated facet joints were those that had the greatest facet joint asymmetry (tropism). However, the mean degree of facet tropism did not increase homogeneously with the progression of the joint degeneration score (p = 0.380). Conclusion It was verified that there are, in fact, a multiplicity of factors related to the degree of facet joint degeneration in the low lumbar spine. Additional studies, correlated with the asymmetry of the facet joints, would be important to elucidate better preventive management of this degeneration, aiming to avert secondary low back pain and sciatica with advancing age. Level of evidence II; Retrospective study.

摘要
目的 评估腰椎间盘突出症患者手术治疗后的关节突关节（facet joint）退变情况，探讨其与潜在影响因素的相关性。
方法 本研究为横断面观察性研究，纳入帕索丰多骨科医院脊柱外科收治的287例接受手术治疗的腰椎间盘突出症患者，对其病历资料、X线片及磁共振成像（magnetic resonance images，MRI）结果进行回顾性分析。收集患者的年龄与性别信息。在影像学检查中，评估以下变量：采用Karacan法（Karacan method）测量关节突关节成角及其不对称度（tropism）、采用Cobb测量法（Cobb method）测量骶骨倾斜角（sacral slope）与腰椎前凸角（lumbar lordosis）、采用Weishaupt分级（Weishaupt classification）评估关节突关节骨关节炎程度、采用Pfirrmann分级（Pfirrmann classification）评估椎间盘退变程度。
结果 本研究观察到关节突关节退变与年龄存在统计学显著性关联（p=0.002），同时关节突关节退变与骶骨倾斜角亦存在显著相关性（p=0.038）。未发现关节突关节退变与腰椎前凸角存在相关性（p=0.934）。研究发现，退变程度最严重的关节突关节，其不对称度亦最高；但关节突不对称度的平均水平并未随关节退变评分的升高呈均匀递增趋势（p=0.380）。
结论 本研究证实，下腰椎关节突关节退变程度与多种因素相关。未来可开展针对关节突关节不对称性的相关研究，以阐明更完善的退变预防策略，从而延缓随年龄增长继发的下腰痛与坐骨神经痛。
证据等级：Ⅱ级；回顾性研究。