Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium

Dino Samartzis, Jason Pui Yin Cheung, Shanmuganathan Rajasekaran, Yoshiharu Kawaguchi, Shankar Acharya, Mamoru Kawakami, Shigenobu Satoh, Wen Jer Chen, Chun Kun Park, Chong Suh Lee, Thanit Foocharoen, Hideki Nagashima, Sunguk Kuh, Zhaomin Zheng, Richard Condor, Manabu Ito, Motoki Iwasaki, Je Hoon Jeong, Keith D.K. Luk, Bambang PrijambodoAmol Rege, Tae Ahn Jahng, Zhuojing Luo, Warat/Anant A. Tassanawipas, Narayana Acharya, Rohit Pokharel, Yong Shen, Takui Ito, Zhihai Zhang, Janardhana Aithala P., Gomatam Vijay Kumar, Rahyussalim Ahmad Jabir, Saumyajit Basu, Baojun Li, Vishal Moudgil, Ben Goss, Phoebe Sham, Richard Williams

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Facet joint tropism is asymmetry in orientation of the bilateral facets. Some studies have shown that tropism may increase the risk of disc degeneration and herniations, as well as degenerative spondylolisthesis (DS). It remains controversial whether tropism is a pre-existing developmental phenomena or secondary to progressive remodeling of the joint structure due to degenerative changes. As such, the following study addressed the occurrence of tropism of the lower lumbar spine (i.e. L3-S1) in a degenerative spondylolisthesis patient model. Methods: An international, multi-center cross-sectional study that consisted of 349 patients with single level DS recruited from 33 spine institutes in the Asia Pacific region was performed. Axial MRI/CT from L3-S1 were utilized to assess left and right facet joint sagittal angulation in relation to the coronal plane. The angulation difference between the bilateral facets was obtained. Tropism was noted if there was 8° or greater angulation difference between the facet joints. Tropism was noted at levels of DS and compared to immediate adjacent and distal non-DS levels, if applicable, to the index level. Age, sex-type and body mass index (BMI) were also noted and assessed in relation to tropism. Results: Of the 349 subjects, there were 63.0 % females, the mean age was 61.8 years and the mean BMI was 25.6 kg/m2. Overall, 9.7, 76.5 and 13.8 % had L3-L4, L4-L5 and L5-S1 DS, respectively. Tropism was present in 47.1, 50.6 and 31.3 % of L3-L4, L4-L5 and L5-S1 of levels with DS, respectively. Tropism involved 33.3 to 50.0 % and 33.3 to 58.8 % of the immediate adjacent and most distal non-DS levels from the DS level, respectively. Patient demographics were not found to be significantly related to tropism at any level (p > 0.05). Conclusions: To the authors' knowledge, this is one of the largest studies conducted, in particular in an Asian population, addressing facet joint tropism. Although levels with DS were noted to have tropism, immediate adjacent and distal levels with no DS also exhibited tropism, and were not related to age and other patient demographics. This study suggests that facet joint tropism or perhaps subsets of facet joint orientation may have a pre-disposed orientation that may be developmental in origin or a combination with secondary changes due to degenerative/slip effects. The presence of tropism should be noted in all imaging assessments, which may have implications in treatment decision-making, prognostication of disease progression, and predictive modeling. Having a deeper understanding of such concepts may further elaborate on the precision phenotyping of the facets and their role in more personalized spine care. Additional prospective and controlled studies are needed to further validate the findings.

Original languageEnglish
Article number9
JournalScoliosis and Spinal Disorders
Volume11
Issue number1
DOIs
Publication statusPublished - 09-02-2016
Externally publishedYes

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Zygapophyseal Joint
Tropism
Spondylolisthesis
Multicenter Studies
Research
Spine
Body Mass Index
Demography
Intervertebral Disc Degeneration

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

Samartzis, Dino ; Cheung, Jason Pui Yin ; Rajasekaran, Shanmuganathan ; Kawaguchi, Yoshiharu ; Acharya, Shankar ; Kawakami, Mamoru ; Satoh, Shigenobu ; Chen, Wen Jer ; Park, Chun Kun ; Lee, Chong Suh ; Foocharoen, Thanit ; Nagashima, Hideki ; Kuh, Sunguk ; Zheng, Zhaomin ; Condor, Richard ; Ito, Manabu ; Iwasaki, Motoki ; Jeong, Je Hoon ; Luk, Keith D.K. ; Prijambodo, Bambang ; Rege, Amol ; Jahng, Tae Ahn ; Luo, Zhuojing ; Tassanawipas, Warat/Anant A. ; Acharya, Narayana ; Pokharel, Rohit ; Shen, Yong ; Ito, Takui ; Zhang, Zhihai ; Aithala P., Janardhana ; Kumar, Gomatam Vijay ; Jabir, Rahyussalim Ahmad ; Basu, Saumyajit ; Li, Baojun ; Moudgil, Vishal ; Goss, Ben ; Sham, Phoebe ; Williams, Richard. / Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium. In: Scoliosis and Spinal Disorders. 2016 ; Vol. 11, No. 1.
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title = "Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium",
abstract = "Background: Facet joint tropism is asymmetry in orientation of the bilateral facets. Some studies have shown that tropism may increase the risk of disc degeneration and herniations, as well as degenerative spondylolisthesis (DS). It remains controversial whether tropism is a pre-existing developmental phenomena or secondary to progressive remodeling of the joint structure due to degenerative changes. As such, the following study addressed the occurrence of tropism of the lower lumbar spine (i.e. L3-S1) in a degenerative spondylolisthesis patient model. Methods: An international, multi-center cross-sectional study that consisted of 349 patients with single level DS recruited from 33 spine institutes in the Asia Pacific region was performed. Axial MRI/CT from L3-S1 were utilized to assess left and right facet joint sagittal angulation in relation to the coronal plane. The angulation difference between the bilateral facets was obtained. Tropism was noted if there was 8° or greater angulation difference between the facet joints. Tropism was noted at levels of DS and compared to immediate adjacent and distal non-DS levels, if applicable, to the index level. Age, sex-type and body mass index (BMI) were also noted and assessed in relation to tropism. Results: Of the 349 subjects, there were 63.0 {\%} females, the mean age was 61.8 years and the mean BMI was 25.6 kg/m2. Overall, 9.7, 76.5 and 13.8 {\%} had L3-L4, L4-L5 and L5-S1 DS, respectively. Tropism was present in 47.1, 50.6 and 31.3 {\%} of L3-L4, L4-L5 and L5-S1 of levels with DS, respectively. Tropism involved 33.3 to 50.0 {\%} and 33.3 to 58.8 {\%} of the immediate adjacent and most distal non-DS levels from the DS level, respectively. Patient demographics were not found to be significantly related to tropism at any level (p > 0.05). Conclusions: To the authors' knowledge, this is one of the largest studies conducted, in particular in an Asian population, addressing facet joint tropism. Although levels with DS were noted to have tropism, immediate adjacent and distal levels with no DS also exhibited tropism, and were not related to age and other patient demographics. This study suggests that facet joint tropism or perhaps subsets of facet joint orientation may have a pre-disposed orientation that may be developmental in origin or a combination with secondary changes due to degenerative/slip effects. The presence of tropism should be noted in all imaging assessments, which may have implications in treatment decision-making, prognostication of disease progression, and predictive modeling. Having a deeper understanding of such concepts may further elaborate on the precision phenotyping of the facets and their role in more personalized spine care. Additional prospective and controlled studies are needed to further validate the findings.",
author = "Dino Samartzis and Cheung, {Jason Pui Yin} and Shanmuganathan Rajasekaran and Yoshiharu Kawaguchi and Shankar Acharya and Mamoru Kawakami and Shigenobu Satoh and Chen, {Wen Jer} and Park, {Chun Kun} and Lee, {Chong Suh} and Thanit Foocharoen and Hideki Nagashima and Sunguk Kuh and Zhaomin Zheng and Richard Condor and Manabu Ito and Motoki Iwasaki and Jeong, {Je Hoon} and Luk, {Keith D.K.} and Bambang Prijambodo and Amol Rege and Jahng, {Tae Ahn} and Zhuojing Luo and Tassanawipas, {Warat/Anant A.} and Narayana Acharya and Rohit Pokharel and Yong Shen and Takui Ito and Zhihai Zhang and {Aithala P.}, Janardhana and Kumar, {Gomatam Vijay} and Jabir, {Rahyussalim Ahmad} and Saumyajit Basu and Baojun Li and Vishal Moudgil and Ben Goss and Phoebe Sham and Richard Williams",
year = "2016",
month = "2",
day = "9",
doi = "10.1186/s13013-016-0062-2",
language = "English",
volume = "11",
journal = "Scoliosis and Spinal Disorders",
issn = "1748-7161",
publisher = "BioMed Central",
number = "1",

}

Samartzis, D, Cheung, JPY, Rajasekaran, S, Kawaguchi, Y, Acharya, S, Kawakami, M, Satoh, S, Chen, WJ, Park, CK, Lee, CS, Foocharoen, T, Nagashima, H, Kuh, S, Zheng, Z, Condor, R, Ito, M, Iwasaki, M, Jeong, JH, Luk, KDK, Prijambodo, B, Rege, A, Jahng, TA, Luo, Z, Tassanawipas, WAA, Acharya, N, Pokharel, R, Shen, Y, Ito, T, Zhang, Z, Aithala P., J, Kumar, GV, Jabir, RA, Basu, S, Li, B, Moudgil, V, Goss, B, Sham, P & Williams, R 2016, 'Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium', Scoliosis and Spinal Disorders, vol. 11, no. 1, 9. https://doi.org/10.1186/s13013-016-0062-2

Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium. / Samartzis, Dino; Cheung, Jason Pui Yin; Rajasekaran, Shanmuganathan; Kawaguchi, Yoshiharu; Acharya, Shankar; Kawakami, Mamoru; Satoh, Shigenobu; Chen, Wen Jer; Park, Chun Kun; Lee, Chong Suh; Foocharoen, Thanit; Nagashima, Hideki; Kuh, Sunguk; Zheng, Zhaomin; Condor, Richard; Ito, Manabu; Iwasaki, Motoki; Jeong, Je Hoon; Luk, Keith D.K.; Prijambodo, Bambang; Rege, Amol; Jahng, Tae Ahn; Luo, Zhuojing; Tassanawipas, Warat/Anant A.; Acharya, Narayana; Pokharel, Rohit; Shen, Yong; Ito, Takui; Zhang, Zhihai; Aithala P., Janardhana; Kumar, Gomatam Vijay; Jabir, Rahyussalim Ahmad; Basu, Saumyajit; Li, Baojun; Moudgil, Vishal; Goss, Ben; Sham, Phoebe; Williams, Richard.

In: Scoliosis and Spinal Disorders, Vol. 11, No. 1, 9, 09.02.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium

AU - Samartzis, Dino

AU - Cheung, Jason Pui Yin

AU - Rajasekaran, Shanmuganathan

AU - Kawaguchi, Yoshiharu

AU - Acharya, Shankar

AU - Kawakami, Mamoru

AU - Satoh, Shigenobu

AU - Chen, Wen Jer

AU - Park, Chun Kun

AU - Lee, Chong Suh

AU - Foocharoen, Thanit

AU - Nagashima, Hideki

AU - Kuh, Sunguk

AU - Zheng, Zhaomin

AU - Condor, Richard

AU - Ito, Manabu

AU - Iwasaki, Motoki

AU - Jeong, Je Hoon

AU - Luk, Keith D.K.

AU - Prijambodo, Bambang

AU - Rege, Amol

AU - Jahng, Tae Ahn

AU - Luo, Zhuojing

AU - Tassanawipas, Warat/Anant A.

AU - Acharya, Narayana

AU - Pokharel, Rohit

AU - Shen, Yong

AU - Ito, Takui

AU - Zhang, Zhihai

AU - Aithala P., Janardhana

AU - Kumar, Gomatam Vijay

AU - Jabir, Rahyussalim Ahmad

AU - Basu, Saumyajit

AU - Li, Baojun

AU - Moudgil, Vishal

AU - Goss, Ben

AU - Sham, Phoebe

AU - Williams, Richard

PY - 2016/2/9

Y1 - 2016/2/9

N2 - Background: Facet joint tropism is asymmetry in orientation of the bilateral facets. Some studies have shown that tropism may increase the risk of disc degeneration and herniations, as well as degenerative spondylolisthesis (DS). It remains controversial whether tropism is a pre-existing developmental phenomena or secondary to progressive remodeling of the joint structure due to degenerative changes. As such, the following study addressed the occurrence of tropism of the lower lumbar spine (i.e. L3-S1) in a degenerative spondylolisthesis patient model. Methods: An international, multi-center cross-sectional study that consisted of 349 patients with single level DS recruited from 33 spine institutes in the Asia Pacific region was performed. Axial MRI/CT from L3-S1 were utilized to assess left and right facet joint sagittal angulation in relation to the coronal plane. The angulation difference between the bilateral facets was obtained. Tropism was noted if there was 8° or greater angulation difference between the facet joints. Tropism was noted at levels of DS and compared to immediate adjacent and distal non-DS levels, if applicable, to the index level. Age, sex-type and body mass index (BMI) were also noted and assessed in relation to tropism. Results: Of the 349 subjects, there were 63.0 % females, the mean age was 61.8 years and the mean BMI was 25.6 kg/m2. Overall, 9.7, 76.5 and 13.8 % had L3-L4, L4-L5 and L5-S1 DS, respectively. Tropism was present in 47.1, 50.6 and 31.3 % of L3-L4, L4-L5 and L5-S1 of levels with DS, respectively. Tropism involved 33.3 to 50.0 % and 33.3 to 58.8 % of the immediate adjacent and most distal non-DS levels from the DS level, respectively. Patient demographics were not found to be significantly related to tropism at any level (p > 0.05). Conclusions: To the authors' knowledge, this is one of the largest studies conducted, in particular in an Asian population, addressing facet joint tropism. Although levels with DS were noted to have tropism, immediate adjacent and distal levels with no DS also exhibited tropism, and were not related to age and other patient demographics. This study suggests that facet joint tropism or perhaps subsets of facet joint orientation may have a pre-disposed orientation that may be developmental in origin or a combination with secondary changes due to degenerative/slip effects. The presence of tropism should be noted in all imaging assessments, which may have implications in treatment decision-making, prognostication of disease progression, and predictive modeling. Having a deeper understanding of such concepts may further elaborate on the precision phenotyping of the facets and their role in more personalized spine care. Additional prospective and controlled studies are needed to further validate the findings.

AB - Background: Facet joint tropism is asymmetry in orientation of the bilateral facets. Some studies have shown that tropism may increase the risk of disc degeneration and herniations, as well as degenerative spondylolisthesis (DS). It remains controversial whether tropism is a pre-existing developmental phenomena or secondary to progressive remodeling of the joint structure due to degenerative changes. As such, the following study addressed the occurrence of tropism of the lower lumbar spine (i.e. L3-S1) in a degenerative spondylolisthesis patient model. Methods: An international, multi-center cross-sectional study that consisted of 349 patients with single level DS recruited from 33 spine institutes in the Asia Pacific region was performed. Axial MRI/CT from L3-S1 were utilized to assess left and right facet joint sagittal angulation in relation to the coronal plane. The angulation difference between the bilateral facets was obtained. Tropism was noted if there was 8° or greater angulation difference between the facet joints. Tropism was noted at levels of DS and compared to immediate adjacent and distal non-DS levels, if applicable, to the index level. Age, sex-type and body mass index (BMI) were also noted and assessed in relation to tropism. Results: Of the 349 subjects, there were 63.0 % females, the mean age was 61.8 years and the mean BMI was 25.6 kg/m2. Overall, 9.7, 76.5 and 13.8 % had L3-L4, L4-L5 and L5-S1 DS, respectively. Tropism was present in 47.1, 50.6 and 31.3 % of L3-L4, L4-L5 and L5-S1 of levels with DS, respectively. Tropism involved 33.3 to 50.0 % and 33.3 to 58.8 % of the immediate adjacent and most distal non-DS levels from the DS level, respectively. Patient demographics were not found to be significantly related to tropism at any level (p > 0.05). Conclusions: To the authors' knowledge, this is one of the largest studies conducted, in particular in an Asian population, addressing facet joint tropism. Although levels with DS were noted to have tropism, immediate adjacent and distal levels with no DS also exhibited tropism, and were not related to age and other patient demographics. This study suggests that facet joint tropism or perhaps subsets of facet joint orientation may have a pre-disposed orientation that may be developmental in origin or a combination with secondary changes due to degenerative/slip effects. The presence of tropism should be noted in all imaging assessments, which may have implications in treatment decision-making, prognostication of disease progression, and predictive modeling. Having a deeper understanding of such concepts may further elaborate on the precision phenotyping of the facets and their role in more personalized spine care. Additional prospective and controlled studies are needed to further validate the findings.

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