Morphologic Study of the Facet Joint in Spondylolysis and Isthmic Spondylolisthesis

Transcription

1 Abstract Morphologic Study of the Facet Joint in Spondylolysis and Isthmic Spondylolisthesis Chang Hoon Jeon, M.D., Woo Sig Kim, M.D., Jae Hyun Cho, M.D.*, Byoung-Suck Kim, M.D., Soo Ik Awe, M.D. and Shin Young Kang, M.D. Department of Orthopaedic Surgery, Diagnostic Radiology*, Ajou University, School of Medicine, Suwon, Korea Study Design : Radiological investigation to study the morphologic difference of posterior facet joint in spondylolysis and isthmic spondylolisthesis. Objectives : To study the correlation of the clinical differences between the one with spondylolysis and another with isthmic spondylolisthesis with morphological analysis of posterior facets of lumbar spine in low back pain, anterior displacement and segmental instability. Summary of Literature Reveiw : There are many studies for the lumbar facet in back pain, disc degeneration, degenerative spondylolisthesis. However, little is known about the correlation of facet joint between the spondylolysis and isthmic spondylolisthesis. Methods : This study is done with 27 specimens which contain posterior facet and lamina from 25 patients due to spondylolysis or isthmic spondylolisthesis. We took the computed tomograms in each specimen and obtained the areas and angles of posterior facets of lumbar spine. Results : The group with spondylolysis has mean area(rt/lt) of 158.4/159.3and angle(rt/lt) of 49.8/54.0. The group with isthmic spondylolisthesis has mean area(rt/lt) of 172.3/189.6and angle(rt/lt) of 44.3/44.8. The group with segmental instability has mean(rt/lt) area of 155.9/161.8and angle of 48.1/50.4. The group without instability has mean area(rt/lt) of 173.4/185.2and angle(rt/lt) of 46.2/48.5. Conclusion : There are no significant differences between the morphologic difference of facets with back pain and without back pain. The group with isthmic spondylolisthesis has greater mean area and less mean angle of facet than the group with spondylolysis, but, there are no statistical significant differences(p>0.05). There are no significant morphologic differences of facet between the group with segmental instability and without segmental instability. Key Words : Facet joint, Spondylolysis, Isthmic spondylolisthesis. Address reprint requests to Chang Hoon Jeon, M.D. Department of Orthopaedic Surgery, College of Medicine, Ajou University #san 5 Wonchun-dong, Paldal-ku, Suwon, , Korea Tel : , Fax : , chjeon@madang.ajou.ac.kr - 9 -

2 Fig. 1. This figure shows that 3-dimensional image of the specimen which was from the patient obtained by Gill s operation, which contains pars defect superiorly, spinous process centrally, inferior facet joint inferiorly. Fig. 2. This figure shows that the method of analyzing the facet joint area in 3-dimensional image using image analyzing program

3 Fig. 3. This figure shows that the method of analyzing the facet joint angle to the sagittal plan(spinous process) in axial cut of 3 dimensional image using image analyzing program. Table 1. Areas and angles of facet joint according to the levels. Level No. Area() Angle( ) Left Right Left Right L L L Table 2. The correlation between the mean area and angle of facet joint and back pain. Pain No. Area() Angle( ) Table 3. The correlation between the mean area and angle of facet joint and anterior slippage Anterior Area() Angle( ) No. Slippage Left Right Left Right Table 4. The correlation between then mean area and angle of facet joint and instability Instability No. Area() Angle( ) Left Right Left Right

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