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Modifications in lumbar facet joint are associated with spondylolisthesis in the degenerative spine diseases: a comparative analysis

  • Original Article - Spine degenerative
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Abstract

Background

Magnetic resonance imaging (MRI) is important in the assessment of degenerative spine disease. However, its role is limited in the identification of spinal instability; therefore, weight-bearing and dynamic studies like X-rays are required. The supine position eliminates the gravitational pull, corrects the vertebral slippage, and opens the facet joints leading to the collection of the synovial fluid into the joint space, which is detected on the MRI and can serve as a marker for instability. We aim to compare the facet fluid, facet hypertrophy, facet angle, and disc degenerative changes among the patients presenting with degenerative spondylolisthesis (DS) and those without.

Methods

We performed a retrospective review for all the patients treated at our institution from January 2015 to December 2016. Facet Fluid Index (FFI) (ratio of facet fluid width and facet joint width) was calculated to assess the joint fluid. The percentage of spondylolisthesis was measured on X-rays. Each radiological parameter was compared between the two groups, i.e., patients with DS and patients without DS. A p value < 0.05 was considered significant.

Results

In total, 61 patients, 28 with DS and 33 without DS, were enrolled. Baseline characteristics were similar in the two groups (p > 0.05). The average values of FFI, facet fluid width, and the difference between the superior and inferior facet were significantly higher in the group with instability (p < 0.05). Multivariate analysis demonstrated a 4.44 (95% confidence interval [CI] 2.03–5.365) times increase in the odds of instability with a unit increase in FFI, p < 0.0001.

Conclusions

We report a positive linear correlation between the facet joint effusion and facet hypertrophy on MRI and the percentage of vertebral translation on X-ray. Prospective studies will determine if these markers can play a role in predicting spinal instability.

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Abbreviations

AUC:

area under the curve

CI:

confidence interval

DS:

degenerative spondylolisthesis

DSD:

degenerative spine disease

FFI:

facet fluid index

IQR:

inter-quartile range

JOA:

Japanese orthopedic association

MRI:

magnetic resonance imaging

NPV:

negative predictive value

ROC:

receiver operating characteristic

SD:

standard deviation

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Acknowledgments

The authors thank Wardah Khalid for the statistical advice.

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Authors and Affiliations

  1. Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 74800, Pakistan

    Komal Naeem, Karim Rizwan Nathani, Saad Akhtar Khan, Hamid Hussain Rai & Syed Ather Enam

  2. Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan

    Muhammad Danish Barakzai & Fatima Mubarak

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  1. Komal Naeem
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  2. Karim Rizwan Nathani
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  3. Muhammad Danish Barakzai
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  4. Saad Akhtar Khan
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  5. Hamid Hussain Rai
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  7. Syed Ather Enam
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Correspondence to Syed Ather Enam.

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The authors declare that they have no conflict of interest.

Details of previous presentation(s)

Part of the content of this paper was presented at the European Association of Neurosurgical Societies 2019 Congress, September 27, 2019; Dublin Ireland, oral presentation; and the 2020 American Association of Neurological Surgeons Annual Scientific Meeting, May 2020, E-poster.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. “For this type of study formal consent is not required.”

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Naeem, K., Nathani, K.R., Barakzai, M.D. et al. Modifications in lumbar facet joint are associated with spondylolisthesis in the degenerative spine diseases: a comparative analysis. Acta Neurochir 163, 863–871 (2021). https://doi.org/10.1007/s00701-020-04657-3

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  • DOI: https://doi.org/10.1007/s00701-020-04657-3

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