Lumbar facet joint subchondral bone density in low back pain and asymptomatic subjects

  • Chien-Chou Pan
  • Peter Simon
  • Alejandro A. Espinoza Orías
  • Ryota Takatori
  • Howard S. An
  • Gunnar B. J. Andersson
  • Nozomu InoueEmail author
Scientific Article



To report in vivo measurements of lumbar facet joint subchondral bone mineral density used in the description of facet joint loading patterns and to interrogate if low back pain is associated with changes in subchondral bone mineral density.

Materials and methods

In vivo measurements of lumbar facet joint subchondral bone mineral density (L1/2 to L5/S1) in Hounsfield units were performed on 89 volunteers (56 controls and 33 with low back pain) by computed tomography osteoabsorptiometry at subchondral regions between 1.5 mm and 2.5 mm below the joint surface. The facet surface was divided into five topographic zones: cranial, lateral, caudal, medial, and central.


We analyzed 1780 facet joint surfaces. Facets were denser (p < 0.0001) both in superior facets and in low back pain subjects (p < 0.0001). For the entire cohort, the facet center zone subchondral bone mineral density was higher (p < 0.0001) than that of the peripheral zones. The analyses indicate that subchondral bone mineral density is highest in patients with low back pain, the superior facets, and the center zone of the facets.


Subchondral bone mineral density is thought to reflect cumulative, long-term distribution of stress acting on a joint. This work shows that higher subchondral bone mineral density values in the center zone indicate predominant stress transmission through the center of the facet joints. Finally, the greater subchondral bone mineral density in patients with low back pain may reflect both increased load bearing by the facets secondary to disc degeneration and misdistribution of loading within the joint.


Lumbar facet joint Subchondral bone density Low back pain 



This study was supported by the National Institute on Arthritis and Musculoskeletal and Skin Diseases Grant (5P01 AR048152-10, PI: GBJ Andersson) and National Center for Complementary and Integrative Health (NCCIH) grant 1R01-AT006692-01A1, PI: N Inoue). The authors wish to thank Dr. Daniel Bohl for his careful help with editing this manuscript.


This study was funded by the NIH - NIAMS and NCCIH institutes.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© ISS 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryRush University Medical CenterChicagoUSA
  2. 2.Department of Orthopedic SurgeryTaichung Veterans General HospitalTaichungTaiwan
  3. 3.Phillip Spiegel Orthopaedic Research LaboratoryFoundation for Orthopaedic Research and EducationTampaUSA
  4. 4.Department of Orthopedics, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan

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