Abstract
Purpose
The objective of this study was to establish the prevalence and significance of ossicles of lumbar articular facets (OLAF) in young athletes with backache diagnosed by multi-detector computed tomography (MDCT).
Materials and methods
The MDCT examinations of the lumbar spine carried out for suspected spondylolysis on 46 consecutive symptomatic young athletes presenting to a sports injury clinic over a 1-year period were retrospectively reviewed. OLAF study included detailed correlation with the structural and morphological stress features of the posterior neural arches. This was then compared with a control group composed of 39 patients.
Results
Twenty-three OLAF were identified in 15 patients. Eleven of the 15 patients with ossicles had posterior element stress changes (PEST)/pars defects. In the control group, two OLAF were identified in two patients, one demonstrating PEST changes.
Conclusion
The high prevalence of OLAF in young symptomatic athletes compared with the asymptomatic control group is indicative of stress fractures. The non-united articular process fractures should be regarded as part of the spectrum of stress-induced changes in the posterior neural arch in the same way as spondylolysis. MDCT with volumetric acquisition and multi-planar reformation is the most reliable investigation in the diagnosis of OLAF.
Key Points
1) This CT study supports a traumatic aetiology for lumbar articular facets ossicles.
2) OLAF represent part of a spectrum of stress-induced changes in the posterior neural arch.
3) OLAF are associated with typical spondylolysis.
4) OLAF can be overlooked on reverse gantry angle computed tomography (RG-CT).
5) OLAF may account for some of the discrepancy between radionuclide and RG-CT studies.
Similar content being viewed by others
References
Kofod S, Boll K. Anomalous ossicle in a lumbar facet joint. Arch Orthop Trauma Surg. 1987;106(5):333–4.
Bailey W. Persistent vertebral process epiphysis. Am J Roentgenol Radium Ther Nucl Med. 1939;42:85–90.
Farmer H. Accessory articular processes in the lumbar spine. Am J Roentgenol Radium Ther Nucl Med. 1939;36(6):763–7.
Hipps HE. Fissure formation in articular facets of the lumbar spine. J Bone Joint Surg. 1939;21(2):289–303.
Mitchell C. Isolated fractures of the articular processes of the lumbar vertebrae. J Bone Joint Surg. 1933;15:608–14.
Kurlander GJ, Dihl JJ. Anomalous ossification centers for the inferior articular processes of the lumbar vertebrae. Am J Roentgenol Radium Ther Nucl Med. 1967;100(1):88–91.
Muller W. Spaltbildung an Gelenk- und Dornfortsatzen der Wilbelsaule auf der basis von Umbauzonen. Fortschr Geb Rongenstr. 1931;XLIV:644.
Willis TA. An analysis of vertebral anomalies. Am J Surg. 1929;6:163.
Scheur L, Black S. The vertebral column. In: Developmental juvenile osteology. Sandiego: Academic Press; 2000. p. 208–13.
Williams A, Newell LM, Collins P. Back and macroscopic anatomy of the spinal cord. In: Standring S, Ellis H, Healy CJ, Johnson D, Williams A, editors. Gray’s anatomy, the anatomical basis of clinical practice, vol 748. 39th ed. Edinburgh: Elsevier Churchill Livingstone; 2005. p. 792–3.
Reichmann S. Longitudinal growth of the lumbar articular processes with reference to the development of clefts. Z Anat Entwicklungsgesch. 1971;133(1):124–34.
Pech P, Haughton VM. CT appearance of unfused ossicles in the lumbar spine. AJNR. 1985;6(4):629–31.
Wang ZL, Yu S, Sether LA, Haughton VM. Incidence of unfused ossicles in the lumbar facet joints: CT, MR, and cryomicrotomy study. J Comput Assist Tomogr. 1989;13(4):594–7.
Gregory PL, Batt ME, Kerslake RW, Webb JK. Single photon emission computerized tomography and reverse gantry computerized tomography findings in patients with back pain investigated for spondylolysis. Clin J Sport Med. 2005;15(2):79–86.
Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med. 2005;33(4):583–90.
Stretch RA, Botha T, Chandler S, Pretorius P. Back injuries in young fast bowlers-a radiological investigation of the healing of spondylolysis and pedicle sclerosis. S Afr Med J. 2003;93(8):611–6.
Motley G, Nyland J, Jacobs J, Caborn DN. The pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression. J Athl Train. 1998;33(4):351–8.
Omar MM, Levinson EM. An unusual fracture of the vertebral articular process in a skier. J Trauma. 1979;19(3):212–3.
McCormack RG, Athwal G. Isolated fracture of the vertebral articular facet in a gymnast. A spondylolysis mimic. Am J Sports Med. 1999;27(1):104–6.
Fehlandt Jr AF, Micheli LJ. Lumbar facet stress fracture in a ballet dancer. Spine. 1993;18(16):2537–9.
Numoto RT, Takeda M, Tani S, Abe T. Fractures of the lumbar and sacral superior articular processes: report of two cases. Neurosurgery. 2005;56(1):193.
Pal GP, Routal RV. Transmission of weight through the lower thoracic and lumbar regions of the vertebral column in man. J Anat. 1987;152:93–105.
Aruna N, Rajeshwari T, Rajangam S. Transmission of the weight through the neural arch of lumbar vertebrae. J Anat Soc India. 2003;52(2):128–31.
Standaert CJ, Herring SA. Spondylolysis: a critical review. Br J Sports Med. 2000;34(6):415–22.
Harvey CJ, Richenberg JL, Saifuddin A, Wolman RL. The radiological investigation of lumbar spondylolysis. Clin Radiol. 1998;53(10):723–8.
Campbell RS, Grainger AJ, Hide IG, Papastefanou S, Greenough CG. Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI. Skeletal Radiol. 2005;34(2):63–73.
Congeni J, McCulloch J, Swanson K. Lumbar spondylolysis. A study of natural progression in athletes. Am J Sports Med. 1997;25(2):248–53.
Keats TE. Atlas of normal Roentgen variants that may simulate disease. 6th ed.. St. Louis: Mosby;1996:267–9.
Allisy-Roberts PJ, Williams JM. Farr's physics for medical imaging. 2nd ed. Philadelphia: Saunders; 2008: 114–115
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumar, D.S., Fotiadou, A., Lalam, R. et al. Ossicles of lumbar articular facets: normal variant or spondylolytic variant?. Skeletal Radiol 41, 1559–1566 (2012). https://doi.org/10.1007/s00256-012-1428-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-012-1428-z