Skip to main content

Advertisement

SpringerLink
Log in

Is there an anatomic basis for the different behavior of Lenke types 1AR and 1AL in idiopathic scoliosis? A study on facet joint tropism influence

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Introduction

AIS type 1 Curves are sub-classified based on the tilt of L4 as 1AR and 1AL. These curves are different w.r.t their curve behavior, progression and level selection. Presently there is no known anatomic etiology for the different behavior. Facet tropism (FT) is defined as the asymmetry between the facet angle of the left and right facet joints. The purpose of this study was to evaluate the correlation between facet tropism in the lumbar segments and occurrence of type 1AR and 1AL curves in AIS patients.

Methods

AIS patients with diagnosis of type 1 AR and 1AL right thoracic AIS curves who underwent posterior instrumented fusion were queried from a single institutions’ database. Patients needed to have an MRI of their entire spine to be included. L2-3, L3-4 and L4-5 Facet angles (FA, angle made by the facet line with the mid-sagittal line at respected vertebral level) were calculated. FT was classified as follows: ≤ 5° (minimal), 6- 10° (mild) and ≥ 11° (severe). 1AR and 1AL curves were compared for FA, FT and FT grade at each lumbar segmental levels.

Results

One hundred nineteen patients were included (77 females, mean age-13.85 years, mean BMI- 21.63, 73 1AL and 46 1AR). The mean thoracic Cobb was 52.5 ± 9.8°, thoracic kyphosis was 28.12 ± 12° and lumbar lordosis was 53.48 ± 12.6°. L3-4 FA on the right side was more coronally oriented in 1AR curves compared to 1AL curves (37° vs. 31°, p = 0.04). On comparing FT at each level, 1AR curves had a higher FT at L3-4 (1.5° vs. − 2.3°, p = 0.01) and L4-5 levels (5.8° vs. − 0.28°, p < 0.001) compared to 1AL patients. Similarly, 1AR patients had significantly more patients with severe FT at L3-4 (34.8% vs. 13.7%, p = 0.02) and at L4-5 (17.3% vs. 6.8%, p = 0.01) compared to 1ALcurves.

Conclusion

L3-4 joints are more coronally oriented in 1AR curves compared to 1AL curves. 1AR patients displayed higher FT at L3-4 and L4-5 compared to 1AL patients. 1AR curves also reveal a higher percentage of severe FT at L3-4 and L4-5 levels. This may influence the curve behavior and progression in these two curve types.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data is avialable with request from the authors.

References

  1. Guan Y, Yoganandan N, Moore J et al (2007) Moment–rotation responses of the human lumbosacral spinal column. J Biomech 40:1975–1980. https://doi.org/10.1016/J.JBIOMECH.2006.09.027

    Article  PubMed  Google Scholar 

  2. Adams MA, Hutton WC (1980) The effect of posture on the role of the apophysial joints in resisting intervertebral compressive forces. J Bone Jt Surg Series B 62:358–362. https://doi.org/10.1302/0301-620X.62B3.6447702

    Article  CAS  Google Scholar 

  3. McKelvy PL (1979) Clinical biomechanics of the spine. Phys Ther 59:1045–1047. https://doi.org/10.1093/PTJ/59.8.1045A

    Article  Google Scholar 

  4. Brailsford JF (1929) Deformities of the lumbosacral region of the spine. Br J Surg 16:562–627. https://doi.org/10.1002/BJS.1800166405

    Article  Google Scholar 

  5. Ko S, Chae S, Choi W et al (2019) The prevalence of facet tropism and its correlation with low back pain in selected community-based populations. Clin Orthop Surg 11(2):176–182. https://doi.org/10.4055/cios.2019.11.2.176

    Article  PubMed  PubMed Central  Google Scholar 

  6. Alonso F, Kirkpatrick CM, Jeong W et al (2017) Lumbar facet tropism: a comprehensive review. World Neurosurg 102:91–96. https://doi.org/10.1016/J.WNEU.2017.02.114

    Article  PubMed  Google Scholar 

  7. Lenke LG, Edwards CC, Bridwell KH (2003) The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve pattewrns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 28(20):S199–207

    Article  PubMed  Google Scholar 

  8. Patel PN, Upasani V, Bastrom TP et al (2008) Spontaneous lumbar curve correction in selective thoracic fusions of idiopathic scoliosis: a comparison of anterior and posterior approaches. Spine (Phila Pa 1976) 33:1068–1073. https://doi.org/10.1097/BRS.0B013E31816F6404

    Article  PubMed  Google Scholar 

  9. Edwards CC, Lenke LG, Peelle M et al (2004) Selective thoracic fusion for adolescent idiopathic scoliosis with C modifier lumbar curves: 2-to 16-year radiographic and clinical results. Spine (Phila Pa 1976) 29:536–546. https://doi.org/10.1097/01.BRS.0000109992.22248.77

    Article  PubMed  Google Scholar 

  10. Miyanji F, Pawelek JB, Van Valin SE et al (2008) Is the lumbar modifier useful in surgical decision making?: Defining two distinct Lenke 1A curve patterns. Spine (Phila Pa 1976) 33:2545–2551. https://doi.org/10.1097/BRS.0B013E3181891822

    Article  PubMed  Google Scholar 

  11. Cho RH, Yaszay B, Bartley CE et al (2012) Which Lenke 1A curves are at the greatest risk for adding-on... and why? Spine (Phila Pa 1976) 37:1384–1390. https://doi.org/10.1097/BRS.0B013E31824BAC7A

    Article  PubMed  Google Scholar 

  12. Fitzgerald R, Upasani VV, Bastrom TP et al (2019) Three-dimensional radiographic analysis of two distinct Lenke 1A curve patterns. Spine Deform 7:66–70. https://doi.org/10.1016/J.JSPD.2018.06.005

    Article  PubMed  Google Scholar 

  13. Karacan I, Aydin T, Sahin Z et al (2004) Facet angles in lumbar disc herniation: their relation to anthropometric features. Spine (Phila Pa 1976) 29(10):1132–1136. https://doi.org/10.1097/00007632-200405150-00016

    Article  PubMed  Google Scholar 

  14. Do DH, Taghavi CE, Fong W et al (2011) The relationship between degree of facet tropism and amount of dynamic disc bulge in lumbar spine of patients symptomatic for low back pain. Eur Spine J 20:71–78. https://doi.org/10.1007/S00586-010-1558-8

    Article  PubMed  Google Scholar 

  15. Iorio JA, Jakoi AM, Singla A (2016) Biomechanics of degenerative spinal disorders. Asian Spine J 10:377. https://doi.org/10.4184/ASJ.2016.10.2.377

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zander T, Rohlmann A, Bergmann G (2004) Influence of ligament stiffness on the mechanical behavior of a functional spinal unit. J Biomech 37:1107–1111. https://doi.org/10.1016/J.JBIOMECH.2003.11.019

    Article  PubMed  Google Scholar 

  17. Bashkuev M, Reitmaier S, Schmidt H (2020) Relationship between intervertebral disc and facet joint degeneration: a probabilistic finite element model study. J Biomech 102:109518. https://doi.org/10.1016/J.JBIOMECH.2019.109518

    Article  PubMed  Google Scholar 

  18. Hefti F, Hefti F (2013) Pathogenesis and biomechanics of adolescent idiopathic scoliosis (AIS). J Child Orthop 7:17–24. https://doi.org/10.1007/s11832-012-0460-9

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rankine J, Spine RD (2010) undefined Unilateral spondylolysis and the presence of facet joint tropism. Spine 35(21):E1111–1114

    Article  PubMed  Google Scholar 

  20. Ma Y, Huang P, Tu Z et al (2021) Associations between facet tropism and vertebral rotation in patients with degenerative lumbar disease. Eur J Med Res. https://doi.org/10.1186/S40001-021-00622-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kouwenhoven J-WM, Castelein RM (2008) The pathogenesis of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 33:2898–2908. https://doi.org/10.1097/BRS.0B013E3181891751

    Article  PubMed  Google Scholar 

  22. Kikanloo SR, Tarpada SP, Cho W (2019) Etiology of adolescent idiopathic scoliosis: a literature review. Asian Spine J 13:519–526. https://doi.org/10.31616/ASJ.2018.0096

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

There was no source of funding for the study.

Author information

Authors and Affiliations

  1. Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children’s Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA

    Subaraman Ramchandran, Stephen George, Benjamin Braun, Ergin Coskun & Thomas Errico

  2. Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA

    Jeffrey Spardy

Authors
  1. Subaraman Ramchandran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen George
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin Braun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey Spardy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ergin Coskun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Errico
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Data acquisition: SR, JS. Data interpretation: SR, SG, JS, BB, TE. Manuscript preparation: SR, SG, EC, BB. Manuscript critical revision: SR, SG, EC, BB, TE. Approved the version to be published: SR, SG, JS, EC, BB, TE. Agree to be accountable for all aspects of work: SR, SG, JS, EC, BB, TE.

Corresponding author

Correspondence to Subaraman Ramchandran.

Ethics declarations

Conflict of interest

Dr. J. Errico is a speaker and consultant to Stryker. He also has royalties from Stryker. Dr. Stephen George is a consultant to Globus Medical. Dr. Subaraman Ramchandran, Dr. Benjamin Braun, Dr. Jeffrey Spardy, Dr. Ergin Coskun, declare they have no financial or non-financial interests to disclose.

Ethical approval

This research was approved by the Institutional Review Board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramchandran, S., George, S., Braun, B. et al. Is there an anatomic basis for the different behavior of Lenke types 1AR and 1AL in idiopathic scoliosis? A study on facet joint tropism influence. Spine Deform 12, 159–164 (2024). https://doi.org/10.1007/s43390-023-00758-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-023-00758-y

Keywords

Search

Navigation