Correlation Between Degenerative Carti Lage Pathology And MRI Change In Lumbar Facet Joint Osteoarthritis

BackgroundLumbar Facet Joint Osteoarthritis(LFOA) is a common lumbar degenerative diseases, its basic pathological characteristics including articular car tilage damage, osteophyte formation, subchondral bone sclerosis, lead to a Joint, hypertrophy and cohesion formed lumbar spinal stenosis, facet Joint reshape the sagittal orientation of the facet Joint, eventually leading to the lumbar degenerative spondylolisthesis. With the aging of the population-n, LFOA will have the increasing incidence. Facet joint degeneration in low back pain and leg pain has been paid more and more attention, and facet joints of lumbar osteoarthritis research also gradually in-depth. Domestic and foreign literature studies show that lumbar small joint osteoarthritis risk factors including five, orientation of lumbar facet joint, age, gender, disc degeneration, spinal segments. Orientation of lumbar facet joint and facet tropism play an important role in the facet joint degeneration process, and were closely related to lumbar spinal stenosis, lumbar degenerative sponclyl-olisthesis. However, the results of the research? considerable controversy. At present there are two different points of view:one is that the orientation of facet joint turn to more sagittal is primary cause, or risk factor. The sagittal orientation of facet joint is congenital morphology; The other is that sagittal orientation of facet joints result from facet joint degenerative remodeling, not innate exist. At present, the pathogenisis of lumbar facet joint, osteoarthritis has not yet clear, most, research only stay in imaging, and not deep in animal study, less sample size, not unified baseline, the human body specimens pathological study rarely reported. This study observe human lumbar facet articular cartilage pathology and MRI change, measurement sagittal orientation angles of facet joints and facet tropism, to investigate the relationship between lumbar spine facet articular cartilage degeneration and MRI change,objective1. To observate lumbar small articular cartilage pathology change, discussed the relationship between the pathology change and the degeneration mechanism, and contrast the pathology and MRI classification.2. To observate lumbar small articular cartilage pathological degeneration, measure lumbar small joint sagittal angel and facet tropism, discusses the relationship among facet joint articular cartilage pathology classification, lumbar sagittal angle, and facet tropism.3. To observate lumbar small joint degeneration imaging classification and facet joint orientation, discuss the both correlation and their clinical significance.Methods1. The study was conduct on25patients who accepted posterior lumbar decompression interbody fusion surgery (15cases of men and women10cases). Use haematoxylin and eosin stain dyeing method to observate a microscope articular cartilage histological change, adopt Nicola cartilage degeneration classification, Weishaup classification standard evaluation, Fujiwara measurement method for measuring the facet joint Angle, contrast lumbar small joint degeneration cartilage pathology classification and imaging classification, discusses relationship between the lumbar spine small articular cartilage degeneration and mechanism with pathological changes, and further discusses and analyses the articular cartilage pathology classification, lumbar sagittal orientation and facet joint tropism.2. Random selection102patients who were diagnosed lumbar spinal stenosis in May2010-September2011.Use Weishaup MRI classification standard to evaluation in small joint degeneration degree, which is divided into4degrees, and at the same time by Fujiwara measurement method for measuring the small joint sagittal angle and facet joint tropism, and to analyse the correlation among the parameters.3. Use the SPSS17.0to analysis of the data, description data by using X+S says, adopt independent t test samples, facet joint degeneration Weishaupt classification rating and small joint Angle with double variables the correlation analysis (Pearson). Facet joint tropism and the small joint degeneration by dual variable degree of correlation analysis (Spearman), measurement data between groups with single is more variables factor analysis of variance (one-way ANOVA) method, multiple comparison with LSD method or Tamhane method, inspection standards for correction. Inspection level a=0.05Result1. Comparison between small joint imaging classification and cartilage pathology classification, preliminary discussion to cartilage degeneration mechanism and pathological changes:We observed there were5cases in imaging grade level one, including cartilage degeneration pathology classification level one lease, and degeneration level two2cases, degeneration level three2cases; there were7cases in imaging degeneration level two, cartilage degeneration pathological grade2in5patients, and degeneration grade3in2cases, imaging degeneration1. level2and cartilage pathology classification degree is low; Imaging degeneration level3in8cases, cartilage degeneration class3in7cases, degeneration level41); Imaging degeneration level45cases, cartilage degeneration level45cases, imaging degeneration level3, level4and cartilage pathology classification in a high degree, and has a good reference value. Observe the cartilage pathological changes, found in cartilage degeneration process, cartilage structure change present three different forms, the first change began in cartilage surface layer, the cartilage layer damage is consistent, thickness thin the same degree, the changing patterns of cartilage degeneration and cause by vbi, cartilage nutrition lack of possibility; The second change from middle cartilage began to appear fissure, can gradually spread to the surface and cartilage subchondral bone layer, or even the cartilage looked layer; The third kind of cartilage injury limited to small local, can have obvious sag defect, and the rest of the cartilage damage mild, the second or third cartilage structure change is more tend to mechanical damage and local stress caused by high.2. Cartilage degeneration classification and lumbar small joint direction change single factor analysis of tip:Lumbar small joint sagittal Angle in different cartilage degeneration pathology between groups significant difference (P<0.05). Cartilage degeneration of the lumbar spine serious pathology to small joint sagittal change.3. Cartilage degeneration classification and lumbar small joint degree of the asymmetry of the single factor analysis tip:Lumbar small joint asymmetry problem in different cartilage degeneration no significant differences between groups (P>0.05). Cartilage degeneration pathology with bilateral small joint asymmetry problem no significant correlation.4. Small joint degeneration imaging with small joint, lumbar classification sagittal view, and the degree of the asymmetry of the correlation analysis: Lumbar small joint Angle in sagittal different imaging degeneration groups significant difference (P<0.05), and a linear related (correlation coefficient is0.484). Lumbar small joint asymmetry problem in different imaging degeneration groups significant difference (P<0.05), and a linear related (correlation coefficient is0.414). The greater the degree of small joint asymmetry, small joint imaging degeneration is, the more serious; Small joint sagittal greater perspective, small joint imaging degeneration the more serious.5. Small joint degeneration imaging and small joint classification sagittal Angle and the degree of the asymmetry of the dependent variable more single factor analysis of variance:for lumbar small joint, imaging degeneration, small joint sagittal and asymmetric degree Angle between interactions.ConclusionCompared with Cartilage pathology and imaging degeneration, between level one and two in cartilage classification, image classification, they were less consistent with each other. In level3and4, they were highly consistent with each other. Cartilage forms of change has diversified, probably with its degeneration mechanism closely related, the lumbar small joint sagittal angle in different cartilage degeneration between groups was significant difference, suggest that the small joint to the sagittal, cartilage degeneration the more serious. Lumbar facet joint Angle and facet joint tropism in different degree of imaging degeneration between groups were significant difference, the bigger facet joint asymmetric degree, the more serious the facet joint degeneration is; the greater facet joint sagittal perspective, the more serious the small joint degeneration is. With bilateral facet joint tropism and facet joints of sagittal orientation, the most serious facet joint degeneration is, andit’s the highest risks factor formation of the lumbar facet joint osteoarthritis.