| Study purpose:The lumbar facet joints(Facet joints,FJs)are bilateral symmetrical synovial joints covered with hyaline cartilage,synovial membrane and joint capsule.Particular joint osteoarthritis is an important feature of degenerative spinal diseases,and it is accompanied by typical osteoarthritis-like changes during degeneration,mainly manifested as narrowing of the small joint space,bone sclerosis,joint hypertrophy,subchondral bone erosion,etc.,which is considered to be a major cause of chronic low back pain.However,in practical clinical work,there seems to be little attention to the low back pain caused by facet degeneration,and most previous studies are limited to a specific parameter of the facet joint,and there are few studies on the comprehensive evaluation of the facet joint.The subchondral bone connects hyaline cartilage and cancellous bone and plays an important role in reducing joint loading.However,so far,few literature reports have studied subchondral bone,and little is known about the changes of subchondral bone structure in facet joints.Therefore,a comprehensive assessment of facet morphology and bone structural parameters is necessary for the diagnosis and treatment of facet OA.To this end,the purpose of this study(1)to quantitatively measure the thickness and density of the subchondral bone,as well as the morphological and bone structural parameters of the facet joints,and reveal their changes in people with symptoms of low back pain.(2)According to the imaging grading criteria of Weishuapt,the lumbar facet joint OA was evaluated,and then the relationship between these quantitative parameters and FJOA was analyzed.Study content and methods:49 eligible patients and normal control group were selected,and all enrolled cases were subjected to multilayer spiral CT(Philips Ingenuity 64)scan,scanning layer thickness 3 mm,reconstruction layer thickness 1mm,visual field 200×200 mm,KV 120 kv,m As 300 m As.The thickness and density of the L3,L4 and the morphological parameters of the facet joints were measured at the upper endplate level of the L 3,L 4 and L5 vertebrae,and the degree of facet degeneration was graded according to the standard of Weishuapt’s imaging method.All the collected data were statistically analyzed by SPSS software to analyze the change patterns of the above parameters in different segments of the lumbar spine and their relationship with the degeneration of the facet joints.Results:1.facet joint orientation(FO)and facet joint tropism(FT)gradually increased with increasing lumbar segments,but there was no significant difference between the patient and control groups.2.the cortical thickness of the facet joint increased with increasing lumbar segments,and the cortical thickness of the superior articular in all facet joints was greater than that of the inferior articular,but there was no significant difference between the patient and control groups.The cortical thickness decreased significantly with age in the patient group(L3: r=﹣0.494 p=0.000,L4: r=﹣0.458 p=0.001,L5: r=﹣0.340 p=0.017)in the control group;also,cortical thickness was not significantly associated with FJOA.3.the cortical density increased with increasing lumbar segments,and the cortical density of the superior articular in all facet joints was greater than that of the inferior articular,but there was no significant difference between the patient and control groups.The density decreased significantly with age(L3: r=﹣0.500 p=0.000,L4: r=﹣0.482 p=0.000,L5: r=﹣0.453 p=0.001),with no correlation in the control group except for L3 level(r=﹣0.361 p=0.011).In addition,cortical thickness showed no significant association with FJOA.4.the density and thickness of the lumbar facet joint showed a significant positive correlation at L3,L4,L5 and L5(patients L3: r=0.484 p=0.000,L4: r=0.601p=0.000,L5: r=0.566 p=0.000,control group L3: r=0.537 p=0.000,L4: r=0.532p=0.000,L5: r=0.531 p=0.000).5.The facet joint space width(FJW)increased with the increase of lumbar segments.Overall,the facet joint space width in the control group was greater than that in the patient group.FJW and FJOA severity significantly(L3: r= ﹣ 0.427p=0.002,L4: r=﹣0.361 p=0.011,L5:r=﹣0.322 p=0.024)but not in the control group.6.Facet joint space width(FJW)can be used as a good indicator to diagnose the severity of FJOA.7.The facet joint space area(FJA)increases gradually with the increase of lumbar spine segments.In patients group(L3:18.72 ± 4.86,L4:21.47 ± 5.34,L5:22.35 ± 6.86 mm~2),control group(L3:19.52 ± 4.49,L4:22.82 ± 5.02,L5: L5.02 ±5.69 ± 5.32 mm~2),Although FJA was only significantly different in the patient group and the control group at L5,after comparing the mean FJA with FJOA,we found a significant negative correlation between FJA and FJOA at all study levels(L3: r=﹣0.234 p=0.020,L4: r=﹣0.248 p=0.014,L5: r=﹣0.252 p=0.012).Conclusion:1.The facet joint orientation(FO)changes from sagittal to coronalization with the increase of spine level.The facet direction and facet tropism reflect the degree of asymmetry of the facet,and the more the facet direction is sagittal,the more correlation it is with the facet degeneration.2.The change law of the thickness and density of the bone cortex of the lumbar facet joints is in line with the evolution process of common osteoarthritis,that is,with the growth of age,the wear and tear of the articular surface gradually increases,and the thickness and density of the bone cortex of the facet joints gradually decrease.In addition,the cortical thickness and density of facet joints were not significantly associated with FJOA.3.Facet joint space width(FJW)is prevalent in the population and has a significant negative correlation with age.The facet joint space width in the patient group was less than the control group and showed a significant negative correlation with FJOA.4.The width of the facet joint space can be used as a good indicator to diagnose the severity of FJOA.5.There is a significant negative correlation between facet joint space area(FJA)and FJOA,that is,the smaller the space area,the more serious the degeneration of facet joint. |
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