Relationship Of Lumbar Facet Joint Asymmetry To Youth Low Back Pain And MR Quantitative Research Related To Exercise Loading

Part Ⅰ Relationship between Orientation and Asymmetry of Lumbar Facet Joint with Youth Nonspecific Low Back PainObjectiveTo investigate the relationship between orientation and asymmetry of lumbar facet joint with youth nonspecific low back pain.Methods:The object of study; diagnostic criteria of nonspecific low back pain:recurrent chronic low back pain for more than 3 months, excluding tuberculosis, tumor, gynecological diseases and lumbar dysplasia, lumbar disc protrusion, lumbar spinal stenosis, spondylolysis and spondylolisthesis and other diseases. The age were between 18 years old to 40 years old.146 patients with low back pain and 112 controls were examined by CT scan, which L3/4, L4/5 and L5/S1 bilateral facet joint angle was measured. The difference of bilateral facet angle more than or equal to 7 degrees was defined as asymmetry. the relationship between orientation and asymmetry of facet jiont with low back pain was analyzed.Statistical methods:Statistical analysis were conducted using SPSS vertion 20.0 statistical software. We used analysis of variance of repeated measure date to calculate significant difference of the facet joint angle between the case group and in the control group; used Chi-Square test to calculate significant difference of facet joint orientation, morphological type and symmetry. P< 0.05 was considered as significance.Results:In the case group,46 cases in angle symmetry, accounting for 31.51%, and 100 cases in asymmetry, accounting for 68.49%; in the control group,63 cases in angle symmetry, accounting for 56.25%, and 49 in asymmetric, accounted for 43.75%. In the case group,44 cases in morphological symmetry, accounting for 30.14%, and 102 cases in asymmetry, accounting for 69.86%; in the control group,71 cases in morphological symmetry, accounting for 63.39%, and 41 cases in asymmetry, accounted for 36.61%. There were significant differences in facet tropism and shape between the case group and the control group (P<0.01).ConclusionAsymmetry of lumbar facet joint angle and shape may be the risk factors of youth nonspecific low back pain.Part II The influence of facet joints symmetry to the values change of ADC and FA in disc by MR diffusion tensor imaging before or after the exercise loadingObjective:To discussion the impact of exercise loading for the ADC values and FA values in normal lumbar disc by MR diffusion tensor imaging, and influence of the faect jionts symmetry to the values change of ADC and FA in disc by MR diffusion tensor imaging before or after the exercise loading, early lumbar disc degeneration mechanism are presented.Subjects and Methods:30 healthy volunteers, including 24 males and 6 females,19-25 years old, were evaluated with MR T2WI and DTI of the lumbar spine before or after exercise respectively. Pfirrmann grading was evaluated with sagittal T2WI, and symmetry of L3 to S1 bilateral facet was estimated in the axial T2WI. BO map, ADC map and FA map were reconstructed according to DTI data. ADC and FA values of L1 to S1 disc was measured before or after exercise loading, the changes of ADC value and FA values before or after exercise loading and influence of faect jionts symmetry to the change was analyzed.Statistical methods:Statistical analysis were conducted using SPSS vertion 20.0 statistical software. We used analysis of variance of repeated measure date to calculate significant difference of the ADC and FA befor or after exercise, and used same method to evaluate the influence of faect jionts symmetry to the values change of ADC and FA before or after the exercise. Same segments of the lumbar intervertebral disc ADC values and FA values changes before or after exercise loading compared using two independent samples t test. P<0.05 was considered as statistically significant.Results:30 volunteers with 150 intervertebral discs were observed, ADC value and FA of 147 discs with Pfirrminn grade Ⅱ were researched. After exercise the ADC value reduced, there was significant difference (P< 0.01); the FA increased, there was no statistical significance (P>0.05).There was statistically significant (P> 0.05) of ADC values and FA values in different segments of the lumbar intervertebral disc before or after exercise.In 30 volunteers,13 cases were symmetric, and 17 cases were asymmetric After the exercise loading, the asymmetric group ADC values decreased more than symmetric group, the difference was statistically significant (P<0.05). The change of FA between the two groups was not obvious.Conclusion:DTI can quantitatively analyze disc diffusion of water molecules, after exercise, ADC value decreased, FA values increased, the change of ADC values is more sensitive. Asymmetry of the faect jionts will strengthen this effect.Part Ⅲ The influence of facet joints symmetry to the values change of T2 in the lumbar intervertebral discs and articular cartilage before or after the exercise loadingObjective:To investigate the effect of exercise loading for the T2 values ain normal lumbar disc and facet joints cartilage by MR T2mapping, and influence of the faect jionts symmetry to the change of T2 values in disc and facet joints cartilage.Subjects and Methods:25 healthy volunteers, including 19 males and 6 females,19～25 years old, were evaluated T2 values of discs and 40 healthy volunteers, including 31 males and 9 females, were evaluated T2 values of facet joints cartilage with MR T2WI and T2mapping of the lumbar spine before or after exercise respectively. Pfirrmann grading was evaluated with sagittal T2WI, and symmetry of L3 to S1 bilateral facet was estimated in the axial T2WI. Reorganizing T2 map using the original data, T2 values of intervertebral disc and bilateral facet articular cartilage were measured before or after the exercise loading. The changes of T2 values before or after exercise loading and the influence of faect jionts symmetry to the change was analyzed.Statistical methods:Statistical analysis were conducted using SPSS vertion 20.0 statistical software. We used analysis of variance of repeated measure date to calculate significant difference of the T2 values befor or after exercise, and used same method to evaluate the influence of faect jionts symmetry to the change of T2 values before or after the exercise. Same segments of the lumbar intervertebral disc T2 values changes before or after exercise loading compared using two independent samples t test. P<0.05 was considered as statistically significant.Results:After exercise the T2 value both of discs and facet joints cartilage reduced, there was significant difference (P< 0.001) in the change of facet joints cartilage only.In 25 volunteers which involved in lumbar discs test,11 cases were symmetric, and 14 cases were asymmetric. After the exercise loading, there was no significant difference (P>0.05) between symmetry group and asymmetric group. In 40 volunteers which involved in facet joints cartilage test,17 cases were symmetric, and 23 cases were asymmetric. After the exercise loading, there was significant difference (P<0.001) between symmetry group and asymmetric group.Conclusion:Magnetic resonance imaging T2mapping can quantitative analyze the change of T2 values in the nucleus pulposus and small articular cartilage before or after exercise. After exercise, the T2 value both of discs and facet joints cartilage reduced,the change of articular cartilage is more sensitive. Asymmetry of the faect jionts will strengthen this effect. Which indicate that the small facet joints asymmetry may be first impact the small articular cartilage, it may be one of the reasons to accelerate the vertebral small joint degeneration.