Correlation Between Abnormal Structure Of Lower Lumbar Facet Joint And Lumbar Disc Herniation In Adolescents

PurposeThe pathology of lumbar disc herniation(LDH)in adolescents is unclear.The purpose of this study was to explore the correlation between abnormal structure of lower lumbar facet joint(includirig Facet Tropism and irregular alteration of facet orientation)and LDH in adolescents.In addit ion,To analyze the physical distribution of 206 patients with lumbar disc herniation in our hospital.MethodsThis is a retrospective cohort study included 52 adolescents(≤20 years old)with LDH in the observation group and 111 adolescents with acute abdominal pain and no history of chronic low back pain or lumbar disc herniation in the control group.FT was defined as>10° difference between bilateral angle of the fact joint.We defined irregular alteration of facet orientation(IAFO)as no gradually increase of the facet joint angle from L3-L4 to L5-S1,including large-small-large(LSL)type,small-large-small(SLS)type,and large-small-smaller(LSS)type.The same levels of 111 adolescents without history of lower back pain or LDH were used as controls.Statistical analysis was performed using the chi-square test and Independent-samplest test.A total of 206 patients with lumbar disc herniation were enrolled.The questionnaire was used to investigate the physique classification of each patient using Wang Qi’s physique nine-point method.Combined with the related factors of lumbar disc herniation.Logistic regression was used to calculate the related influencing factors of the first three biased constitutions.ResultsThere was no significant difference in the fact angle of each segment between LDH group and control group(P>0.05).In the LDH group,19 patients had FT in L3-L4 segment,27 patients had FT in L4-L5 segment and 24 patients had FT in L5-S1 segment.In the control group,there were 19 patients,28 patients and 18 patients with FT in corresponding segment.The probability of occurrence of FT in each segment of the LDH group was significantly higher than that in the control group(P<0.05).About 34 patients with L4-L5 disc herniation in LDH group,FT appeared in 15 patients.Among the 19 patients with L5-S1 disc herniation,FT appeared in 13 patients.There was a significant difference(P<0.05)when FT appeared in the corresponding segment compared with that in the control group(P<0.05).There was no significant correlation between FT and central and lateral disc herniation(P=0.465).There were 25 patients with IAFO in the LDH group,while 34 patients with IAFO in the controls(p=0.031).In the L4-L5 segments of the LDH patients,there were 16 SLS types of IAFO and no LSL types.While in the L5-S1 segments,there were 6 SLS types of IAFO and 3 LSL types.The top three deviating physiques were yang deficiency,blood stasis and damp heat.After logistic regression analysis,yang deficiency was related to occupational nature.Blood sputum was related to long-term single working posture.Damp heat related to smoking history.ConclusionsFT and IAFO is more common in lower lumbar spine in adolescents with LDH,and is associated with adolescent.LDH.But FT is not associated with the direction of lumbar disc herniation.From the perspective of TCM constitutional theory,the biased constitution of patients with lunbar disc herniation is more common in yang deficiency,blood stasis and damp heat.The related influencing factors are also different.The dialectical treatment and nursing should consider the patient’s physical factors.