Facet asymmetry in normal vertebral growth: characterization and etiologic theory of scoliosis

Abstract

Study design: The shape and orientation of the thoracic and lumbar zygapophyseal facets at the T1-L5 level in children were measured and analyzed.

Objective: To detect the pattern of zygapophyseal facet asymmetry in the thoracic and lumbar spines in children.

Summary of background data: Whereas many studies have defined the pattern of zygapophyseal facet asymmetry in adults, there is insufficient data in children.

Methods: A 3-dimensional digitizer was used to measure zygapophyseal facet size, topography (length, width, concavity, convexity, and lateral interfacet height), and orientation (transverse and sagittal facet angles) at the T1-L5 level. Thirty-two complete, nonpathologic skeletons of children (age range from 4 to 17 years), housed at the Hamman-Todd Human Osteological Collection (Cleveland Museum of Natural History, Cleveland, OH) were assessed. Statistical analysis included paired t tests and analysis of variance.

Results: In general, zygapophyseal facet asymmetry in children exists only in the superior facets of the thoracic spine and is independent of age: The right superior facet is significantly shorter than the left in all thoracic vertebrae T1-T12 (up to -2.91 mm at T1), and significantly wider than the left in thoracic vertebrae T1-T9 (T8 excluded) (P < 0.003). The right superior transverse and sagittal facet angles are significantly greater than the left in thoracic vertebrae T1-T11, indicating a lesser inclination (in the sagittal plane) and more frontally positioned facet (in the transverse plane) (P < 0.003). Facet asymmetry was not evident in the superior or inferior facets of the lumbar vertebrae.

Conclusion: Facet asymmetry in thoracic vertebrae appears in early childhood. The pattern of this asymmetry differs from that reported for adults and may be considered as a possible contributing etiological factor in the development of different types of idiopathic scoliosis.