The relationship between degree of facet tropism and amount of dynamic disc bulge in lumbar spine of patients symptomatic for low back pain

Abstract

Facet tropism has been investigated as a predisposing factor for degenerative changes in the lumbar spine; however, no prior study has evaluated the relationship between disc bulge and facet tropism. In this study, we used kinetic magnetic resonance imaging (kMRI) to investigate the association between degree of facet tropism and amount of disc bulge in the lumbar spine in relation to age. kMRIs in the flexion, neutral, and extension positions were performed on 410 consecutive patients with low back pain. T2-weighted midsagittal and axial mid-disc cuts were analyzed to measure disc bulge and facet angle. Facet asymmetry was calculated and classified as: no facet tropism, <6°; mild facet tropism, 6-11°; or severe facet tropism, ≥11°. Maximal static bulge (MSB), maximal dynamic bulge (MDB), and age in the facet tropism groups were compared by age subpopulations and MDB categories, defined by the positions between which the largest change in disc bulge occurs. We found the severe facet tropism group to be associated with a nearly significant increase in MSB and MDB over the no facet tropism group in the older subpopulation at the L4-L5 level only, and a larger MDB in the L4-L5 MDB category [E-N], where the greatest change in disc bulge occurs between neutral and extension positions (p = 0.013). Our findings suggest that severe facet tropism is associated with increased disc bulge at L4-L5 in only a subset of older age patients, but may in large part be due to biomechanical factors that define the [E-N] category.

Fig. 1

Disc bulge measurement. Using T2-weighted midsagittal cuts from L3–S1, points were marked at the corner of each vertebral body, at the midpoint of the endplates, for spinal canal diameter and pedicle height. Disc bulge was calculated using this marked image by MRI Analyzer Version 3 (Truemetric Corporation, Bellflower, CA)

Fig. 2

Facet angle measurement. A facet line connecting the margins of the superior facet margin was drawn for each facet joint, and the angle with respect to the reference midsagittal line (α _L and α _R) was calculated by MRI Analyzer 3 bilaterally

Fig. 3

L4–L5: MSB, and MDB in the overall population. There was no significant difference in either MSB or MDB between the facet tropism groups

Fig. 4

L4–L5: MDB between age subpopulations and facet tropism groups. There is a significant difference in MDB between the age subpopulations in the FT++ group only. There is a significant difference in MDB between FT++ and FT− groups in the subpopulation with age ≥41 years only (*p < 0.01, ^† p = 0.051)

Fig. 5

L4–L5: MDB in MDB categories and facet tropism groups. There is a significant difference in MDB between the MDB categories in the FT++ group only. There is a significant difference in MDB between FT++ and FT−, and trend toward difference between FT++ and FT+ (*p < 0.05, ^† p < 0.05, ^‡ p = 0.076)

Fig. 6

L4–L5: MSB and MDB in [E–N] category, age ≥41 years. There was a significant difference in MDB between FT++ and FT− groups (*p < 0.05)