The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine

被引:411
作者
Fujiwara, A
Lim, TH
An, HS
Tanaka, N
Jeon, CH
Andersson, GBJ
Haughton, VM
机构
[1] Rush Presbyterian St Lukes Med Ctr, Dept Orthoped Surg, Chicago, IL 60612 USA
[2] Univ Wisconsin Hosp & Clin, Dept Radiol, Madison, WI 53792 USA
关键词
biomechanics; disc degeneration; facet joint osteoarthritis; lumbar spine; magnetic resonance imaging; segmental spinal motion;
D O I
10.1097/00007632-200012010-00011
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. A biomechanical and imaging study of human cadaveric spinal motion Segments, Objective. To investigate the effect of both disc degeneration and facet joint osteoarthritis on lumbar segmental motion. Summary of Background Data. Spinal degeneration includes the osteoarthritic changes of the facet joint as well as disc degeneration. Disc degeneration has been reported to be associated with spinal motion. The association of facet joint osteoarthritis with lumbar segmental motion characteristics and the combined influence of disc degeneration and facet osteoarthritis has not yet been investigated. Methods. A total of 110 lumbar-motion segments (52 female, 58 male) from 44 human lumbar spines were studied (mean age = 69 years). Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V [advanced) and the osteoarthritic changes in the facet joints in terms of cartilage degeneration, subchondral sclerosis, and osteophytes. Disc height, endplate size, and facet joint orientation and width also were measured from the computed tomographic images. Rotational: movements of the motion segment in response to the flexion, extensions lateral bending, and axial rotational moments were measured using a three-dimensional motion analysis system. Results. Female motion segments showed significantly greater motion (lateral bending: P < 0.001, flexion: P < 0.01, extension: P< 0.05) and smaller endplate size (P ( 0.001) than male ones. The segmental motion increased with increasing severity of disc degeneration up to Grade IV, but decreased in both genders when the disc degeneration advanced to Grade V. In male segments, the disc degeneration-related motion changes were significant in axial rotation (P ( 0.001), lateral bending (P < 0.05), and flexion (P < 0.05), whereas female segments showed significant changes only in axial rotation (P < 0.001). With cartilage degeneration of the facet joints, the axial rotational motion increased, whereas the lateral bending and flexion motion decreased in female segments. In male segments, however, motion in all directions increased with Grade 3 cartilage degeneration and decreased with Grade 4 cartilage:degeneration. Subchondral sclerosis significantly decreased the;motion (female: axial rotation, P< 0.05: extension, P< 0.05 vs, male: flexion, P < 0.05). Severity of osteophytes had no significant association with the segmental motion. Conclusion. Axial rotational motion was most affected by disc degeneration, and the effects of disc degeneration on the motion were similar between genders. Facet joint osteoarthritis also affected segmental motion, and the influence differed for male and female spines. Further studies are needed to clarify whether the degenerative process of facet joint osteoarthritis differs between genders and how facet joint osteoarthritis affects the stability of the spinal motion segment.
引用
收藏
页码:3036 / 3044
页数:9
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