Analyzing the morphologic characteristics of pedicle-facet joints in lumbar spondylolysis: correlation with spinopelvic parameters and its clinical relevance
Analyzing the morphologic characteristics of pedicle-facet joints in lumbar spondylolysis: correlation with spinopelvic parameters and its clinical relevance
于江林 1唐一凡 2杜忠秋 3戚晓阳 2施鸿飞 2熊进 2陈一心 2邱旭升 4马宝意 闫富宏
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作者信息
1. 江苏大学鼓楼临床医学院，南京 210008
2. 南京大学医学院附属鼓楼医院，南京 210008
3. 南京中医药大学鼓楼临床医学院，南京 210008
4. 江苏大学鼓楼临床医学院，南京 210008;南京大学医学院附属鼓楼医院，南京 210008
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摘要
目的 基于脊柱骨盆参数分析腰椎峡部裂患者椎弓根-关节突形态学特点，并探讨其临床意义。 方法 纳入2020年5月至2023年1月于西南医科大学附属医院就诊的L5峡部裂患者121例（峡部裂组）、L4，5退行性滑脱患者108例（滑脱组）以及L4，5正常但L5S1椎间盘突出的患者100例（对照组），均行腰椎X线片及CT三维重建检查。在站立中立位腰椎侧位X线片上测量椎体滑移率（percentage of slip，SP）和脊柱骨盆参数，包括骶骨倾斜角（sacral slope，SS）和腰椎前凸角（lumbar lordosis，LL）。在腰椎CT三维重建像上测量L4和L5椎弓根-关节突关节的形态参数，包括关节突关节角（facet joint angle，FJA）、椎弓根-关节突关节角（pedicle facet angle，PFA）、关节突关节骨关节炎（osteoarthritis，OA）分级和关节突关节不对称性（facet joint tropism，FT）。比较峡部裂组、滑脱组和对照组脊柱骨盆参数、椎弓根-关节突关节形态参数的差异，分析各组组内脊柱骨盆参数和L4和L5椎弓根-关节突关节形态参数的相关性，比较各组内L4和L5椎弓根-关节突关节形态参数的差异。 结果 峡部裂组、滑脱组和对照组患者SS、LL的差异有统计学意义（F=21.910，P<0.001；F=22.439，P<0.001），峡部裂组患者SS、LL最大，滑脱组次之，对照组最小。三组间椎弓根-关节突关节形态参数比较结果显示，峡部裂组L4 FJA最大，对照组次之，滑脱组最小（F=344.791，P<0.001）；滑脱组L4 PFA最大，峡部裂组次之，对照组最小（F=193.725，P<0.001）；滑脱组L4关节突关节OA分级明显重于峡部裂组和对照组（H=467.925，P<0.001），而峡部裂组与对照组的差异无统计学意义（P>0.05）。Pearson相关分析表明，各组内SS、LL与FJA均呈负相关，而SS、LL与PFA均呈正相关（P<0.05）；各组内L4 FJA均小于L5，L4 PFA均大于L5，差异有统计学意义（P<0.05）；峡部裂组L4关节突关节OA分级明显轻于L5（Z=7.043，P<0.001），滑脱组L4关节突关节OA分级明显重于L5（Z=11.868，P<0.001），对照组L4与L5关节突关节OA分级的差异无统计学意义（Z=0.556，P=0.578）。 结论 腰椎峡部裂患者具有更大的SS和LL，其椎弓根-关节突形态学特点的明显变化提示腰椎局部受到生物应力作用更大。 Objective To delineate the morphological features of pedicle-facet joints in lumbar spondylolysis patients, correlating these with spinopelvic parameters to explore their mechanisms and clinical implications. Methods This study enrolled 121 patients with L5 spondylolysis (IS group), 108 with L4, 5 degenerative spondylolisthesis (DS group), and 100 with normal L4, 5 but L5S1 lumbar disc herniation (NL group), who underwent radiography and multislice spiral CT from May 2020 to January 2023. Parameters including vertebral slip percentage (SP) and spinopelvic alignments, such as sacral slope and lumbar lordosis, were quantified using standing lateral lumbar radiographs. Morphological parameters of the L4 and L5 facet joints were measured on 3D reconstructed lumbar CT images, including the facet joint angle (FJA), pedicle-facet joint angle (PFA), facet joint osteoarthritis (OA), and facet joint tropism (FT). Results The analysis revealed significant variances in SS and LL among the groups (F=21.910, P<0.001 F=22.439, P<0.001). The IS group exhibited the highest SS and LL, followed by the DS and NL groups. Morphological assessments showed the largest L4 FJA in the IS group, with progressive decreases in the DS and NL groups (F=344.791, P<0.001). Conversely, L4 PFA was greatest in the DS group (F=193.725, P<0.001). Notably, L4 OA was markedly more severe in the DS group compared to IS and NL groups (H=467.925, P<0.001), with no significant disparity between IS and NL groups (P>0.05). Correlation analyses within each cohort highlighted a negative association of sacral slope and lumbar lordosis with facet joint angles, yet a positive correlation with pedicle-facet joint angles both with statistical significance (P<0.05). Furthermore, L4 facet joint angles were consistently smaller than those at L5, and L4 pedicle-facet joint angles were larger than L5 (P<0.05). Osteoarthritis at L5 was more pronounced in the IS group compared to L4 (Z=7.043, P<0.001), a trend inversely observed in the DS group (Z=11.868, P<0.001), while the NL group showed no significant osteoarthritic variance between levels (Z=0.556, P=0.578). Conclusion Patients with lumbar spondylolysis demonstrate elevated sacral slope and lumbar lordosis, indicative of increased localized biomechanical stress in the lumbar spine. These alterations in the morphology of the pedicle-facet joints highlight the distinctive structural adaptations and potential strain distributions within this cohort.
Abstract
Objective To delineate the morphological features of pedicle-facet joints in lumbar spondylolysis patients, correlating these with spinopelvic parameters to explore their mechanisms and clinical implications. Methods This study enrolled 121 patients with L5 spondylolysis (IS group), 108 with L4, 5 degenerative spondylolisthesis (DS group), and 100 with normal L4, 5 but L5S1 lumbar disc herniation (NL group), who underwent radiography and multislice spiral CT from May 2020 to January 2023. Parameters including vertebral slip percentage (SP) and spinopelvic alignments, such as sacral slope and lumbar lordosis, were quantified using standing lateral lumbar radiographs. Morphological parameters of the L4 and L5 facet joints were measured on 3D reconstructed lumbar CT images, including the facet joint angle (FJA), pedicle-facet joint angle (PFA), facet joint osteoarthritis (OA), and facet joint tropism (FT). Results The analysis revealed significant variances in SS and LL among the groups (F=21.910, P<0.001 F=22.439, P<0.001). The IS group exhibited the highest SS and LL, followed by the DS and NL groups. Morphological assessments showed the largest L4 FJA in the IS group, with progressive decreases in the DS and NL groups (F=344.791, P<0.001). Conversely, L4 PFA was greatest in the DS group (F=193.725, P<0.001). Notably, L4 OA was markedly more severe in the DS group compared to IS and NL groups (H=467.925, P<0.001), with no significant disparity between IS and NL groups (P>0.05). Correlation analyses within each cohort highlighted a negative association of sacral slope and lumbar lordosis with facet joint angles, yet a positive correlation with pedicle-facet joint angles both with statistical significance (P<0.05). Furthermore, L4 facet joint angles were consistently smaller than those at L5, and L4 pedicle-facet joint angles were larger than L5 (P<0.05). Osteoarthritis at L5 was more pronounced in the IS group compared to L4 (Z=7.043, P<0.001), a trend inversely observed in the DS group (Z=11.868, P<0.001), while the NL group showed no significant osteoarthritic variance between levels (Z=0.556, P=0.578). Conclusion Patients with lumbar spondylolysis demonstrate elevated sacral slope and lumbar lordosis, indicative of increased localized biomechanical stress in the lumbar spine. These alterations in the morphology of the pedicle-facet joints highlight the distinctive structural adaptations and potential strain distributions within this cohort.
万方数据