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Asymmetric Facet Joint Osteoarthritis and Its Relationships to Facet Orientation, Facet Tropism, and Ligamentum Flavum Thickening

Liu, Hai-xiao MD; Shen, Yue MD; Shang, Ping MD; Ma, Yan-xu MD; Cheng, Xiao-jie MD; Xu, Hua-zi MD

doi: 10.1097/BSD.0b013e31827ad875
Primary Research

Study Design: The degrees of osteoarthritis of the left and right facet joints were evaluated by using computerized tomography among elderly patients with low back or leg pain.

Objective: To reveal the phenomenon of asymmetry regarding facet joint osteoarthritis (FJOA) in old patients and establish its relationships to spinal level, facet orientation, facet tropism and ligamentum flavum (LF) thickening.

Summary of Background Data: There were few reports regarding left-right asymmetry among severity of FJOA and its relationships to spinal level, facet orientation, facet tropism, and LF thickening remained unclear.

Methods: The grade of bilateral FJOA was evaluated using 4-grade scale on computerized tomography images at the L3–4, L4–5, and L5–S1 levels of patients with age ranging from 60 to 80 years. All subjects were divided into 2 groups: symmetric FJOA group (FJOA I–II on both sides or FJOA III–IV on both sides) and asymmetric FJOA group (FJOA I–II on one side and FJOA III–IV on the other side). The relationships of FJOA to spinal level, facet orientation, facet tropism, and LF hypertrophy were evaluated.

Results: No association between asymmetric FJOA and spinal level was noted (P>0.05). In asymmetric FJOA group, significant difference in facet orientation between 2 sides was observed at the L4–5 (P=0.018) and L5–S1 levels (P=0.033). Compared with symmetric FJOA, asymmetric FJOA showed significant difference in prevalence of facet tropism at the L5–S1 level (P<0.001). The LF showed significantly thicker on the side of FJOA III–IV than the side of FJOA I–II at each level in asymmetric FJOA group (P<0.05). However, no difference was found in thickness between 2 sides in symmetric FJOA group (P>0.05).

Conclusions: Asymmetric FJOA is associated with facet orientation and tropism, but not with spinal level. There is a close relationship between severity of FJOA and LF thickness.

Departments of *Orthopaedic Surgery


Medical Imaging, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China

The authors declare no conflict of interest.

Reprints: Hua-zi Xu, MD, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, Wenzhou 325000, China (e-mail:

Received June 23, 2012

Accepted October 24, 2012

© 2016 by Lippincott Williams & Wilkins, Inc.