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Lumbar Facet and Interfacet Shape Variation During Growth in Children From the General Population: A Three-Year Follow-up MRI Study

Masharawi, Youssef M. PhD*†; Kjaer, Per PhD, MSc, PT; Bendix, Tom PhD§; Manniche, Claus MD, PhD; May, Hila BSc; Mirovsky, Yigal MD; Anekshtein, Yoram MD; Jensen, Tue S. MSc; Hershkovitz, Israel PhD

doi: 10.1097/BRS.0b013e3181971b6a

Study Design. A descriptive magnetic resonance imaging (MRI) study on the growth of the lumbar zygapophyseal facets and interfacet area in children from the general population.

Objective. To characterize lumbar facet and interfacet shape variation during growth.

Summary of Background Data. The growth of the lumbar facet and interfacet area in children from the general population has rarely been discussed in the literature. This is an important caveat considering the important role these structures play in the development of spinal anomalies.

Materials and Methods. All lumbar (L1-S1) facet and interfacet widths and transverse orientations were measured twice by the same investigator (Y.M.) from T2-weighted MRIs of 100 healthy children (51 boys and 49 girls) from the general population at the mean age of 12 to 13 years (t 0) and after 3 years at the mean age of 15 to 16 years (t 1) using the iQ-VIEW system. Statistical analysis included Student t tests and Pearson r after the Kolmogorov-Smirnov test for normal distribution.

Results. The superior facet width is correlated with individual’s height only in boys at t 0 (0.56 ≤ r ≤ 0.66). No significant asymmetry in lumbar facet width and orientation is seen in children independent of gender both at t 0 and t 1. Lumbar facets have widened significantly only in boys from t 0 to t 1 (up to 30.8%). Girls at t 1 manifest greater superior interfacet width relatively to the superior vertebral body width than boys at L2–L4. No significant difference is indicated in facet orientation of the 2 sexes at t 0 and t 1. In boys only, the superior facet rotates significantly from t 0 to t 1 (up to−10° in the interfacet angle) toward a more sagittal orientation.

Conclusion. The lumbar facet joints in boys continue to develop after the age of 12, whereas facets in girls seem to have reached maturity at that age. Moreover, lumbar facet asymmetry when noted in children can be considered as a deviation from the normal state. Further research should look into what the consequences might be.

Lumbar facet and interfacet shape of 100 healthy children was measured twice from magnetic resonance imaging at the age of 12 to 13 and after 3 years. Lumbar facets are symmetric in all children; significantly widen during growth only in boys yet girls manifest greater relative superior interfacet width than boys.

From the *Spinal Research Laboratory, Department of Physical Therapy, The Stanley Steyer School of Health Professions and †Department of Anatomy and Anthropology Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ‡The Back Research Center, Back Center Funen and §Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark Part of Clinical Locomotion Science, Ringe, Denmark; and ¶Spinal Unit, Department of Orthopedics, Assaf Harofe Medical Center, Zrifin, Israel.

Acknowledgment date: July 24, 2008. Revision date: September 10, 2008. Acceptance date: September 10, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Other funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Youssef M. Masharawi, PhD, Tel-Aviv University, University Campus, P.O.B. 39040, Ramat-Aviv, 69978 Israel; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.