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Facet Orientation and Tropism: Associations With Facet Joint Osteoarthritis and Degeneratives

Kalichman, Leonid, PT, PhD*; Suri, Pradeep, MD†‡§; Guermazi, Ali, MD; Li, Ling, MPH; Hunter, David J., MBBS, PhD*†

doi: 10.1097/BRS.0b013e3181aa2acb
Clinical Case Series

Study Design. Cross-sectional study.

Objective. To evaluate the association between lumbar spine facet joint orientation, facet joint tropism, and facet joint osteoarthritis (OA) and degenerative spondylolisthesis (DS) identified by multidetector computed tomography in the community-based Framingham Heart Study.

Summary of Background Data. The association between lumbar facet joint OA, DS, and facet orientation and tropism remains unclear.

Methods. This study was an ancillary project to the Framingham Heart Study. A sample of 3529 participants of the Framingham Heart Study aged 40 to 80 underwent multidetector computed tomography imaging to assess aortic calcification. One hundred eighty-eight individuals were consecutively enrolled in this ancillary study to assess radiographic features associated with low back pain. Facet joint OA was evaluated at the L3–L4, L4–L5, and L5–S1 spinal levels, using a 4-grade scale. The association between facet joint OA, DS, and facet orientation, and tropism was examined using multiple logistic regression models adjusting for age, sex, and body mass index.

Results. At each spinal level the facet joints with OA were more sagittally oriented than those without OA, but the difference was statistically significant only at L4–L5 spinal level (P = 0.0007). Facet tropism did not show an association with facet joint OA at any spinal level. Facet orientation was significantly associated with DS (0.89 [0.84–0.94]), however, facet tropism showed no association with DS.

Conclusions. The current study confirms a significant association between sagittal orientation and OA of the lumbar facet joints at L4–L5 and DS. Facet tropism was not associated with occurrence of facet joint OA or DS. Additional, longitudinal studies are needed to understand the causal relationship between facet joint morphology and OA.

In the cross-sectional, community-based study, we found a significant association between sagittal facet orientation and lumbar facet joint osteoarthritis at L4–L5, and degenerative spondylolisthesis. Facet tropism was not associated with occurrence of facet joint osteoarthritis or degenerative spondylolisthesis. Additional, longitudinal studies are needed to understand the causal relationships.

From the *Boston University School of Medicine, Boston MA; †Division of Research, New England Baptist Hospital, Boston, MA; ‡Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; §Spaulding Rehabilitation Hospital, Boston, MA; and ¶Department of Radiology, Boston University School of Medicine, Boston, MA.

Acknowledgment date: November 23, 2008. First revision date: January 28, 2009. Second revision date: February 5, 2009. Acceptance date: February 9, 2009.

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

Federal and foundation 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.

Supported by the National Heart, Lung, and Blood Institute's Framingham Heart Study contract (No. N01-HC-25195) for the recruitment, enrollment, and examination of the Offspring and Third Generation Cohorts, and the imaging by computed tomography scan and also L. K. is supported by an Arthritis Foundation Postdoctoral Grant. Supported by the Rehabilitation Medicine Scientist Training K12 Program (RMSTP) and National Institutes of Health grant (K12 HD 01097) (to P.S.).

Address correspondence and reprint requests to David J. Hunter, MBBS, PhD, Division of Research, New England Baptist Hospital, 125 Parker Hill Ave, Boston MA 02120; E-mail: or Leonid Kalichman, Boston University School of Medicine, Boston, MA; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.