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Dr. Coelho just posted this on the ISIS board - I thought it deserved our attention as well:
Chicken or egg?
Chicken:
Spine. 1990 Feb;15(2):111-3.Links
Discs degenerate before facets.Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS.
Department of Orthopedics, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
The purpose of this study was to determine the relationship between facet joint osteoarthritis and disc degeneration in subjects in whom both MRI and CT scans had been obtained. The MRI scans were used to determine disc degeneration, the CT scans to determine facet joint osteoarthritis. It was hypothesized that disc degeneration would sometimes occur without the presence of facet joint osteoarthritis, but that facet joint osteoarthritis would only occur in the presence of disc degeneration. Sixty-eight sets of scans were included and 330 discs and 390 facet joints were evaluated. There were 144 degenerated discs and 41 levels with facet osteoarthritis. Disc degeneration without facet osteoarthritis was found at 108 levels, while all but one of 41 levels with facet degeneration also had disc degeneration. That one exception occurred in a patient with advanced Paget's disease. Disc degeneration and facet osteoarthritis both were found to increase with increasing age. There was no difference between women and men. Degeneration at the L4-5 and L5-S1 levels was significantly more prevalent than at the L3-4 levels, while degeneration at the L3-4 level was significantly more common than at the L1-2 and L2-3 levels. We conclude that disc degeneration occurs before facet joint osteoarthritis, which may be secondary to mechanical changes in the loading of the facet joints.
PMID: 2326704 [PubMed - indexed for MEDLINE]
Egg:
Clin Orthop Relat Res. 2007 Aug 30; [Epub ahead of print] Links
Does Lumbar Facet Arthrosis Precede Disc Degeneration?: A Postmortem Study.Eubanks JD, Lee MJ, Cassinelli E, Ahn NU.
From the *Department of Orthopaedics, Case Western Reserve University, Cleveland, OH; and the Department of Orthopaedics, Rush Medical Center, Chicago, IL.
It is believed lumbar degeneration begins in the disc, where desiccation and collapse lead to instability and compensatory facet arthrosis. We explored the contrary contention that facet degeneration precedes disc degeneration by examining 647 skeletal lumbar spines. Using facet osteophytosis as a measure of facet degeneration and vertebral rim osteophytosis as a measure of disc degeneration, we assumed bone degeneration in both locations equally reflected the progression of those in the soft tissues. We graded arthrosis Grade 0 to 4 on a continuum from no arthritis to ankylosis. The data were analyzed for different age groups to examine patterns of degeneration with age. Specimens younger than 30 years of age had a higher prevalence of facet osteophytosis compared with vertebral rim osteophotosis at L1-L2 and L2-L3. Specimens aged 30 to 39 years showed more facet osteophytosis than vertebral rim osteophytosis at L4-L5. Specimens older than 40 years, however, showed more vertebral rim osteophytosis compared with facet osteophytosis at all levels except L4-L5 and L5-S1. This skeletal study suggests facet osteophytosis appears early in the degenerative process, preceding vertebral rim osteophytosis of degenerating intervertebral discs. However, once facets begin deteriorating with age, vertebral rim osteophytosis overtakes continued facet osteophytosis. These data challenge the belief that facet osteophytosis follows vertebral rim osteophytosis; rather, it appears vertebral rim osteophytosis progresses more rapidly in later years, but facet osteophotosis occurs early, predominating in younger individuals.
PMID: 17767079 [PubMed - as supplied by publisher]
Chicken or egg?
Chicken:
Spine. 1990 Feb;15(2):111-3.Links
Discs degenerate before facets.Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS.
Department of Orthopedics, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
The purpose of this study was to determine the relationship between facet joint osteoarthritis and disc degeneration in subjects in whom both MRI and CT scans had been obtained. The MRI scans were used to determine disc degeneration, the CT scans to determine facet joint osteoarthritis. It was hypothesized that disc degeneration would sometimes occur without the presence of facet joint osteoarthritis, but that facet joint osteoarthritis would only occur in the presence of disc degeneration. Sixty-eight sets of scans were included and 330 discs and 390 facet joints were evaluated. There were 144 degenerated discs and 41 levels with facet osteoarthritis. Disc degeneration without facet osteoarthritis was found at 108 levels, while all but one of 41 levels with facet degeneration also had disc degeneration. That one exception occurred in a patient with advanced Paget's disease. Disc degeneration and facet osteoarthritis both were found to increase with increasing age. There was no difference between women and men. Degeneration at the L4-5 and L5-S1 levels was significantly more prevalent than at the L3-4 levels, while degeneration at the L3-4 level was significantly more common than at the L1-2 and L2-3 levels. We conclude that disc degeneration occurs before facet joint osteoarthritis, which may be secondary to mechanical changes in the loading of the facet joints.
PMID: 2326704 [PubMed - indexed for MEDLINE]
Egg:
Clin Orthop Relat Res. 2007 Aug 30; [Epub ahead of print] Links
Does Lumbar Facet Arthrosis Precede Disc Degeneration?: A Postmortem Study.Eubanks JD, Lee MJ, Cassinelli E, Ahn NU.
From the *Department of Orthopaedics, Case Western Reserve University, Cleveland, OH; and the Department of Orthopaedics, Rush Medical Center, Chicago, IL.
It is believed lumbar degeneration begins in the disc, where desiccation and collapse lead to instability and compensatory facet arthrosis. We explored the contrary contention that facet degeneration precedes disc degeneration by examining 647 skeletal lumbar spines. Using facet osteophytosis as a measure of facet degeneration and vertebral rim osteophytosis as a measure of disc degeneration, we assumed bone degeneration in both locations equally reflected the progression of those in the soft tissues. We graded arthrosis Grade 0 to 4 on a continuum from no arthritis to ankylosis. The data were analyzed for different age groups to examine patterns of degeneration with age. Specimens younger than 30 years of age had a higher prevalence of facet osteophytosis compared with vertebral rim osteophotosis at L1-L2 and L2-L3. Specimens aged 30 to 39 years showed more facet osteophytosis than vertebral rim osteophytosis at L4-L5. Specimens older than 40 years, however, showed more vertebral rim osteophytosis compared with facet osteophytosis at all levels except L4-L5 and L5-S1. This skeletal study suggests facet osteophytosis appears early in the degenerative process, preceding vertebral rim osteophytosis of degenerating intervertebral discs. However, once facets begin deteriorating with age, vertebral rim osteophytosis overtakes continued facet osteophytosis. These data challenge the belief that facet osteophytosis follows vertebral rim osteophytosis; rather, it appears vertebral rim osteophytosis progresses more rapidly in later years, but facet osteophotosis occurs early, predominating in younger individuals.
PMID: 17767079 [PubMed - as supplied by publisher]
