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Degenerative spondylolisthesis. Developmental or acquired?
T W Love1, A B Fagan, R D Fraser
1Royal Adelaide Hospital, South Australia, Australia.
The Journal of Bone and Joint Surgery. British Volume
|August 27, 1999
Summary
Degenerative spondylolisthesis is more common in women, but facet joint morphology doesn't explain this difference. Loss of soft-tissue resilience likely causes facet joint failure, leading to subluxation.
Area of Science:
- Orthopedics
- Radiology
- Geriatric Medicine
Background:
- Degenerative spondylolisthesis (DS) is notably more prevalent in women than men.
- The underlying reasons for this significant gender disparity in DS remain largely unexplained.
- Previous hypotheses have focused on anatomical differences, including facet joint morphology.
Purpose of the Study:
- To investigate the role of facet joint morphology in the gender difference observed in degenerative spondylolisthesis.
- To determine if specific facet joint orientations contribute to the higher incidence of DS in women.
- To explore the relationship between facet joint angle, arthritis, and the development of DS.
Main Methods:
- Radiographic and CT scan analysis of 118 patients over 55 years old diagnosed with DS.
- Comparison with a control group of individuals under 46 years old.
- Assessment of facet joint orientation and angle in both patient and control groups.
Main Results:
- Patients with DS exhibited a higher prevalence of sagittally-oriented facet joints, confirming previous observations.
- No significant correlation was found between facet joint morphology and the gender difference in DS.
- The increased facet joint angle in DS patients was attributed to arthritic remodeling, not a primary causative factor.
Conclusions:
- Facet joint morphology does not appear to be the primary driver of the gender disparity in degenerative spondylolisthesis.
- Arthritic changes, rather than inherent joint structure, are more likely responsible for the altered facet joint angles observed in DS.
- Reduced soft-tissue resilience, leading to facet joint failure as a final protective mechanism against subluxation, is a more probable explanation for DS development.