Association of CT-based facet joint degeneration with low back pain and spinopelvic parameters in grade I L4-5 degenerative lumbar spondylolisthesis.
Abstract
Background
Facet joint degeneration may contribute to axial low back pain in degenerative lumbar spondylolisthesis, but its relationship with symptoms and sagittal alignment remains uncertain. This study examined associations between computed tomography (CT)-based L4-5 facet degeneration, low back pain, disability, and spinopelvic parameters in grade I degenerative lumbar spondylolisthesis.
Methods
A single-center retrospective cross-sectional cohort included 126 patients, classified as having mild (n = 38), moderate (n = 52), or severe (n = 36) degeneration according to the summed bilateral L4-5 Weishaupt score. CT measurements, low back pain visual analogue scale (VAS), Oswestry Disability Index (ODI), and standing spinopelvic parameters were assessed using group comparisons, Spearman correlation, and multivariable linear regression. Because numerous comparisons and correlations were examined without a prespecified multiplicity adjustment, these analyses were considered exploratory and nominal P values are reported.
Results
Low back pain VAS scores were 3.0 ± 1.2, 4.5 ± 1.3, and 5.8 ± 1.0, while ODI values were 23.6% ± 8.3%, 35.2% ± 8.8%, and 46.1% ± 10.2% in the mild, moderate, and severe groups, respectively (all nominal P < 0.001). Facet degeneration score correlated positively with low back pain VAS, ODI, slip percentage, pelvic incidence-lumbar lordosis mismatch (PI-LL), and sagittal vertical axis (r = 0.69, 0.73, 0.70, 0.41, and 0.46, respectively; all nominal P < 0.001), and negatively with mean facet angle (r = -0.58, nominal P < 0.001). Facet degeneration score and PI-LL remained associated with low back pain VAS after adjustment for the measured covariates.
Conclusions
In this retrospective cohort, more severe CT-based facet degeneration was associated with greater low back pain, disability, vertebral slip, and sagittal malalignment. These cross-sectional and exploratory findings demonstrate association rather than causation and require prospective validation.