Facet Tropism in Low Back Pain Patients

Background: Lumbar facet tropism refers to an asymmetry in the orientation of the facet joints within the axial plane of the lumbar spine. It is theorized that this anatomical variation can alter the biomechanics of the spine, potentially predisposing it to degenerative changes.

The literature suggests a possible association between facet tropism and lumbar disc pathologies, especially disc herniation and degeneration. Furthermore, asymmetry in the facet joints has been proposed as a factor that might contribute to the development of spondylolisthesis, defined as the forward slippage of one vertebra over another. This instability in the spine can lead to low back pain and other related clinical symptoms. However, the precise nature and strength of the relationship between facet tropism and these degenerative spinal conditions remain unclear.

To address this, the current retrospective study will examine patients who presented to a Physical Medicine and Rehabilitation outpatient clinic reporting low back pain and who subsequently underwent lumbar Magnetic Resonance Imaging (MRI). The MRI images of these patients will be analyzed to identify the presence of facet tropism, disc herniation, and spondylolisthesis at the L3-L4, L4-L5, and L5-S1 spinal levels.

This retrospective study aims to explore the potential link between lumbar facet tropism and the presence of both lumbar disc herniation and spondylolisthesis in individuals experiencing low back pain.

Methods:Between 01/11/2023-01/05/2025, patients who applied to Istanbul Physical Therapy and Rehabilitation Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with the complaint of low back pain and outpatient clinic archive files will be included in the study in accordance with the inclusion and exclusion criteria. Demographic data (age, gender), etiopathology (lumbar disc herniation, spondylosis, spondylolisthesis etc.), physical therapy modalities and drug use information will be noted from the archive files. The presence/grade of disc herniation, presence of spondylolisthesis and facet measurements of lumbar MRI patients registered in the hospital imaging system will be recorded. The data will be statistically analyzed and the relationship between facet tropism, disc herniation and listhesis will be tested.

Inclusion criteria

• Male and female patients aged 18-80 years
• Patients admitted to the outpatient clinic with complaints of low back pain
• Patients with complete demographic and clinical data in their archive files
• Patients with lumbar MRI registered in the hospital imaging system after clinic admission

Exclusion criteria

• Patients with a history of lumbar surgery
• History of trauma in the lumbar region
• Active inflammatory joint disease
• Patients with central nervous system diseases such as Parkinson's disease, multiple sclerosis
• Malignancy
• Files with missing archive file records