Does facet joint morphology affect the development of spondylolysis?
Hayato Ishitani
PMID 33362349WHAT IT FOUND
Junior athletes with L5 spondylolysis had L4/L5 facet joints oriented more in the coronal plane than athletes without spondylolysis.
This study cannot show that the orientation caused the defect.
Key findings
01At L4/L5, facet joint angles were significantly more coronally orientated in the bilateral spondylolysis group and in the spondylolysis side of the unilateral group than in the control group.
02At L5/S1, no significant differences were found among the bilateral, unilateral spondylolysis side, unilateral normal side, and control groups.
03No significant differences in L4/L5 facet joint angle were found between bilateral and unilateral spondylolysis sides, bilateral and normal sides, spondylolysis and normal sides, or normal side and controls.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was retrospective and did not follow athletes over time, so it cannot show that facet joint morphology caused spondylolysis. All participants had lower back pain, so the results may not apply to athletes without pain. Controls were athletes without spondylolysis whose pain eventually disappeared, which may make the comparison group different from typical asymptomatic athletes. Measurements were made by one observer from CT images, and the paper does not say the observer was blinded to group. The sample was relatively small and limited to L5 spondylolysis, with multivertebral defects and previous lumbar surgery excluded. The results are limited to facet joint angles; the paper does not report pain, function, training load, or treatment outcomes.
Declared interests
The author declared no conflict of interest.
The easy way to misread this
Do not conclude that a more coronal L4/L5 facet joint causes spondylolysis or that CT screening should be used to prevent it. The study compared existing groups and did not follow athletes over time, so it cannot establish cause or prevention.