Summary
The change from coronal to sagittal plane orientation of the zygapophyseal (facet) joints at the thoracolumbar junction, coupled with differences in lumbar and thoracic spine mobility, may predispose the T10 to L2 segments to injury. To test for an association between the level of injury and variations in orientation of the zygapophyseal joints, CT investigations of 44 spinal injured patients were studied. Of these, 28 sustained burst/compression fractures and 16 demonstrated a rotation injury with disruption to one or both zygapo-Physeal joints. Injuries were examined to determine whether more congruent “mortice” joints localised the segmental level of trauma. The Chi-square statistic was used: to compare the transitional characteristics of 44 clinical cases with a “normal” patient database (n=630); to examine differences in transition patterns between the “compression” and “rotation” injury groups; and to compare the incidence of mortice joints between the clinical and normal series. A significant difference between the transition patterns of the clinical and normal series (p <0.001) appeared to account for the higher frequency of abrupt transitions in the 44 injury cases. No significant differences distinguished the transition patterns of the two injury groups. A higher incidence of mortice joints was demonstrated in the injury group compared with the normal population (p<0.02). These findings suggest that individuals with an abrupt transition have a greater predisposition to injures at the thoracolumbar junction.
Résumé
Les variations d'orientation des facettes articulaires de la charnière thoraco-lombaire du plan coronal au plan sagittal associées aux différences de mobilité des rachis lombaire et thoracique, prédisposent aux traumatismes des segments T10 à L2. Pour vérifier l'existence d'une relation entre le niveau lésionnel et l'orientation des facettes, une étude tomodensitométrique a été réalisée chez 44 traumatisés du rachis. Parmi eux, 28 présentaient une fracture avec éclatement ou écrasement, et 16 étaient porteurs d'une lésion d'un, voire de 2 processus articulaires. Les lésions furent étudiées pour déterminer si une articulation « mortaise » plus congruente était à l'origine du niveau de la lésion. Un test de χ2 fut pratiqué: pour comparer les caractéristiques de la charnière chez les 44 patients avec celles d'une population normale (nb: 630); pour préciser les différences anatomiques entre le groupe des lésions par compression et le groupe des lésions par rotation; pour comparer l'influence des facettes « mortaises» entre les 2 séries de sujets normaux et de traumatisés. Il existe une plus grande fréquence de « transition brusque de la charnière» entre les groupes normaux et traumatisés (p<0,001). Il n'existe pas de différence significative selon le type du traumatisme. On constate avec une plus grande fréquence l'existence d'articulations « mortaises » dans le groupe des traumatisés vis-à-vis du groupe des sujets normaux (p <0,02). Ces résultats suggèrent que les sujets présentant une transition brusque au niveau de la charnière ont une plus grande disposition au traumatisme.
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Singer, K.P., Willen, J., Breidahl, P.D. et al. Radiologic study of the influence of zygapophyseal joint orientation on spinal injuries at the thoracolumbar junction. Surg Radiol Anat 11, 233–239 (1989). https://doi.org/10.1007/BF02337830
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DOI: https://doi.org/10.1007/BF02337830