Systematic Review of Facet Tropism as it Relates to Degenerative Disc Disease in the Lumbar Spine: The Overlooked Synovial Joint

Presented at SMISS Annual Forum 2018
By Fabio Pencle MBBS
With Moawiah Mustafa , Luai Mustafa , Omar Viqar , Zaid Sheikh , Kingsley Chin MD,

Disclosures: Fabio Pencle MBBS None Moawiah Mustafa None, Luai Mustafa None, Omar Viqar None, Zaid Sheikh None, Kingsley Chin MD D; SpineFrontier,


Lower back pain affects 28% of adults and is the fifth most common reason for visiting a physician in the United States. Degenerative disc disease, degenerative spondylolisthesis, arthritis, and facet arthrosis are major contributory pathologies for lower back pain. The facet joints, also known as the zygapophyseal joints, are located in the posterior aspect of the vertebral column and are the only true synovial joints between the vertebrae in humans.


Our goal is to study the facet processes in particular because of scarce information noted in the literature. The question remains if facet tropism is the root underlying cause leading to these major contributing pathologies or merely a symptom of another etiology.


According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of PubMed, Scopus, Cochrane database and EMBASE was performed on February 6th, 2018. The employed search strategy including all Medical Subject Heading (MeSH) terms consisted of the following: (“Facet Tropism”) AND (“Degenerative disc disease”).


A total of 8813 unique articles were identified from all four databases through the systematic search. The title and abstract were screened for meeting the inclusion criteria. A total of 30 articles were found with a combination of keywords (“Facet Tropism”) AND (“Degenerative disc disease”). Analysis of studies demonstrated that facet tropism was associated with muscular asymmetry in patients with chronic low back pain. Several key relationships have been shown across the studies. There is an increased stress transmission, stress concentration across the facet joint and disc. This could cause spondylosis, spondylolisthesis at proximal adjacent segment as well as lumbar degenerative disc disease. One study noted more FT in people with progressive facet arthrosis (PFA) vs. without PFA. The data presented in this study suggests that facet tropism is correlated significantly with facet joint degeneration in segments which are involved in frequent segmental motion. Mean facet tropism showed no significant difference between patients with far lateral and posterolateral lumbar disk herniations, this contradicts the previous article.


This study aimed to review the available literature to assess facet joint tropism in lumbar degenerative disc disease. The literature and analysis demonstrate a definite correlation between both and may be a major factor for the treatment in lower back pain.