We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years ( ) as well as in 52% of females and 49% of males ( ). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated with more coronal (increased degree) FJ orientation at L2/3 ( ) with a cutoff point at ≥32°. FJs were more coronally oriented (48.8°) in individuals ≤40 years and more sagittally oriented (45.6°) in individuals ≥41 years at L5/S1 ( ). Mean FJ asymmetry was 4.89° at L2/3, 6.01° at L3/4, 6.67° at L4/5, and 7.27° at L5/S1, without a significant difference for FJ arthritis. FJ arthritis is common, increases with age, and affects both genders equally. More coronally oriented FJs (≥32°) in the upper lumbar spine may be an individual risk factor for development of FJ arthritis. 1. Introduction A functional spinal unit consists of anteriorly located adjacent vertebrae separated by an intervertebral disc and posteriorly located facet (zygapophyseal) joints (FJ) [1]. FJs are composed of an inferior articular process, facing anteriorly, and a superior articular process, facing posteriorly, of two adjacent vertebrae [2]. Being synovial-lined, diarthrodial, and freely moveable functional units, they transmit shear forces and help the intervertebral discs in carrying about 16% of the vertical load [3, 4]. FJ orientation planes differ at various levels, with a more sagittal and curved orientation for resistance against axial rotation in the upper compared to a more coronal and flat orientation for resistance against flexion and shearing forces in the lower lumbar segments [5, 6]. FJ asymmetry or tropism describes the asymmetry of the left and right FJ angle [7, 8]. Low back pain is one of the most common health problems [9]. It affects up to 85% of people at least once during their lifetime and up to 5% chronically [10]. Even though etiologies of low back pain are multifactorial [11], FJ arthritis is common and affects at least 50% of the population [12]. After Ghormley [13] first described a facet syndrome in 1933, there has been an ongoing debate [14, 15] about the possible association low back pain and FJ pathology [16]. FJs are synovial covered joints with hyaline cartilage [17] and innervated by the medial branches of the dorsal rami from two levels [18, 19]. Recently, it has been shown that
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