title: An International Multicenter Study Assessing the Role of Ethnicity on Variation of Lumbar Facet Joint Orientation and the Occurrence of Degenerative Spondylolisthesis in Asia Pacific: A Study from the AOSpine Asia Pacific Research Collaboration Consortium.
abstract: Study Design A multinational, multiethnic, cross-sectional image-based study was performed in 33 institutions, representing 10 countries, which were part of the AOSpine Asia Pacific Research Collaboration Consortium. Objective Lumbar facet joint orientation has been reported to be associated with the development of degenerative spondylolisthesis (DS). The role of ethnicity regarding facet joint orientation remains uncertain. As such, the following study was performed across a wide-ranging population base to assess the role of ethnicity in facet joint orientation in patients with DS in the Asia Pacific region. Methods Lateral standing X-rays and axial magnetic resonance imaging scans were obtained for patients with lumbar DS. The DS parameters and facet joint angulations were assessed from L3-S1. Sex, age, body mass index (BMI), and ethnicity were also noted. Results The study included 371 patients with known ethnic origin (mean age: 62.0 years; 64% males, 36% females). The mean BMI was 25.6 kg/m(2). The level of DS was most prevalent at L4-L5 (74.7%). There were 28.8% Indian, 28.6% Japanese, 18.1% Chinese, 8.6% Korean, 6.5% Thai, 4.9% Caucasian, 2.7% Filipino, and 1.9% Malay patients. Variations in facet joint angulations were noted from L3 to S1 and between patients with and without DS (p < 0.05). No differences were noted with regards to sex and overall BMI to facet joint angulations (p > 0.05); however, increasing age was found to increase the degree of angulation throughout the lumbar spine (p < 0.05). Accounting for age and the presence or absence of DS at each level, no statistically significant differences between ethnicity and degree of facet joint angulations from L3-L5 were noted (p > 0.05). Ethnic variations were noted in non-DS L5-S1 facet joint angulations, predominantly between Caucasian, Chinese, and Indian ethnicities (p < 0.05). Conclusions This study is the first to suggest that ethnicity may not play a role in facet joint orientation in the majority of cases of DS in the Asia-Pacific region. Findings from this study may facilitate future comparative studies in other multiethnic populations. An understanding of ethnic variability may assist in identifying those patients at risk of postsurgical development or progression of DS. This study also serves as a model for large-scale multicenter studies across different ethnic groups and cultural boundaries in Asia.
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Jason Pui Yin
authors.initials: JP
authors.lastname: Cheung
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Goss
authors.affiliation: Department of Orthopaedics, Ganga Hospital, Coimbatore, India.
authors.forename: Shanmuganathan
authors.initials: S
authors.lastname: Rajasekaran
authors.affiliation: Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Department of Orthopedics, Sir Gangaram Hospital, New Delhi, India.
authors.forename: Shankar
authors.initials: S
authors.lastname: Acharya
authors.affiliation: Spine Care Center, Wakayama Medical University, Kihoku Hospital, Ito-gun, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kawakami
authors.affiliation: Department of Spine Surgery, Eniwa Hospital, Hokkaido, Japan.
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Satoh
authors.affiliation: Department of Orthopaedic, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Catholic University of Korea, Seoul, South Korea.
authors.forename: Chun-Kun
authors.initials: CK
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Chong-Suh
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Khonkaen Regional Hospital, Khonkean, Thailand.
authors.forename: Thanit
authors.initials: T
authors.lastname: Foocharoen
authors.affiliation: Department of Orthopedic Surgery, Tottori University, Yonago, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nagashima
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Seoul, South Korea.
authors.forename: Sunguk
authors.initials: S
authors.lastname: Kuh
authors.affiliation: Department of Spine Surgery, The First Hospital Affiliated of Zhongshan University, Guangzhou, China.
authors.forename: Zhaomin
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Department of Orthopedics, Cebu Orthopaedic Institute, Cebu, Philippines.
authors.forename: Richard
authors.initials: R
authors.lastname: Condor
authors.affiliation: Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Neurosurgery, College of Medicine, Soon Chun Hyang Unviersity Bucheon Hospital, Bucheon, South Korea.
authors.forename: Je Hoon
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Keith D K
authors.initials: KD
authors.lastname: Luk
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine Airlargga University, Surabaya, Indonesia.
authors.forename: Bambang
authors.initials: B
authors.lastname: Prijambodo
authors.affiliation: Department of Orthopaedics, Deenanath Mangeshkar Hospital, Jehangir Hospital, Pune, India.
authors.forename: Amol
authors.initials: A
authors.lastname: Rege
authors.affiliation: Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Tae-Ahn
authors.initials: TA
authors.lastname: Jahng
authors.affiliation: Department of Orthopaedic Surgery, The Fourth Military Medical University, Xi'an, China.
authors.forename: Zhuojing
authors.initials: Z
authors.lastname: Luo
authors.affiliation: Department of Orthopedics, Phramongkuthklao Army Hospital, Bangkok, Thailand.
authors.forename: Warat
authors.initials: W
authors.lastname: Tassanawipas
authors.affiliation: Dwaraka Institute of Spine Care, Bellary, India.
authors.forename: Narayana
authors.initials: N
authors.lastname: Acharya
authors.affiliation: Department of Orthopedics and Trauma Surgery, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Rohit
authors.initials: R
authors.lastname: Pokharel
authors.affiliation: Department of Spine Surgery, The Third Hospital of Hebei Medical University of China, Shijiazhuang, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Orthopaedic Surgery, Niigata City General Hospital, Niigata, Japan.
authors.forename: Takui
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Orthopaedic Surgery, Aviation General Hospital, Beijing, China.
authors.forename: Zhihai
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Kasturba Medical College, Manipal University, Mangalore, India.
authors.forename: Janardhana
authors.initials: J
authors.lastname: Aithala P
authors.affiliation: Department of Neurosurgery, Fortis Hospital, Kolkata, India.
authors.forename: Gomatam Vijay
authors.initials: GV
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedic and Traumatology, University of Indonesia / RS Ciptomangunkusumo, Jakarta, Indonesia.
authors.forename: Rahyussalim Ahmad
authors.initials: RA
authors.lastname: Jabir
authors.affiliation: Division of Neurosciences, Park Clinic, Kolkata, India.
authors.forename: Saumyajit
authors.initials: S
authors.lastname: Basu
authors.affiliation: Department of Spine Surgery, The Third Hospital of Hebei Medical University of China, Shijiazhuang, China.
authors.forename: Baojun
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Orthopedic, Punjab Institute of Medical Sciences Jalandhar, Jalandhar, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Moudgil
authors.affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Sham
authors.affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Dino
authors.initials: D
authors.lastname: Samartzis
keywords: AOSpine; Asia; degenerative; ethnicity; facet; joints; morphology; spondylolisthesis
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