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      Prevalence of Facet Effusion and Its Relationship with Lumbar Spondylolisthesis and Low Back Pain: The Wakayama Spine Study

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          Facet effusion represents a magnetic resonance imaging finding suggesting accumulation of fluid in the facet joint, potentially predictive of lumbar spondylolisthesis and low back pain. However, its prevalence and epidemiological characteristics in the general population remain unclear, because previous studies only included patients or volunteers. The aim of the present study was to investigate the prevalence of facet effusion in the general population and to describe its potential relationship with spondylolisthesis and low back pain.

          Material and methods

          Our study enrolled 808 participants from the Wakayama Spine Study who underwent magnetic resonance imaging investigations in supine position. Facet effusion was defined as a measurable, curvilinear, high-intensity signal within the facet joint, closely matching that of cerebrospinal fluid on the axial T2 images. We used standing lateral radiographs to diagnose L4 spondylolisthesis.


          We found that the prevalence of facet effusion in the lumbar spine was 34.3%, which did not differ significantly between men and women (p=0.13) and did not tend to increase with age, either in men (p=0.81) or in women (p=0.65). Additionally, we found no significant association between facet effusion and low back pain (odds ratio, 1.04–1.49; 95% confidence interval, 0.57–2.64; p=0.17–0.85), or between facet effusion and L4 spondylolisthesis (odds ratio, 1.55; 95% confidence interval, 0.80–2.86; p=0.17). In a subset of participants with L4 spondylolisthesis, we also noted that facet effusion was not significantly associated with low back pain (odds ratio, 1.26; 95% confidence interval, 0.37–4.27; p=0.70).


          This is the first study of facet effusion employing a population-based cohort, and the findings are thus expected to accurately describe the relationship between facet effusion and low back pain in the general population. We are planning a follow-up survey of the Wakayama Spine Study cohort to clarify the natural history of facet effusion and its relationship with clinical symptoms.

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          Most cited references 25

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          A consensus approach toward the standardization of back pain definitions for use in prevalence studies.

          A modified Delphi study conducted with 28 experts in back pain research from 12 countries. To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data. Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies. Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article. Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs. These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.
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            Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study.

            Musculoskeletal diseases, especially osteoarthritis (OA) and osteoporosis (OP), impair activities of daily life (ADL) and quality of life (QOL) in the elderly. Although preventive strategies for these diseases are urgently required in an aging society, epidemiological data on these diseases are scant. To clarify the prevalence of knee osteoarthritis (KOA), lumbar spondylosis (LS), and osteoporosis (OP) in Japan, and estimate the number of people with these diseases, we started a large-scale population-based cohort study entitled research on osteoarthritis/osteoporosis against disability (ROAD) in 2005. This study involved the collection of clinical information from three cohorts composed of participants located in urban, mountainous, and coastal areas. KOA and LS were radiographically defined as a grade of > or =2 by the Kellgren-Lawrence scale; OP was defined by the criteria of the Japanese Society for Bone and Mineral Research. The 3,040 participants in total were divided into six groups based on their age: or =80 years. The prevalence of KOA in the age groups or =80 years 0, 9.1, 24.3, 35.2, 48.2, and 51.6%, respectively, in men, and the prevalence in women of the same age groups was 3.2, 11.4, 30.3, 57.1, 71.9, and 80.7%, respectively. With respect to the age groups, the prevalence of LS was 14.3, 45.5, 72.9, 74.6, 85.3, and 90.1% in men, and 9.7, 28.6, 41.7, 55.4, 75.1, and 78.2% in women, respectively. Data of the prevalence of OP at the lumbar spine and femoral neck were also obtained. The estimated number of patients with KOA, LS, and L2-L4 and femoral neck OP in Japan was approximately 25, 38, 6.4, and 11 million, respectively. In summary, we estimated the prevalence of OA and OP, and the number of people affected with these diseases in Japan. The ROAD study will elucidate epidemiological evidence concerning determinants of bone and joint disease.
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              Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study.

              The purposes of this study were to investigate the prevalence and distribution of intervertebral disc degeneration (DD) over the entire spine using magnetic resonance imaging (MRI), and to examine the factors and symptoms potentially associated with DD.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                31 December 2019
                : 12
                : 3521-3528
                [1 ]Department of Orthopaedic Surgery, Wakayama Medical University , Wakayama City, Wakayama, Japan
                [2 ]Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo , Bunkyo-ku, Tokyo, Japan
                [3 ]Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo , Bunkyo-ku, Tokyo, Japan
                [4 ]National Rehabilitation Center for Persons with Disabilities , Tokorozawa City, Saitama, Japan
                [5 ]Department of Orthopaedic Surgery, The University of Tokyo , Bunkyo-ku, Tokyo, Japan
                [6 ]Tokyo Neurological Center , Minato-ku, Tokyo, Japan
                [7 ]Towa Hospital , Adachi-ku, Tokyo, Japan
                [8 ]Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital , Wakayama City, Wakayama, Japan
                Author notes
                Correspondence: Hiroshi Hashizume Department of Orthopaedic Surgery, Wakayama Medical University , Wakayama City, 811-1 Kimiidera, Wakayama City, Wakayama641-8510, JapanTel +81-73-441-0645Fax +81-73-448-3008 Email hashizum@wakayama-med.ac.jp

                These authors contributed equally to this work

                © 2019 Shinto et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 4, References: 27, Pages: 8
                This study was supported by H23-Choujyu-002 (Director, TA), H-25-Choujyu-007 (Director, NY), H25-Nanchitou (Men)-005 (Director, ST), 201417014A (Director, NY), and H22-Choujyu-Wakate-007 (Director, SM) from the Ministry of Health, Labour and Welfare, URL: http://www.mhlw.go.jp/ ; a Grant-in-Aid for Scientific Research (B26293139, B23390172 to NY, B2629333, C20591774 to SM, C26462249 to HH, C25462305 to HY) and a Grant-in-Aid for Young Researcher (B25860448 to YI, B26861286 to MT, B26860419 to RK), and Grant-in-Aid for Challenging Exploratory Research (15K15219 to NY, 26670307 to SM, 24659666 to HO, 25670293 to TA) of JSPS KAKENHI grant, URL: https://www.jsps.go.jp/j-grantsinaid/ ; a Grant from the Japanese Orthopaedics and Traumatology Foundation, Inc. (No. 287) to MT, URL: http://jotf.jp/invitation.html ; and Collaborating Research with NSF 08033011-00262 (Director, NY) from the Ministry of Education, Culture, Sports, Science and Technology in Japan, URL: http://www.mext.go.jp/english/ . This study also was supported by grants from the Japan Osteoporosis Society (NY, SM, HO, and TA), URL: http://www.josteo.com/ja/index.html , a grant from JA Kyosai Research Institute (HO), URL: http://www.jkri.or.jp/ , grants from Mitsui Sumitomo Insurance Welfare Foundation (SM), URL: http://www.ms-ins.com/welfare/index.htm , and research aid from the Japanese Orthopaedic Association (JOA-Subsidized Science Project Research 2006-1 & 2010-2; Director, HK), URL: https://www.joa.or.jp/english/english_frame.html . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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