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Min Ho Kong, Henry J. Hymanson, Kwan Young Song, Dong Kyu Chin, Yong Eun Cho, Do Heum Yoon and Jeffrey C. Wang

instability. 19 , 21 For grading, each segment was assessed based on 5 parameters. Three observers blinded to clinical information performed the radiographic measurements. Disc degeneration was classified into 1 of 5 grades based on Pfirrmann's criteria 26 using kinetic MR imaging. Grade I corresponded to normal discs and Grade V indicated advanced disc degeneration. Facet joint osteoarthritis was classified into 4 grades: Grade 1 corresponded to normal facet joints, and Grades 2–4 corresponded to mildly, moderately, and severely osteoarthritic facet joints, respectively

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Masahiro Ozaki, Nobuyuki Fujita, Azusa Miyamoto, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Eijiro Okada, Mitsuru Yagi, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, Hitoshi Kono and Kota Watanabe

L umbar spinal canal stenosis (LSS), a degenerative musculoskeletal disorder, manifests by the narrowing of the lumbar spinal canal, which compresses the cauda equina and nerve root. Patients with LSS often exhibit neurological symptoms of the lower extremities, including leg pain, numbness, motor deficit, sensory disturbance, and intermittent claudication. Age-related degenerative changes of the lumbar spine, including intervertebral disc degeneration, facet joint osteoarthritis, and hypertrophy of the ligamentum flavum, are the primary etiologies of LSS. In

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Gun Keorochana, Cyrus E. Taghavi, Shiau-Tzu Tzeng, Yuichiro Morishita, Jeong Hyun Yoo, Kwang-Bok Lee, Jen-Chung Liao and Jeffrey C. Wang

D egenerative changes of the lumbar spine are a major cause of low-back pain and disability. 13 Previous studies have demonstrated the important role of disc degeneration and facet joint osteoarthritis, but they have usually ignored the contribution of the posterior spinal ligaments. Recent studies have highlighted the effect of disc degeneration on facet joint osteoarthritis and vice versa; 3 , 7 , 26 however, few studies have examined the degenerative processes and interactions of the ISL. 6 Significant degenerative changes also occur in spinal

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Yoon-Kwang Kwon, Ju-Hee Jang, Choon-Dae Lee and Sang-Ho Lee

degenerative spondylolisthesis underscores that the motion of discs inferior to slipped vertebrae increases as well, for less efficient limiting of anterior-posterior translation in slipped vertebrae. 18 These findings are supported by contentions of Fujiwara et al. that disc degeneration and facet joint osteoarthritis affect anterior translatory instability and axial rotation, 6 , 7 and by Sharma et al., who maintain that facets are important in resisting the anterior shear displacements that accompany flexion and restricting rotations on extension. 28 Finally, work by

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Bronek M. Boszczyk, Alexandra A. Boszczyk, Andreas Korge, Andreas Grillhösl, Wolf-Dietrich Boos, Reinhard Putz, Stefan Milz and Michael Benjamin

F, Fassari F, et al: Predisposing factors in degenerative spondylolisthesis. A radiographic and CT study. Int Orthop 21: 337–342, 1997 9. Farfan HF : Effects of torsion on the intervertebral joints. Can J Surg 12 : 336 – 341 , 1969 Farfan HF: Effects of torsion on the intervertebral joints. Can J Surg 12: 336–341, 1969 10. Fujiwara A , Lim TH , An HS , et al : The effect of disc degeneration and facet joint osteoarthritis on segmental flexibility of the lumbar spine. Spine 25

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Benjamin D. Elder, Krishanthan Vigneswaran, Kyriacos A. Athanasiou and Daniel H. Kim

. These levels were selected because they represent the most prevalent areas of facet joint arthritis, and would therefore probably be the predominant areas requiring replacement tissue. Methods Specimen Preparation Cartilage was harvested from the superior surface of L3–4 and L4–5 facet joints of 2–4-year-old male mongrel dogs ( Figs. 1a and b ) that were killed at the end of research studies not involving the musculoskeletal system or spine. No animal had clinical evidence of facet joint osteoarthritis or disc disease. Each facet joint was opened proximally

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Keishi Maruo, Toshiya Tachibana, Shinichi Inoue, Fumihiro Arizumi and Shinichi Yoshiya

. Reviewed submitted version of manuscript: all authors. References 1 Archavlis E , Carvi y Nievas M : Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis . Eur Spine J 22 : 1731 – 1740 , 2013 2 Baaj AA , Dakwar E , Le TV , Smith DA , Ramos E , Smith WD , : Complications of the mini-open anterolateral approach to the thoracolumbar spine . J Clin Neurosci 19 : 1265 – 1267 , 2012 3 Barcelos AC , Botelho RV : Treatment

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Andrew T. Healy, Prasath Mageswaran, Daniel Lubelski, Benjamin P. Rosenbaum, Virgilio Matheus, Edward C. Benzel and Thomas E. Mroz

cervical spine. 8 Of the more than 40 grading systems described in a review by Kettler and Wilke, few used CT imaging, demonstrated acceptable interrater reliability, or showed correlation with biomechanical motion. 3 , 6 , 8 , 11 , 13 , 16 , 19 , 22 Fluoroscopic studies have found a correlation between decreasing thoracolumbar range of motion (ROM) and age older than 30 years. 1 , 14 , 17 Biomechanical studies have found that facet joint osteoarthritis is associated with anterior translational instability in the sagittal plane, 4 and that degenerative disc disease

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Bo Young Cho, Judith A. Murovic and Jon Park

spondylolisthesis with spinal stenosis . J Spinal Disord 6 : 461 – 472 , 1993 7 Chaput C , Padon D , Rush J , Lenehan E , Rahm M : The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis . Spine 32 : 1883 – 1887 , 2007 8 Fujiwara A , Lim TH , An HS , Tanaka N , Jeon CH , Andersson GB , : The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine . Spine 25 : 3036 – 3044 , 2000 9 Fujiwara A

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Nestor G. Rodriguez-Martinez, Luis Perez-Orribo, Samuel Kalb, Phillip M. Reyes, Anna G. U. S. Newcomb, Jeremy Hughes, Nicholas Theodore and Neil R. Crawford

but recent research indicates that heredity plays the dominant role in disc degeneration. 1 , 2 , 9 , 13 , 14 , 32 A high association between obesity and disc degeneration has been reported in both the juvenile and adult populations. 30 , 31 Furthermore, it has been shown that spines from obese patients have a significantly greater prevalence of facet joint osteoarthritis. 15 Despite this link between degeneration and obesity, little is known about the relationship between obesity and spine biomechanics. The relationship between disc degeneration and spinal