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
Authors: Williams Richard , Cheung Jason Pui Yin , Goss Ben , Rajasekaran Shanmuganathan , Kawaguchi Yoshiharu , Acharya Shankar , Kawakami Mamoru , Satoh Shigenobu , Chen Wen-Jer , Park Chun-Kun , Lee Chong-Suh , Foocharoen Thanit , Nagashima Hideki , Kuh Sunguk , Zheng Zhaomin , Condor Richard , Ito Manabu , Iwasaki Motoki , Jeong Je Hoon , Luk Keith D. K. , Prijambodo Bambang , Rege Amol , Jahng Tae-Ahn , Luo Zhuojing , Tassanawipas Warat , Acharya Narayana , Pokharel Rohit , Shen Yong , Ito Takui , Zhang Zhihai , Aithala P Janardhana , Kumar Gomatam Vijay , Jabir Rahyussalim Ahmad , Basu Saumyajit , Li Baojun , Moudgil Vishal , Sham Phoebe , Samartzis Dino 
Published: July 2015

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/m2. 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.