Degenerative Zygapophyseal Joint Subluxation of the Lumbar Spine: A Modified Classification and Clinical Considerations

TL;DR

This paper describes a rare spinal condition involving degenerative joint subluxation and proposes a new classification system for better diagnosis and treatment.

Contribution

The paper introduces a revised MRI-based classification system that includes subluxation as a distinct degenerative criterion.

Findings

Advanced degenerative facet joint changes with subluxation were observed in patients without trauma or spondylolisthesis.

Current grading systems fail to capture the subluxation patterns seen in these cases.

Tailored surgical approaches improved outcomes for patients with radiological or intraoperative instability.

Abstract

Degenerative lumbar zygapophyseal (facet) joint subluxation without prior trauma, fracture, spondylolysis, or spondylolisthesis is extremely uncommon and represents a distinct clinical entity. This study aims to present rare cases of advanced degenerative facet joint changes combined with unilateral or bilateral facet joint subluxation in the absence of trauma. All patients experienced chronic symptoms unresponsive to conservative treatment. MRI findings demonstrated Grade 4 degeneration per Grogan’s classification, along with distinct subluxation patterns not captured by existing grading systems. Surgical treatment, including decompression with or without instrumented fusion, was tailored to the presence of radiological or intraoperative instability. These findings emphasize the clinical relevance of facet joint subluxation as a distinct degenerative entity, suggesting the need for a revised MRI-based grading system that includes subluxation as a separate criterion. This revised classification system, incorporating degenerative causes, could enhance diagnostic precision and therapeutic strategies in these types of injuries.

Figures