Facet joint osteoarthritis as a predictor of surgical strategy and outcomes in lumbar disc herniation.

Abstract

Objective: To evaluate the association between lumbar facet joint osteoarthritis and the choice of surgical strategy as well as postoperative outcomes in patients undergoing surgery for lumbar disc herniation. Study Design: Retrospective Observational Research. Setting: Doctors Hospital and Medcial Centre Lahore. Period: 15^th March 2024 to 14^th March 2025. Methods: Involved 83 patients treated with surgical intervention concerning single-level LDH. Preoperative MRI was applied to evaluate FJOA based on the Weishaupt classification and disc degeneration based on the Pfirrmann grading system. The clinical outcomes were recorded in the Oswestry Disability Index (ODI) and EQ-5D scores, while radiographic outcomes included vertebral slip and Cobb angle. Statistical analysis was performed to examine associations between FJOA severity and surgical outcomes. Results: Weishaupt Grade 1 and 2 facet joint degeneration were most common, seen in 43.4% and 30.1% of patients, respectively. Grade 3 degeneration showed the highest mean facet tropism (8.12°). Pfirrmann Grade 3 and 4 disc degeneration was predominant. Significant postoperative improvement was observed in ODI (mean change: 21.5, p < 0.001) and EQ-5D (mean change: 0.25, p < 0.001). Although there was a significant increase in vertebral slip (mean change: 0.6 mm, p < 0.001), no significant change was found in dynamic slip or Cobb angle, indicating preserved spinal alignment. Conclusion: Facet joint osteoarthritis, particularly in its moderate to severe forms, is highly prevalent in patients with LDH and is associated with increased facet asymmetry. However, with appropriate surgical planning, including facet-sparing techniques, favorable clinical outcomes can still be achieved without compromising spinal stability. Preoperative assessment of facet pathology can guide surgical decision-making and optimize patient outcomes.