Lumbar Facet Joint Morphology and Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis
In brief
Facet tropism averaged 2.7 degrees greater in degenerative lumbar slippage
A meta-analysis of 39 studies found that people with degenerative lumbar slippage had more sagittally oriented facet joints and an average 2.7-degree increase in continuous facet tropism versus controls. Binary tropism was not significantly associated, and substantial variation in orientation findings, limited sex-specific data and lack of longitudinal evidence leave causality uncertain.
- Journal
- Global spine journal (Q1)
- Published
- 18 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Alberto Suarez, Justin Gumbs, Michelle Schmidt, Zeena Shather, Hanna Neustadter, Dominic Lafalce, et al.
- PMID
- 42893425
- DOI
- 10.1177/21925682261499356
Why clinicians should know about it
- Picked for Spine Surgery (top studies of the week, 25 October 2026): Systematic review/meta‑analysis of lumbar facet morphology and spondylolisthesis
Abstract
Study DesignSystematic review and meta-analysis.ObjectivesTo evaluate the associations between lumbar facet orientation, facet tropism, and degenerative lumbar spondylolisthesis (DLS), while assessing sex-specific differences in facet morphology.MethodsA PRISMA-compliant systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420261417450). PubMed/MEDLINE, Embase, Scopus, Cochrane CENTRAL, and Web of Science were searched through June 2026. Studies evaluating lumbar facet morphology in adults with DLS were included. Random-effects meta-analyses using restricted maximum likelihood estimation and Hartung-Knapp adjustment were performed. Risk of bias and evidence certainty were assessed.ResultsThirty-nine studies met the inclusion criteria. Sixteen studies (3,321 participants) were included in the facet orientation meta-analysis. Patients with DLS demonstrated more sagittally oriented facet joints than controls (SMD 1.30, 95% CI 0.78-1.82; p < 0.0001; I2 = 97.2%). Nine studies (1,913 participants) showed greater continuous facet tropism in DLS patients (MD 2.72°, 95% CI 2.07°-3.38°; p < 0.0001; I2 = 47.2%). Binary facet tropism was not statistically significant (OR 2.20, 95% CI 0.85-5.66; p = 0.0817). Sex-specific, severity, and instability data were insufficient for quantitative synthesis.ConclusionDLS is associated with more sagittally oriented facet joints and greater continuous facet tropism than controls. Limited sex-specific data and heterogeneity highlight the need for standardized measurement techniques and prospective longitudinal studies to clarify causality and sex-related effects.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.