Relationship between facet joint tropism and degeneration of facet joints and intervertebral discs based on a histological study

The problem of the pathology of the facet joints of the lumbar spine remains significant and is medical and social due to persistent pain syndrome, high incidence of morbidity and frequent disability outcomes. The complex anatomical and topographic relationships of the facet joints, intervertebral discs and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. A pair of facet joints and an intervertebral disc constitute a functional unit - a "three-component complex" and are interconnected with each other. The article examines the anatomical and morphological features and radiological classifications of degenerative changes in the facet joints, which are currently used in clinical practice. Facet joint pathologies are the most common nosological form of degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and the formation of chronic pain syndrome. The features of facet syndrome diagnostics are presented on a clinical example of surgical treatment by means of laser dereception of facet joints.

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Effect of CT-based attenuation correction on uptake ratios in skeletal SPECT

Nuklearmedizin ◽

10.1055/s-0037-1616624 ◽

2007 ◽

Vol 46 (01) ◽

pp. 38-42 ◽

Cited By ~ 12

Author(s):

V. Schulz ◽

I. Nickel ◽

A. Nömayr ◽

A. H. Vija ◽

C. Hocke ◽

...

Keyword(s):

Vertebral Body ◽

Facet Joint ◽

One Dimension ◽

Patient Specific ◽

Data Sets ◽

Facet Joints ◽

Lumbar Vertebral Body ◽

Ct System ◽

Ct Data ◽

Attenuation Corrected

SummaryThe aim of this study was to determine the clinical relevance of compensating SPECT data for patient specific attenuation by the use of CT data simultaneously acquired with SPECT/CT when analyzing the skeletal uptake of polyphosphonates (DPD). Furthermore, the influence of misregistration between SPECT and CT data on uptake ratios was investigated. Methods: Thirty-six data sets from bone SPECTs performed on a hybrid SPECT/CT system were retrospectively analyzed. Using regions of interest (ROIs), raw counts were determined in the fifth lumbar vertebral body, its facet joints, both anterior iliacal spinae, and of the whole transversal slice. ROI measurements were performed in uncorrected (NAC) and attenuation-corrected (AC) images. Furthermore, the ROI measurements were also performed in AC scans in which SPECT and CT images had been misaligned by 1 cm in one dimension beforehand (ACX, ACY, ACZ). Results: After AC, DPD uptake ratios differed significantly from the NAC values in all regions studied ranging from 32% for the left facet joint to 39% for the vertebral body. AC using misaligned pairs of patient data sets led to a significant change of whole-slice uptake ratios whose differences ranged from 3,5 to 25%. For ACX, the average left-to-right ratio of the facet joints was by 8% and for the superior iliacal spines by 31% lower than the values determined for the matched images (p <0.05). Conclusions: AC significantly affects DPD uptake ratios. Furthermore, misalignment between SPECT and CT may introduce significant errors in quantification, potentially also affecting leftto- right ratios. Therefore, at clinical evaluation of attenuation- corrected scans special attention should be given to possible misalignments between SPECT and CT.

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CyberKnife rhizotomy for facetogenic back pain: a pilot study

Neurosurgical FOCUS ◽

10.3171/foc-07/12/e2 ◽

2007 ◽

Vol 23 (6) ◽

pp. E1 ◽

Cited By ~ 3

Author(s):

Gordon Li ◽

Chirag Patil ◽

John R. Adler ◽

Shivanand P. Lad ◽

Scott G. Soltys ◽

...

Keyword(s):

Back Pain ◽

Radiofrequency Ablation ◽

Facet Joint ◽

Late Onset ◽

Target Volume ◽

Facet Joints ◽

Positron Emission ◽

Cyberknife Radiosurgery ◽

Joint Injections

Object By targeting the medial branches of the dorsal rami, radiofrequency ablation and facet joint injections can provide temporary amelioration of facet joint–producing (or facetogenic) back pain. The authors used CyberKnife radiosurgery to denervate affected facet joints with the goal of obtaining a less invasive yet more thorough and durable antinociceptive rhizotomy. Methods Patients with refractory low-back pain, in whom symptoms are temporarily resolved by facet joint injections, were eligible. The patients were required to exhibit positron emission tomography–positive findings at the affected levels. Radiosurgical rhizotomy, targeting the facet joint, was performed in a single session with a marginal prescription dose of 40 Gy and a maximal dose of 60 Gy. Results Seven facet joints in 5 patients with presumptive facetogenic back pain underwent CyberKnife lesioning. The median follow-up was 9.8 months (range 3–16 months). The mean planning target volume was 1.7 cm3 (range 0.9–2.7 cm3). A dose of 40 Gy was prescribed to a mean isodose line of 79% (range 75–80%). Within 1 month of radiosurgery, improvement in pain was observed in 3 of the 5 patients with durable responses at 16, 12, and 6 months, respectively, of follow-up. Two patients, after 12 and 3 months of follow-up, have neither improved nor worsened. No patient has experienced acute or late-onset toxicity. Conclusions These preliminary results suggest that CyberKnife radiosurgery could be a safe, effective, and non-invasive alternative to radiofrequency ablation for managing facetogenic back pain. No patient suffered recurrent symptoms after radiosurgery. It is not yet known whether pain relief due to such lesions will be more durable than that produced by alternative procedures. A larger series of patients with long-term follow-up is ongoing.

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Posterior Epidural Migration of Sequestrated Lumbar Disc Fragments Into the Bilateral Facet Joints

Neurosurgery ◽

10.1227/neu.0b013e3182245b21 ◽

2011 ◽

Vol 69 (5) ◽

pp. E1148-E1151 ◽

Cited By ~ 5

Author(s):

Tzuu-Yuan Huang ◽

Kung-Shing Lee ◽

Tai-Hsin Tsai ◽

Yu-Feng Su ◽

Shiuh-Lin Hwang

Keyword(s):

Differential Diagnosis ◽

Facet Joint ◽

Lumbar Disc ◽

Synovial Cyst ◽

Leg Pain ◽

Hybrid Technique ◽

Facet Joints ◽

Disc Disease ◽

First Case ◽

Rod System

Abstract BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment. CLINICAL PRESENTATION A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesys flexible rod system at L3-S1 for multisegment degenerative disc disease. The lesion proved to be an epidural disc fragment with sequestration into bilateral facet joints. CONCLUSION A free disc fragment should be considered in the differential diagnosis of posterior epidural lesions, and even in the facet joint.

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Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160078 ◽

2016 ◽

Vol 74 (9) ◽

pp. 745-749 ◽

Cited By ~ 11

Author(s):

Catarina C. Lins ◽

Diego T. Prado ◽

Andrei F. Joaquim

Keyword(s):

Surgical Treatment ◽

Facet Joint ◽

Direct Reduction ◽

Point Of View ◽

Facet Joints ◽

Spine Trauma ◽

Joint Dislocations ◽

Cervical Facet ◽

Cervical Facet Joint ◽

Anterior Posterior

ABSTRACT Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD), but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

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Severe Facet Joint Arthrosis Caused C7/T1 Myelopathy: A Case Report

Case Reports in Medicine ◽

10.1155/2009/481459 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Toshimi Aizawa ◽

Hiroshi Ozawa ◽

Takeshi Hoshikawa ◽

Takashi Kusakabe ◽

Eiji Itoi

Keyword(s):

Cervical Myelopathy ◽

Rare Case ◽

Facet Joint ◽

Spinous Process ◽

Intervertebral Disc Herniation ◽

Facet Joints ◽

Single Level ◽

Neurological Improvement ◽

Bony Spur ◽

Radiological Examinations

Cervical myelopathy is caused by degenerative processes of the spine including intervertebral disc herniation and posterior spur usually developing at C3/4 to C5/6. C7/T1 single level myelopathy is very rare because of the anatomical characteristics. Facet joint arthrosis can be a cause of cervical myelopathy but only a few cases have been reported. The authors report an extremely rare case of C7/T1 myelopathy caused by facet joint arthrosis. A 58-year-old male presented with hand and gait clumsiness. The radiological examinations revealed severe C7/T1 facet joint arthrosis with bony spur extending into the spinal canal, which compressed the spinal cord laterally. The T1 spinous process indicated nonunion of a “clay-shoveler's” fracture, which suggested that his cervico-thoracic spine had been frequently moved, and thus severe arthrosis had occurred in the facet joints. A right hemilaminectomy of C7 and C7/T1 facetectomy with single level spinal fusion led to complete neurological improvement.

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The Effects of Orientation of Lumbar Facet Joints on the Facet Joint Contact Forces

Spine ◽

10.1097/brs.0000000000002290 ◽

2018 ◽

Vol 43 (4) ◽

pp. E216-E220 ◽

Cited By ~ 6

Author(s):

Xiang Liu ◽

Zhiping Huang ◽

Ruozhou Zhou ◽

Qingan Zhu ◽

Wei Ji ◽

...

Keyword(s):

Facet Joint ◽

Contact Forces ◽

Facet Joints ◽

Joint Contact ◽

Lumbar Facet ◽

Lumbar Facet Joints

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Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints

European Spine Journal ◽

10.1007/s00586-009-0887-y ◽

2009 ◽

Vol 18 (3) ◽

pp. 370-370

Author(s):

Joris Walraevens ◽

Baoge Liu ◽

Joke Meersschaert ◽

Philippe Demaerel ◽

Hans Delye ◽

...

Keyword(s):

Quantitative Assessment ◽

Intervertebral Discs ◽

Facet Joints ◽

Qualitative And Quantitative

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Thoracic Facet Nerve Block: Fluoroscopy

10.1093/med/9780199908004.003.0015 ◽

2016 ◽

Author(s):

Shrif Costandi ◽

Youssef Saweris ◽

Michael Kot ◽

Nagy Mekhail

Keyword(s):

Facet Joint ◽

Anatomic Variation ◽

Medial Branch ◽

Shortness Of Breath ◽

Facet Joints ◽

Thoracic Region ◽

Promising Technique ◽

Steroid Injections ◽

Facet Joint Pain ◽

Facet Arthropathy

The benefit of intra-articular local anaesthetic and steroid injections for the diagnosis and treatment of facet joint pain is controversial. Thoracic facet medial branch blocks are mainly used to confirm the diagnosis of thoracic facet arthropathy. Anatomic variability is blamed for failed treatments. Conventionally, thermal radiofrequency (RF) has been used to denervate thoracic facet joints. Cooled radiofrequency ablation (c-RFA) of the thoracic medial branch is emerging as a novel promising technique that provides relatively larger lesions that could compensate for the anatomic variation of these branches and improve outcomes. The most feared complication of RF procedures in the thoracic region is pneumothorax, which may manifest as shortness of breath or pain with inspiration. Using proper technique for placement of the needles under fluoroscopic guidance renders the risk of this complication almost negligible.

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Overview on Percutaneous Therapies of Disc Diseases

Medicina ◽

10.3390/medicina55080471 ◽

2019 ◽

Vol 55 (8) ◽

pp. 471

Author(s):

Masala ◽

Salimei ◽

Lacchè ◽

Marcia ◽

Massari

Keyword(s):

Review Paper ◽

Intervertebral Discs ◽

Low Back ◽

Facet Joints ◽

Sacroiliac Joints ◽

Nerve Roots ◽

Technical Aspects ◽

Percutaneous Procedures ◽

Emerging Trends ◽

Great Share

Low back pain is an extremely common pathology affecting a great share of the population, in particular, young adults. Many structures can be responsible for pain such as intervertebral discs, facet joints, nerve roots, and sacroiliac joints. This review paper focuses on disc pathology and the percutaneous procedures available to date for its treatment. For each option, we will assess the indications, technical aspects, advantages, and complications, as well as outcomes reported in the literature and new emerging trends in the field.

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