Facet Joint Degeneration Research Articles

Clinical report of lumbar facet syndrome complicated with lower limb symptoms without lumbar spinal canal stenosis

Clinical report of lumbar facet syndrome complicated with lower limb symptoms without lumbar spinal canal stenosis

Facet syndrome. Minimally invasive surgical treatment. Clinical case with a literature review

Background: Degenerative pathology of the facet joints of the lumbar spine remains a significant medical and social problem due to persistent pain syndrome, high incidence and disability rate.
 Clinical case description: A patient complaining of pain and discomfort in the lumbosacral spine on the right, arising in the upright position, intensifying with bending and flexion-extension of the trunk, and periodically spreading to the right gluteal region and along the posterior surface of the thigh, was admitted to the neurosurgical department of the Irkutsk Scientific Center of Surgery and Traumatology. A surgical treatment was performed in the form of dereception of the LIILIII, LIIILIV, LIVLV arch-process joints. In the postoperative period, the patient noted a decrease in the intensity of pain in the lumbosacral spine to 3 points by a visual analog scale and was discharged from the department on the 5th day after the surgery in a satisfactory condition.
 Conclusion: Facet joint pathologies represent a most common nosological form of the degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and chronic pain syndrome. The complex anatomical and topographic relationships between the facet joints, intervertebral discs, and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. Understanding the morphological, clinical, and radiological features of the course of the facet joint degeneration makes it possible to increase the diagnostic capabilities for detecting facet syndrome of the lumbar spine and effectively apply transcutaneous surgical technologies for the treatment of chronic pain syndromes.

Risk factors for adjacent segment disease requiring reoperation after posterior lumbar interbody fusion with screw fixation: focus on paraspinal muscle, facet joint, and disc degeneration.

Adjacent segment disease (ASD) requiring revision surgery is the most serious complication that can occur in patients undergoing posterior lumbar interbody fusion (PLIF) surgery. This study aimed to determine the risk factors for surgical ASD requiring revision surgery after PLIF with screw fixation surgery. We especially focused on paraspinal muscle, facet joint, and disc degeneration. Among the patients who underwent PLIF with screw fixation due to degenerative spinal disease from January 2010 to December 2019, patients who underwent revision surgery for the development of ASD were enrolled. To evaluate the risk factors for surgical ASD, we selected a control group. Each patient in the control group was matched by age, sex, fusion level, number of fused segments, secondary MRI follow-up interval, and follow-up duration with a patient in the surgical ASD group. The radiographic and demographic data were compared between the surgical ASD and control groups. There were statistically significant differences between the two groups in radiological parameters of preoperative facet degeneration, facet effusion, facet angle, and fatty degeneration of the multifidus muscle. Multivariable logistic regression analysis revealed that preoperative facet effusion (odds ratio [OR] 6.48), preoperative facet angle (OR 1.24), and progression of fatty degeneration in the multifidus muscle (OR 1.07) were significant risk factors for surgical ASD. Preexisting high-grade adjacent facet effusion, sagittally oriented facet joint angle, and progressive fatty degeneration of the multifidus muscle are associated with the development of surgical ASD after PLIF surgery.

18F]-sodium fluoride PET/MR for painful lumbar facet joint degeneration – a randomized controlled clinical trial

BACKGROUND CONTEXT[18F]-sodium fluoride (NaF) PET/MR is a modern diagnostic modality for imaging increased bone turnover. Its merits in detecting painful facet joint osteoarthritis in patients with lumbar back pain are unknown. PURPOSETo perform a prospective randomized controlled study investigating [18F]-NaF PET/MR for detecting painful facet joints in comparison to the standard of care (SOC), including clinical examination and conventional MRI. STUDY DESIGN/SETTINGRandomized controlled clinical study. PATIENT SAMPLEThirty-nine patients. OUTCOME MEASURESVisual analog pain scale (VAS) before and at several time points after facet joint infiltration. METHODSPatients with low back pain and suspected facet joint osteoarthritis underwent lumbar [18F]-NaF PET/MR, besides conventional MRI and clinical examination. After randomization, they either received local anesthetics/ corticosteroid infiltration of facet joints as defined by clinical examination and conventional MRI (SOC), or according to the hot spots on PET/MR. VAS was documented at 15 minutes, 1 day, 1 week and 1 month after infiltration. Thirty-nine patients underwent PET/MR before the study was stopped due to new Good Manufacturing Practice requirement and new regulations by radiation protection authorities limiting staff radiation exposure during the production of this radiotracer. RESULTSSignificant pain reduction compared to baseline was shown at every timepoint in both groups, except at 1 month after infiltration in the SOC group. Pain levels did not differ between SOC (n=17) and PET/MR patients (n=12) before infiltration and at 15 minutes, 1 day, 1 week and 1 month after infiltration. No significant correlation was detected between the sum of the PET/MR activity and the initial pain scores or relative reduction of pain after 15 minutes.The constructed study groups of patients with infiltration of all facet joints being PET/MR-positive (n=18) had significantly less pain after 1 months than patients with infiltration in PET/MR-negative facet joints (n=11) (VAS: 4 [0, 9] vs. 7 [2, 10], p=.046). CONCLUSIONSThere is no correlation of pain to NaF activity nor a relevant superiority of [18F]-NaF PET/MR for identification of painful facet joints compared to the standard of care.

Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial

ObjectiveThe purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). MethodsThis was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. ResultsThe most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). ConclusionFor the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time.

What Causes the Discrepancy between Quantitative Computed Tomography and Dual Energy X-Ray Absorptiometry?

Objective: Dual energy X-ray absorptiometry (DXA) is a standard tool for measuring the bone mineral density (BMD), but it sometimes provides inaccurate results. In contrast, quantitative computed tomography (QCT) measures the BMD more accurately by directly measuring the trabecular bone. This study examined the factors that cause the discrepancy between DXA and QCT with advanced spinal imaging.Methods: The medical records of 59 patients who underwent DXA, QCT, and a lumbar spine magnetic resonance imaging (MRI) were reviewed retrospectively. The following values were measured on plain radiographs, computed tomography, and MRI: lumbar lordosis, segmental scoliosis, compression fracture, spondylosis, abdominal aortic calcification, facet joint degeneration, and Modic change. The significant parameters contributing to the discordance results between DXA and QCT were evaluated by logistic regression analysis.Results: QCT identified osteoporosis in 43 patients (72.88%). DXA identified 15 osteoporotic patients (25.42%). Of the 44 patients not diagnosed with osteoporosis by DXA, 30 patients (68.18%) were diagnosed with osteoporosis by QCT. Multivariate logistic regression analysis showed that the result of DXA might be overestimated by a degenerated facet joint (odds ratio [OR] 4.58; 95% confidence interval [CI], 1.1-19.07) and measurements at a fracture site (OR, 1.63; 95% CI, 1.23-2.15).Conclusion: DXA might miss a diagnosis of osteoporosis. Facet joint hypertrophy due to degeneration revealed a stronger association with the overestimation of the BMD by DXA than the formation of osteophytes at the vertebral body. Therefore, the results of DXA should be interpreted carefully, considering the possibility of interruption.

Hsp22 Inhibits Oxidative Stress-Induced Endplate Chondrocyte Apoptosis by Regulating Mitochondrial Pathway

Background:Facet joint degeneration (FJD), which is also called facet joint syndrome (FJS), has become one of the most commonly seen etiological factors for lumbago. Cartilage lesion triggered by lumbar facet joint (LFJ) degeneration might be related to mitochondrial impairment, but the its underlying mechanism remains unclear.Materials and methods:The endplate chondrocytes were induced by hydrogen peroxide (H2O2) to mimic the pathological conditions of oxidative stress. Enzyme linked immunosorbent assay (ELISA) were used for the evaluation of reactive oxygen species (ROS). Adenosine-triphosphate (ATP) level was assessed using ATP detection, along with the detection the expression of cytochrome C in mitochondria (mito-cyt c) and in cell cytoplasm (cyto-cyt c) and cleaved caspase 3 by Western blot analysis. TUNEL assay was conducted for the measurement of cell apoptosis in endplate chondrocytes. Reverse transcription-polymerase chain reaction (RT-qPCR) was used to verify the expression of heat shock protein 22 (HSP22) and the transfection efficiency of HSP22 interference plasmid.Results:It was found that H2O2promoted the mitochondrial dysfunction, ROS generation and cell apoptosis in endplate chondrocytes. Moreover, HSP22 was down-regulated in H2O2-induced endplate chondrocytes, and interference of HSP22 decreased the ROS production, increased the ATP level and promoted the cell apoptosis, resulting in the enhanced impairment of endplate chondrocytes. Additionally, mitochondrial ROS inhibitor (Mito-TEMPO) ameliorated the injury effects of HSP22 silencing in the H2O2-induced endplate chondrocytes.Conclusion:In conclusion, HSP22 inhibits oxidative stress-induced endplate chondrocyte apoptosis by regulating mitochondrial pathway, possibly providing novel guidance direction for the treatment of LFJ degeneration.

ОСОБЕННОСТИ ТЕРАПИИ ПРИ БОЛИ В СПИНЕ У БОЛЬНЫХ С ФАСЕТОЧНЫМ СИНДРОМОМ

Back and neck pain are among the most common medical complaints in developed countries, with up to 66% of the population suffering from acute nonspecific back pain. As early as 1911, Goldthwaite J.E. proved that the articular joints of the spine can serve as a source of pain impulsation, with the proportion of facet syndrome increasing in older age groups, which can cause a clinical dilemma in identifying causes of back pain in the elderly. Like other synovial joints, the bicuspid joints, which are richly innervated by nociceptors, are also at risk of developing dystrophic changes with destruction of articular cartilage and, accordingly, the development of pain, which is provoked by stretching of the bicuspid joint capsule against the background of inflammatory modulators activation. Aim. The aim of the study was to investigate the efficacy of different methods of treatment of facet syndrome. Material and methods. An analytical review of publications in the scientific medical literature was performed. Results and discussion. In facetsyndrome, both local injection therapy with glucocorticosteroids, hyaluronic acid, local anesthetics, mesenchymal stem cells, and platelet-derived autoplasma are effective. Additional application of non-pharmacological treatments such as therapeutic gymnastics, physiotherapy, and therapeutic massage potentiates the effects of conventional conservative therapy. Radiofrequency laser neurotomy has been recognized as an alternative effective treatment for facet syndrome with a long-term positive effect. The choice of drugs and cellular substances for therapeutic blocks is wide enough and provides an adequate therapeutic approach to the treatment of nonspecific back pain caused by articular joint lesions. Conclusion. The diagnosis of facet syndrome is a diagnosis of exclusion, which requires a thorough differential diagnosis to choose further adequate treatment strategy.

Neurosurgical Spine Implants in Geriatric Patients Treated Surgically for Lumbar Stenosis

Introduction. The incidence of degenerative lumbar spine stenosis increases with age. While young people tend tohave simple disc herniations with root compression, older people develop degenerative stenosis: facet joint hypertrophy,osteophytes, and ligamentum flavum hypertrophy. A typical for senility is neurogenic claudication caused by lumbarforaminal stenosis. Its symptoms decrease in spine flexion.Aim. The study consisted of a retrospective evaluation of medical data: analysis of the patient’s age, description ofthe surgical procedure and a list of spine implants.Material and Methods. The analysis included patients treated surgically for lumbar stenosis in 2020 in NeurosurgicalDepartment of Collegium Medicum in Nicolaus Copernicus University (Bydgoszcz, Poland).Results. The perioperative risk increases with the age of patients, therefore procedures in elderly patients shouldusually be less invasive, ephemeral, and even under local anesthesia. Therefore, neurosurgeons tend to insert spinalimplants in senility to support the surgical effect and optimize the time of the procedure. Interspinous spacers areimplants for neurogenic claudication. Interspinous spacers causes foraminal distraction and thus can theoreticallyinduce nerve roots decompression in indirect mechanism, less invasive, with less tissue damage. We notice significantlymore frequent use of interspinous spacers in patients over seventy.Conclusions. This observation requires further research and analysis; however, it is consistent with the availableliterature and the actual state of clinical practice. This has potentially important implications for neurosurgicalnursing — in geriatric patients after lumbar spine surgery, implants are significantly more common — interspinousspacers, which should be considered in nursing perioperative recommendations. (JNNN 2021;10(3):91–95)

Wnt16 protects chondrocytes from lumbar facet joint osteoarthritis through the Wnt/β-catenin pathway in low back pain patients

Purpose Low back pain (LBP) is a long-lasting and chronic symptom without any exact cause. This study attempts to propose a new staging system based on the original grading system combined with pathological results and clinical symptoms to better clarify the dynamic evolution of LBP related to cartilage degeneration during facet joint osteoarthritis (FJOA). To explore a potential target for diagnosis, treatment, and drug intervention of facet joint osteoarthritis related LBP via protecting chondrocytes. Materials and methods All the facet joints were divided into 4 groups according to our new degenerative staging system based on Weishaupt grade, CT and MRI. Collect the facet joint samples from patients whom suffered lumbar fusion surgery for lumbar disc herniation. Molecular biology experiments were used to explore the effect of Wnt16 on the degeneration of facet joints. Micro-CT examination and pain stimulation test checked the biological function of Wnt16 in rats. Results Wnt16 was significantly increased and more aggregated in the facet joint chondrocytes in the Phase III and Phase IV, which is consistent with the pathological findings of cartilage degeneration (OARSI). We found that Wnt16 participated in the regulation of FJOA via Wnt/β-catenin pathway in vitro, which was inhibited by specific inhibitor DKK1. The rats, rich expressed Wnt16, showed higher paw withdrawal thresholds and prolonged paw withdrawal latency to FJOA related LBP. Micro-CT examination for the lumbar spine of rats showed Wnt16 protected the chondrocytes from FJOA. Conclusions This study defined a new staging system for LBP related cartilage degeneration of facet joint based on the original grading system combined with pathological results and clinical symptoms. Wnt16 is expected to be a potential target for treatment of FJOA via protecting chondrocytes.

Minimally Invasive Posterior Tubular Microsurgical Approach for the Management of Symptomatic Synovial Cysts of the Lumbar and Cervical Spine.

Synovial cysts are commonly associated with instability. Whether to fuse patients is a matter of controversy. Simple resection may offer favorable clinical outcomes but may come at the expense of recurrence rate. We describe our experience with the minimally invasive management of these lesions using microsurgical dissection through a tubular retractor system. A retrospective cohort study of symptomatic patients with synovial cysts treated by a minimally invasive tubular approach from 2001 to 2018 was performed. We evaluated variables such as preexisting spinal pathology, previous surgery, radiological findings, comorbidities, and secondary surgery requiring fusion. We used the visual analog scale (VAS), the Oswestry disability index (ODI), and the Macnab scale for clinical evaluation. There were 35 patients with a mean age of 63 years. The mean duration of symptoms before surgery was 195 weeks. Axial pain was present in 77.1% of cases; radiculopathy was the main symptom in 94.3% of cases. The most frequent site was L4-L5 (62.8%). Presenting comorbidities were lumbar stenosis (28.6% of patients), spondylolisthesis (8.6%), and facet hypertrophy (31.4%). Mean surgical time was 143 minutes (range, 55-360 minutes). The mean hospital stay was 2 days, ranging from 1 to 5 days. No complications were encountered as a consequence of the surgical procedure. All patients showed neurophysiological improvement after surgical intervention. A total of 34 patients (97.14%) showed clinical improvement at the end of follow-up, averaging 17 months and ranging from 1 to 60 months, 28 patients (80%) had good to excellent Macnab outcomes, 6 patients (17.14%) were rated as fair, and 1 (2.86%) patient had a poor Macnab outcome. Radicular VAS significantly changed (P < .05) from a preoperative mean of 8.23 ± 1.24 to a postoperative mean of 2.23 ± 1.94. ODI significantly decreased (P < .05) from a preoperative of mean of 41.02 ± 12.56 to a postoperative of mean of 11.82 ± 10.56. We performed fusion at initial surgery in 37.1% of cases; however, 3 more patients required secondary fusion at follow-up. Our series corroborates the prior literature with a low incidence of synovial cysts in the cervical spine and none in the thoracic spine. The present work shows the efficacy of minimally invasive surgery in the treatment of these lesions. Synovial cysts were associated with instability, ultimately requiring fusion in the majority of patients. The authors' study includes a large patient series with minimally invasive microsurgical decompression performed through a tubular retractor to date. 3.

Correlation of Tumor Necrosis Factor-α Expression with Pain Level in Degenerative Lumbar Canal Stenosis Patients

Introduction: Pain in degenerative lumbar canal stenosis is caused by osteoarthritis of a facet joint and intervertebral disc degeneration. Some inflammatory mediators such as tumor necrosis factor (TNF)-α are present in degenerative lumbar canal stenosis. This study aimed to evaluate the correlation of pain and functional pre-operative scores with the expression of TNF-α in nucleus pulposus, annulus fibrosus, and facet joint. Methods: Patients diagnosed with degenerative lumbar canal stenosis and planned for surgical treatment were included in this study. Patients with history of fracture, neoplasm, and/or infection of the spine were excluded. Tissue samples were collected from the nucleus pulposus, annulus fibrosus, facet joint, flavum ligament and paraspinal muscles of the spine during the surgery. TNF-α expression was examined semi-quantitively and correlated with the axial and radicular pain that were measured using Visual Analog Score (VAS) score. The result was then statistically analyzed. Results: The expression of TNF-α in the paraspinal muscle (6.30±14.20) was significantly higher compared to other locations. TNF-α expression in the facet joint group was significantly correlated with the intensity of low back pain measured by VAS score (r=0.893, p &lt; 0.001), and pre-operative functional outcome based on Oswestry Disability Index (ODI) (r=0.948, p &lt; 0.001). Conclusion: TNF-α expression, especially in the facet joint, is significantly associated with the pain intensity and pre-operative ODI that allow pain reduction with less invasive treatment in lumbar canal stenosis patients.

THE EFFECT OF CRYOABLATION ON FUNCTIONING AND GAIT IN PATIENTS WITH LOW BACK PAIN

Introduction Low back pain and comorbid afflictions negatively influence the quality of life, postural control and gait. Facet joint syndrome is one of the causes of low back pain. Cryoablation is a minimal invasive percutaneuous technique for zygapophysial joint syndrome. Aim The aim of the study was to investigate the effectiveness of the cryoablation in patients with chronic low back pain on pain, disability and spatiotemporal gait parameters in the course of facet joint syndrome. Material and methods The study included 19 patients (13 women, 7 men) with chronic low back and facet arthropathic changes in MRI, and with failure in conservative treatment. The evaluation was performed before and with one-month follow-up after cryoablation and included pain assessment (Numeric Rating Scale), the evaluation of functional state and disability (Revised Oswestry Low Back Pain Disability Index, Roland-Morris Disability Questionnaire) and analysis of spatiotemporal gait parameters (treadmill). Results A significant improvement in pain, functioning and spatiotemporal gait parameters such as distance and the number of steps were found. Conclusions Cryoablation is an effective method for pain reduction in facet joint syndrome, which improves functioning and gait. Cryoanalgesia is a safe procedure for the treatment of low back pain related to facet joint syndrome if earlier conservative management failed. Keywords: cryoablation, low back pain, functional assessment, gait

RELATIONSHIP BETWEEN URODYNAMIC PARAMETERS AND LEVEL OF SPINAL CORD INJURY

Introduction Low back pain and comorbid afflictions influence negatively on the quality of life, postural control and gait. Facet joint syndrome is one of the causes of low back pain. Cryoablation is a minimal invasive percutaneuous technique for zygapophysial joint syndrome. Aim The aim of the study was to investigate the effectiveness of the cryoablation in patients with chronic low back pain on pain, disability and spatiotemporal gait parameters in the course of facet joint syndrome. Material and methods The study included 19 patients (13 women, 7 men) with chronic low back and facet arthropathic changes in MRI, and with failure in conservative treatment. The evaluation was performed before and with one-month follow-up after cryoablation and included pain assessment (Numeric Rating Scale), the evaluation of functional state and disability (Revised Oswestry Low Back Pain Disability Index, Roland-Morris Disability Questionnaire) and an analysis of spatiotemporal gait parameters (treadmill). Results A significant improvement in pain, functioning and spatiotemporal gait parameters such as distance and the number of steps were found. Conclusions Cryoablation is an effective method for pain reduction in facet joint syndrome, which improves functioning and gait. Cryoanalgesia is a safe procedure for the treatment of low back pain related to facet joint syndrome if earlier conservative management failed. Keywords: cryoablation, low back pain, functional assessment, gait

How is spinal range of motion affected by disc- and facet degeneration and spinopelvic anatomy?

BackgroundWe aimed to investigate how disc- and facet joint degeneration relate to ROM and spinopelvic alignment parameters. Their interrelation, however, is not yet understood, although eminent in patient specific modeling approaches and surgical decision making. Further is not yet sufficiently understood whether spinal alignment parameters relate to the degenerative states. MethodsThe ROM of lumbar spinal segments was quantified using flexion/extension radiographs of 90 patients. The grades of degeneration of discs (IDD, Pfirrmann grades, n=440) and facet joints (FJD, Weishaupt classification, n=406) were assessed in CT and MRI scans. ResultsThe grade of IDD was significantly related to changes in ROM (p<0.01) whereas no association was observed with the amount of FJD. Grade V IDD was associated with a significant decrease in motion (p<0.01) compared to all other IDD grades (II-IV), which did not differ significantly among each other. The combined occurrence of IDD and FJD revealed the largest angular segmental ROM in segments with the lowest IDD (II) and lowest FJD (0). The lowermost ROM was present in fused segments (control), followed by those with severe IDD (V). In combination with FJD, the destabilizing effect of initial IDD was only observed if FJD was already in an advanced state. ConclusionsWhile the degree of facet joint degeneration seems not significantly associated with limitations in spinal motion, severe lumbar disc degeneration limits segmental motion, nearly equal to spinal fusion. This should affect counseling patients undergoing spinal fusion with questions on the probability of adjacent segment degeneration compared to the natural course.

The order of degeneration of lumbar intervertebral disc and lumbar facet joint and its correlation with age.

The order of degeneration of lumbar intervertebral disc and lumbar facet joint and its correlation with age.

Chronology of disc degeneration and facet joint arthritis in lumbar spine is variable - A CT based cross-sectional study

BackgroundThe notion that disc degeneration (DD) always precedes facet joint arthritis (FJA) has held sway for many decades. However, it is not always the case. We hypothesized that DD is not always the first offender studied the prevalence of isolated DD and isolated FJA in the lumbar spine. MethodsInter-vertebral discs and bilateral facet joints of lumbar spines of 135 participants were graded. The participants were divided into one of the four categories. ‘No degeneration,’ ‘Isolated disc degeneration without facet joint arthritis,’ ‘Combined disc degeneration and facet joint arthritis,’ and ‘Isolated facet joint arthritis without disc degeneration.’ Multivariate logistic regression analysis was done to evaluate the predictive factors for spinal degeneration using FJA as a dependent variable while age, sex, BMI, smoking history, and DD as predictor variables. ResultsThe majority of participants had isolated FJA 64 (47.4%). Combined DD and FJA were noted in 32 (23.7%), isolated DD in 8 (5.9%), while 31(23%) had no degeneration. Only age was found to be significantly contributing to the prediction model in multivariate analysis. ConclusionOur study shows that spinal degeneration may begin either in the disc or in the facet joints depending upon the aetiological factors. It is a vicious circle that may be entered at any point, FJA or DD.

Surgical treatment of facet syndrome in segmental instability of the lumbar spine

A clinical example shows a rare case of surgical treatment of facet syndrome, which is formed against the background of instability of the spinal motion segment of the spine at the L IV -L V level using the method of laser vaporization and denervation of the facet joints. The aim of the work is to consider the clinical and diagnostic indicators of facet syndrome and to assess the role of imaging research methods in the diagnosis of this syndrome. At the outpatient stage, with long-term persistent pain syndrome in the lumbar spine, non-stop conservative methods of treatment, the patient underwent survey radiography and MRI examination of this area in order to exclude a specific process (oncopathology, pathological fracture against the background of osteoporosis, spondylitis, etc.) Chronic pain syndrome with its ineffective conservative treatment leads to maladjustment of the psychoemotional and professional-labor state of the patient. Determining the source of pain impulses in the lumbar spine can be difficult, since pain can cause degenerative and pathological changes in various anatomical structures of the spine (intervertebral disc, facet joints, ligaments, muscles, etc.), which can form a clinical picture of pain syndrome with its various manifestations and symptoms, which do not always clearly determine the level and structure of the affected spine. In this connection, for the timely and correct determination of the diagnosis of all patients with chronic pain syndrome in the lumbar spine, it is necessary to be sent to specialized neurosurgical institutions, in which patients undergo a set of necessary medical and diagnostic procedures to determine the further management tactics and treatment algorithm for this category of patients.

122. Does vertebral body tethering cause disc and facet joint degeneration? An MRI study with minimum two years of follow-up

<h3>BACKGROUND CONTEXT</h3> Disc health after various growth modulation techniques have been assessed in animal models, and tethering was claimed to prevent degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the results of animal studies wherein tethering is applied on healthy spines to create a deformity cannot be extrapolated to humans, in which tethering is used for deformity correction. As biomechanical properties are different, effects of vertebral body tethering (VBT) surgery on discs and facet joints in clinical series are not precisely acknowledged. There are concerns that VBT surgery may cause degeneration at both intermediate and adjacent levels. <h3>PURPOSE</h3> Our aim was to investigate the integrity of discs and facet joints that are subject to compressive forces and relative stabilization during growth modulation. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of a prospectively collected data. <h3>PATIENT SAMPLE</h3> This study included 25 (23F, 2M) consecutive adolescent idiopathic scoliosis (AIS) patients with a mean follow-up of 29 (24-62) months who underwent thoracoscopic VBT surgery between 2014 to 2017 were included. <h3>OUTCOME MEASURES</h3> Disc and facet joint degeneration scores on MRI. <h3>Methods</h3> Demographic, perioperative and radiographic data were collected. Overcorrection, mechanical and pulmonary complications, and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years of follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared. Discs were assessed using Pfirrmann grade. Facet joint degeneration was graded on a scale of 0-3. Changes from preop to follow-up MRIs were analyzed using McNemar's Test and Related Samples Marginal Homogeneity Test. <h3>Results</h3> The mean age at surgery was 12.2 (10–14) years and median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. Preoperative mean height of 155.3 (130-178) cm was increased to 163.4 (149-187) cm at latest follow-up. The mean preoperative MT curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° at first erect, which was modulated to 12°±11.5° during follow-up. There was 1 (4%) broken tether, 5 (20%) overcorrected curves, 3 (12%) implant-related complications and 1 (4%) reoperation for a thoracoscopic tether release before the follow-up MRI was obtained. A total of 217 levels of discs and bilateral facet joints, were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet joint scores revealed no significant differences between patients. One case (4%) with an increase in disc scores already had multilevel moderate degeneration preoperatively, while another case (4%) displayed a single-level new-onset grade-2 bilateral facet degeneration. <h3>Conclusions</h3> This study reports MRI findings of 25 rapid and steady growing adolescents (Sanders 2-7) who had undergone thoracoscopic VBT surgery. At an average of 29 months (24-62) after growth modulation with VBT surgery, radiographic degenerative findings were not present in 97.7% of the intermediate and adjacent discs and 99.3% of the facet joints. Studies with longer follow-up are warranted to further analyze the effects of relative stabilization and altered biomechanical loads. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Radiological follow-up of the degenerated facet joints after lateral lumbar interbody fusion with percutaneous pedicle screw fixation: Focus on spontaneous facet joint fusion

BackgroundLateral lumbar interbody fusion (LLIF) is widely used in degenerative lumbar spine surgery. Previous studies of radiographic investigations after LLIF have assessed the anterior interbody fusion rate, the changes in the segmental lumbar lordosis, efficacy of indirect neural decompression, and remodeling of the ligamentum flavum hypertrophy and spinal canal dimension, and so on. The purpose of this study was to evaluate the radiological changes in the degenerated facet joints following LLIF with bilateral percutaneous pedicle screw (PPS) fixation, focusing on spontaneous fusion. MethodsWe retrospectively analyzed 31 patients (79 surgical levels) who underwent two- or three-level LLIF with PPS fixation without direct posterior decompression and bone grafting. We assessed the fusion rate and characteristics of the facet joints’ fusion process on the preoperative, immediately postoperative, 12-month, and at least 2-year computed tomography (CT) images. On average, the last follow-up CT was performed after 30.2 months. Multivariate logistic regression analysis investigated factors related to spontaneous facet joint fusion postoperatively. ResultsThe fusion rates of the interbody and facet joints were 32.9% (26/79) and 19.0% (15/79) after 12-months and 79.7% (63/79) and 58.2% (46/79) at the final CT follow-up, respectively. Of the 46 cases with spontaneous facet fusion, three cases fused posteriorly only. Concomitant anterior interbody fusion was seen in 43/46 (93.5%) cases. Facet fusion started in a ring shape from the outermost joint edges, exposing subchondral bone without cartilage covering, and progressed to the central thicker cartilage regions. Multivariate analysis established that concomitant anterior interbody fusion (adjusted odds ratio [aOR]: 12.10, P = 0.0035) and preoperative facet joint osteoarthritis of Weishaupt Grade ≧ 1 (aOR: 4.770, P = 0.0068) were significant contributing factors to postoperative spontaneous facet fusion. ConclusionsOur study shows that spontaneous facet fusion frequently occurs after LLIF and may be an indicator of the inherent structural stability of the LLIF construct.