Cervical Facet Joint Research Articles

Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial

ObjectiveThe study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated...

Combined effect of artificial cervical disc replacement and facet tropism on the index-level facet joints: a finite element study

BackgroundArtificial Cervical Disc Replacement (ACDR) is an effective treatment for cervical degenerative disc diseases. However, clinical information regarding the facet joint alterations after ACDR was limited. Facet tropism is common in the sub-axial cervical spine. Our previous research indicated that facet tropism could lead to increased pressure on the cervical facet joints. This study aimed to assess the impact of facet tropism on the facet contact force and facet capsule stress after ACDR.MethodsA C2–T1 cervical finite element model was constructed from computed tomography (CT) scans of a 28-year-old male volunteer. Symmetrical, moderate asymmetrical (7 degrees tropism), and severe asymmetrical (14 degrees tropism) models were created at the C5/C6 level by altering the facet orientation at the C5-C6 level. The C5/C6 ACDR was simulated in the intact, moderate asymmetrical and severe asymmetrical models. A 75-N follower load with 1.0-Nm moments was applied to the top of C2 vertebra in the models to simulate flexion, extension, lateral bending, and axial rotation with the T1 vertebra fixed. The range of motions (ROMs) under all moments, facet contact forces (FCFs) and facet capsule strains were tested.ResultsIn the asymmetrical model, the right FCFs considerably increased under flexion, extension, right bending, left rotation, especially under right bending the right sided FCF of the severe asymmetrical model was about 5.44 times of the neutral position, and 3.14 times of the symmetrical model. and concentrated on the cephalad part of the facets. The facet capsule stresses on both sides remarkably increased under extension, lateral bending and right rotation. In the moderate and severe asymmetrical models, the capsule strain was greater on both sides of each position than in the symmetric model.ConclusionsThe face tropism increased facet contact force and facet capsule strain after ACDR, especially under extension, lateral bending, and rotation, and also could result in abnormal stress distribution on the facet joint surface and facet joint capsule. The results suggest that face tropism might be a risk factor for post-operative facet joint degeneration progression after ACDR. Facet tropism may be noteworthy when ACDR is considered as a surgical option.

Efficacy and Accuracy of Ultrasound Guided Injections in the Treatment of Cervical Facet Joint Syndrome: A Systematic Review.

Background/Objectives: Cervical facet joint syndrome (CFJS) is a frequent cause of neck pain and motor disability. Among the available therapies for CFJS, ultrasound (US)-guided injections are becoming more and more widespread, but the evidence about their accuracy and effectiveness is still debated in the scientific literature. The aim of this systematic review is to assess efficacy, accuracy and feasibility of US-guided cervical facet injections for the related chronic neck pain treatment. Methods: This review was conducted following the preferred reporting items for systematic reviews and meta-analysis 2020 (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar and Cochrane Library databases. Qualitative assessment of the selected studies was carried out using the modified Oxford quality scoring system. Nine studies with a total of 958 patients were included in this review. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered at PROSPERO 2024 (n°CRD42024512214). Results: The results of this review suggest that the US-guided cervical facet injection for CFJS treatment is an effective technique in terms of accuracy (using the lateral technique it ranges from 92% to 98%), and efficiency (it grants pain relief with a decrease in the procedure time and fewer needle passes in comparison with the X-ray-guided technique, which also involves radiation exposure). Conclusions: US-guided injections are a safe and effective method to treat this musculoskeletal disease, granting a high functional recovery and long-lasting pain relief, net of the used drugs. However, these procedures are strictly operator-dependent and require important training to acquire good expertise.

11. Cervicogenic headache and occipital neuralgia.

Cervicogenic headache (CEH) and occipital neuralgia (ON) are headaches originating in the occiput and that radiate to the vertex. Because of the intimate relationship between structures based in the occiput and those in the upper cervical region, there is significant overlap between the presentation of CEH and ON. Diagnosis starts with a headache history to assess for diagnostic criteria formulated by the International Headache Society. Physical examination evaluates range of motion of the neck and the presence of tender areas or pressure points. The literature for the diagnosis and treatment of CEH and ON was searched from 2015 through August 2022, retrieved, and summarized. Conservative treatment includes pain education and self-care, analgesic medication, physical therapy (such as reducing secondary muscle tension and improving posture), the use of TENS (transcutaneous electrical nerve stimulation), or a combination of the aforementioned treatments. Injection at various anatomical locations with local anesthetic with or without corticosteroids can provide pain relief for a short period. Deep cervical plexus block can result in improved pain for less than 6 months. In both CEH and ON, an occipital nerve block can provide important diagnostic information and improve pain in some patients, with PRF providing greater long-term pain control. Radiofrequency ablation of the cervical facet joints can result in improvement for over 1 year. Occipital nerve stimulation (ONS) should be considered for the treatment of refractory ON. The treatment of CEH preferentially consists of radiofrequency treatment of the facet joints, while for ON, pulsed radiofrequency of the occipital nerves is indicated. For refractory cases, ONS may be considered.

Efficacy Comparison of Osteopathic Muscle Energy Techniques and Cervical Mobilization on Pain, Disability, and Proprioception in Cervical Spondylosis Patients.

BACKGROUND Cervical spondylosis (CS) is a degenerative disease of the cervical spine characterized by persistent neck pain. Cervical facet joint mobilization (CM) and the osteopathic muscle energy technique (MET) are effective manual procedures for the treatment of neck pain. In this study, we compared the efficacy of the MET and CM techniques on pain, disability, and proprioception in 76 patients with CS. MATERIAL AND METHODS A total of 96 participants with a diagnosis of CS were randomized into an electro-thermal therapy (ET) group (control group, n=32), ET+MET group (experiment I, n=32), and ET+CM group (experiment II, n=32). All patients received 3 treatment sessions per week for 4 consecutive weeks. Pain intensity, functional disability and cervical position sense were measured using the visual analog scale (VAS), Copenhagen Neck Functional Disability Scale (CNFDS), and cervical range of motion (CROM) device. RESULTS The study was completed by 76 participants. VAS and CNFDS scores decreased significantly after treatment in all 3 groups (P<0.001); however, there was no significant difference between the groups (P>0.05). Between-group analysis showed a significant difference in extension joint position error in favor of MET (P<0.001), while there was no significant difference between the groups in other movement directions (P>0.05). CONCLUSIONS MET and CM have similar effects on improving pain and disability in individuals with CS and chronic neck pain. However, the results of this study show that MET combined with ET is a more effective method for improving cervical position sense.

The Relationship Between Craniocervical Morphology and the Presence and Level of Cervical Facet Joint Degeneration.

To investigate the relationship between craniocervical morphology and the presence and level of cervical facet joint degeneration (FJD). A total of 108 consecutive female patients aged 45-55 years who had undergone neck + brain CT angiography were included in this retrospective sectional study. Only patients of a certain age and of the same gender were included in order to eliminate the differences that create a disposition to the development of spinal degeneration. The presence of facet joint (FJ) arthritis (grade ≥2 degeneration in at least one affected facet joint) and the grade of the facet joint degeneration for each patient were recorded. A total of 20 lengths and 3 angles of craniocervical morphology were measured. The differences between the individuals with and without FJ arthritis were investigated with the independent-sample t test, and the relationship between the FJD grade and craniocervical morphology was investigated using the Spearman correlation test. Individuals with FJ arthritis were found to have longer Grabb-Oakes measurement, shorter FM AP length, lower ADI, lower EOP thickness, higher clivus length, higher crista gall-ATS distance, lower CCA angle, lower distance between the C1 vertebra lateral masses, and higher BAI than those without FJ arthritis (P ˂ 0.05). Besides, we found that the FJD grade increased as the Grabb-Oakes measurement increased, ADI distance decreased, FM AP length decreased, EOP thickness decreased, clivus length increased, basal angle increased, distance between the C1 vertebra lateral masses decreased, and BAI increased (P ˂ 0.05). Differences in craniocervical morphology are statistically associated with degenerative processes that result in degenerative changes in the facet joint. Therefore, some morphological changes in craniocervical anatomy cause changes in the momentum and distribution of the load on the facet joints, predisposing the patient to facet arthropathy and osteoarthritis.

Cervical facet joint degeneration, facet joint angle and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4/5: a propensity score-matched study

BACKGROUND CONTEXTPrior studies have hypothesized that degenerative cervical spondylolisthesis (DCS) may be influenced by loss of stability due to disc, facet joint or cervical alignment. Meanwhile, it is commonly believed that the facet joints and paraspinal muscles participate in maintaining cervical spine stability. However, the impact of paraspinal muscle morphology and detailed facet joint features on DCS requires further investigation. PURPOSETo compare facet joint characteristics, disc degeneration and muscle morphology between patients with DCS and those without DCS. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEConsecutive surgical patients with degenerative cervical spondylosis from June 2016 to August 2023 were recruited. OUTCOME MEASURESDCS was assessed on X-ray based on the translation distance. Cervical facet joint degeneration (CFD), the facet joint angle on the axial plane (FA-A) and the facet joint angle on the sagittal plane (FA-S), and facet joint tropism (FT) were measured on computerized tomography (CT). Paraspinal muscle degeneration was assessed on magnetic resonance imaging (MRI) including by the adjusted cross-sectional area (aCSA), the functional aCSA, the fat infiltration ratio (FI%). The Pfirrmann grade of the cervical disc was also evaluated. METHODSDemographic and clinical data were compared in matched and unmatched cohorts. Disc degeneration, muscle degeneration and facet joint characteristics, including FA, FT and CFD, were compared between patients with and without DCS. Furthermore, the degree of CFD was compared with that of adjacent segments in both groups. Additionally, logistic regression was performed to determine independent risk factors for DCS. Finally, the receiver operating characteristic (ROC) curve, area under the curve (AUC) and cutoff value for the risk factors were calculated. RESULTSA total of 431 surgical patients were propensity score matched for age, sex and BMI, and 146 patients were included in the final analysis, with 73 patients in the DCS group and 73 patients in the non-DCS group. DCS patients exhibited more severe CFD at C4/5 (segment with spondylolisthesis). Additionally, DCS was generally associated with more severe CFD, a more horizontal FA-S, more FT and worse paraspinal muscle health but similar disc degeneration. In addition, anterior spondylolisthesis was related to more severe CFD and decreased functional aCSA of the flexors and extensors. Finally, more severe CFD, a more horizontal FA-S and a higher FI% on deep extensor were revealed to be risk factors for DCS, with cutoff values of 1.5, 44.5̊, and 37.1%, respectively. CONCLUSIONSThis study demonstrated that CFD, the FA and FT and parasipnal muscle degeneration were associated with DCS. And may provide novel insight into the pathogenesis and nature history of DCS and suggest the evolution of degeneration in the cervical spine.

Use of the DTRAX Posterior Cervical Facet Joint Fusion and Distraction Device: A Case Series Including 50 Patients

Objective: This retrospective study aimed to assess the efficacy, safety, and feasibility of the DTRAX system for posterior cervical facet fusion in cervical degenerative pathology.Methods: A retrospective analysis of 50 cases involving DTRAX for posterior cervical facet fusion between January 2017 and January 2022. Patient selection criteria, surgical techniques, outcome measures, and data analysis methods were defined.Results: Among the 50 patients included in this study, 21 were women (42%) and 29 were men (58%). Fusion levels varied, with 36 patients undergoing fusion at a single level (72%), 12 at 2 levels (24%), and 2 at 3 levels (4%), totalling 132 implants. The average age was 44.26 years; most patients presented with neck pain, and 23 also reported arm pain (46%). Discharge within 24 hours was common. Pseudoarthrosis was the leading indication (32%), followed by foraminal stenosis (28%) and failed prosthetic implants (24%). Postoperatively, significant reductions in neck and radicular pain were observed, with visual analogue scale scores decreasing steadily over 12 months (p&lt;0.001). Functional improvements, measured by Neck Disability Index scores, were sustained, with a slight increase at 6 and 12 months (p&lt;0.001). The fusion rates at 6 and 12 months were 88% and 96%, respectively. Complications were infrequent, including transient paraesthesia (2%), anterior revision surgery for foraminal stenosis (2%), and suboptimal implant positioning (4%).Conclusion: Favourable clinical and functional outcomes, high fusion rates, and relatively low complication rates were observed with the DTRAX system. Further studies are needed for validation and long-term assessment of efficacy and safety.

Outcomes of cooled radiofrequency ablation of cervical nerves for the treatment of chronic pain.

Chronic pain, defined as pain persisting for more than 3-6 months, has a mean one-year prevalence in the United States of 25.8% and is one of the most frequent reasons adults seek medical care. Treatment options include physical therapy, analgesics, anticonvulsants, exercise, and muscle relaxants. Even with conventional treatment modalities, in a subset of patients, pain may persist. Cooled radiofrequency ablation (c-RFA), a minimally invasive therapy, employs thermal energy generated by electrical currents to disrupt the transmission of pain stimuli along nociceptive pathways. This leads to an attenuation of pain impulses, primarily through nerve tissue necrosis. The potential of c-RFA to alleviate chronic pain for patients who struggle to find relief elsewhere accentuates the importance of rigorously investigating its outcomes. This study investigates whether patients receiving c-RFA for relief of chronic neck pain caused by cervical facet joint arthropathy experience a reduction in pain scores, the length of this reduction in pain scores, and the magnitude of this reduction in pain. This study was a retrospective analysis of data extracted from UW-Health Electronic Medical Health records (EMR), encompassing cervical c-RFA procedures performed from 2015 through 2022. Patient data were obtained, including diagnosis, pre-operative pain score, post-operative pain score, duration of relief, patient age, sex, and BMI. A two-tailed paired t-test was used to statistically analyze the pre-operative and post-operative pain scores, in which a p-value ≤0.05 was considered significant. A total of 450 cervical c-RFA procedures were reviewed, 152 were excluded due to absent pre- or post-op pain scores. 298 were included in the analysis, comprising 203 unique patients: 129 females and 74 males with an average age of 56.03 ± 12.76 and a BMI of 28.76 ± 6.05. Improvement of pain symptoms was reported in 85.23% (n = 263), 6% (n = 19) reported complete pain remission, 8.72% (n = 26) reported no change, and 3.02% (n = 9) reported worsening symptoms. Patients reported an average pre-operative pain score of 6.15 (M = 6.15, SD = 1.55) and an average post-operative pain score of 3.64 (M = 3.64, SD = 2.09) this achieved significance (p < 0.0001). Of the 85.23% (n = 263) charts that noted improvement, there is an average of 48.04% ± 26.53 reduction from their pre-operative pain scores. The average duration of relief lasted 6.67 ± 4.84 months. This study supports the potential efficacy of c-RFA as a minimally invasive treatment for chronic neck pain secondary to cervical facet joint arthropathy refractory to conventional treatment measures, demonstrating significant relief for a substantial length of time. Due to chronic pain's detrimental effect on one's quality of life, finding effective treatment options is essential, especially for those refractory to conventional treatments.

Sudden Death Due to Necrotizing Fasciitis After Routine Cervical Radiofrequency Ablation Treatment.

Cervical facet joint neurotomy, also known as cervical radiofrequency ablation (RFA) or cervical facet rhizotomy, is a medical procedure aimed at alleviating chronic neck pain caused by issues related to the cervical facet joints through ablation of neurons (J Pain Res 2021;14:2807-2831). Although generally safe, adverse events can occur. Infection is a rare consequence of this procedure. Most injection-site infections related to cervical RFA occur spontaneously and resolve with oral antibiotics without sequelae (World Neurosurg 2018;111:e644-e648). We report a case in which a cervical RFA injection resulted in the development of necrotizing fasciitis and ultimately death. To our knowledge, this has not been previously reported and is the first documented fatality due to infectious sequelae of a cervical RFA procedure.

Can ultrasound-guided medial branch blocks be used to select patients for cervical facet joint radiofrequency neurotomy? A matched retrospective cohort validation study.

Medial branch blocks are used to select patients for cervical facet joint radiofrequency neurotomy (CRFN). Blocks are typically performed under fluoroscopic guidance (ie, fluoroscopy-guided blocks [FLBs]). The validity of ultrasound-guided blocks (USBs) is not well established. No prior research has compared cervical USB validity and FLB validity with CRFN outcome used as the criterion standard. To evaluate cervical USB versus FLB validity with CRFN outcome used as the criterion standard. Demographic and outcome data were extracted from the electronic medical records of 2 affiliated musculoskeletal pain management clinics for all patients between 2015 and 2023 inclusive who had cervical USB leading to CRFN. CRFN outcomes of each USB patient were compared with those of a matched FLB patient from the radiofrequency neurotomy (RFN) outcome database of the same clinics. Matching variables included patient age, sex, pain duration, diagnostic/prognostic block paradigm, and CRFN number. Each patient completed a numeric rating scale (NRS) pain score and Pain Disability Quality-of-Life Questionnaire (PDQQ) just before and 3months after CRFN. At repeat CRFN, patients provided a retrospective estimate of the duration and average magnitude (percentage) of relief after the CRFN. USB and FLB groups were comprised of 27 patients (58 RFNs) and 38 patients (58 RFNs), respectively. Post-RFN NRS pain severity and PDQQ-Spine scores demonstrated comparable (P > .05) absolute improvements, proportion of patients achieving ≥50% improvement, and attainment of the minimum clinically important difference. Retrospective estimates of pain relief magnitude and duration were also comparable. This study finds cervical USB and FLB to be comparably valid as defined by their ability to predict CRFN outcome. Within the limitations of operator competence, USB can be used to select patients for CRFN.

Septic arthritis of the cervical facet joint: Clinical report and review of the literature.

Facet joint septic arthritis (FJSA) is an uncommon cause of neck pain, most frequently occurring in the lumbosacral spine. Cervical facet joint septic arthritis is particularly rare. Symptoms typically include spinal or paraspinal pain and tenderness, with severe infections potentially causing neurological impairments. This condition can progress to discitis and osteomyelitis. High clinical suspicion is required for accurate diagnosis and timely treatment. To present the first known case of cervical spine FJSA caused by Moraxella species and provide an updated narrative review of cervical spine FJSA. A case study of a 66-year-old male with cervical spine FJSA caused by Moraxella osloensis is detailed. Additionally, a librarian-assisted literature search was conducted on MEDLINE Pubmed, filtering for adult human trials and including various study types, resulting in the inclusion of 9 relevant manuscripts. The patient's symptoms included neck, right upper thoracic, and periscapular pain, with episodes of numbness and tingling. MRI revealed septic arthritis at the C7-T1 facet joint and associated osteomyelitis. Cultures identified Moraxella osloensis as the causative agent. The patient was successfully treated with antibiotics and experienced significant symptom improvement. Literature review highlights that Staphylococcus aureus is the most common causative agent of cervical FJSA, with diagnosis typically involving MRI and culture tests. Treatment generally includes long-term antibiotics, with some cases requiring surgical intervention. This report underscores the need for high clinical suspicion in diagnosing FJSA and highlights the importance of early intervention. It documents the first known case of cervical spine FJSA caused by Moraxella osloensis, contributing valuable information to the limited literature on this rare condition.

The Burden of Spine Structural Damage on Function in Patients With Axial Spondyloarthritis: Adaptation-Mediated Uncoupling?

To investigate the association between spinal damage and functional capacity in patients with axial spondyloarthritis (axSpA) and to compare the performance of 2 radiographic scores (modified Stoke Ankylosing Spondylitis Spine Score [mSASSS] and Combined Ankylosing Spondylitis Spine Score [CASSS]). Radiographs from 101 patients with axSpA were scored for cervical facet joints (CFJ) and mSASSS for vertebral bodies. CASSS was calculated as the sum of both scores. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI); disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS); mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI); and quality of life by Ankylosing Spondylitis Quality of Life (ASQOL). Univariate and multivariate analyses were performed to investigate the association between possible explanatory variables and outcomes. BASFI correlated strongly with ASQOL (Spearman ρ 0.66) and BASDAI (ρ 0.70), moderately with BASMI (ρ 0.46) and ASDAS (ρ 0.59), and weakly with mSASSS (ρ 0.29) and CASSS (ρ 0.28). A best-fit multivariate model for BASFI, adjusted for symptom duration, age, sex, and smoking status, included BASDAI (B 0.76, P < 0.001), BASMI (B 0.62, P < 0.001), and history of total hip arthroplasty (B 1.22, P = 0.05). Radiographic scores were predictors of BASFI only when BASMI was removed from the model (mSASSS: B 0.03, P = 0.01; CASSS: B 0.02, P = 0.01). Spinal damage was independently associated with physical function in axSpA, but to a lesser extent than disease activity and mobility. Moreover, incorporating CFJ assessment in the mSASSS did not improve the ability to predict function.

Finite element analysis of the biomechanical effects of anterior and posterior cervical fusion surgery for bilateral cervical dislocation

Lower cervical spine injuries often manifest as lower cervical vertebral fractures and dislocations, as well as lower cervical facet joint dislocations. Especially in cases of bilateral facet joint dislocations, it is important to rapidly and effectively relieve spinal cord and nerve root compression to prevent secondary spinal cord injury, while also providing reliable and long-lasting stability to the injured segment after surgery. Combined anterior and posterior approaches have the advantages of both pure anterior or posterior approaches, but the actual situation is complex and variable, making systematic theoretical analysis crucial. This study, with bilateral facet joint dislocation of the C6 segment and cervical spinal cord injury as the research background, established a three-dimensional model of the cervical spine C3-C7 after implementing four types of anterior-posterior combined surgeries. The four surgical approaches consist of four combinations: anterior parallel or inclined screw placement combined with posterior Margel or Anderson method screw insertion. Through finite element method, a systematic comparative analysis of the theoretical effects of the four combined surgeries in treating bilateral facet joint dislocation of the cervical spine was conducted. The conclusion was that the variations in the four combined fixation methods have a certain impact on the biomechanical characteristics of the intervertebral disc nucleus. There is a clear mutual influence relationship among anterior and posterior fixation instruments. Based on the model used in this study, it is recommended to use a torque greater than 2.1 nm to tighten the locking nut of the posterior rod to ensure reliable internal fixation.

The efficacy of multimodal physiotherapy and usual care in chronic whiplash-associated disorders with facet-mediated pain undergoing platelet rich plasma (PRP) treatment: a series of single case experimental designs (SCEDs)

Purpose Chronic whiplash-associated disorders (WAD) is a heterogeneous condition with limited effective treatment options available. This study evaluated the efficacy of multimodal physiotherapy and usual care in chronic WAD with facet-mediated pain receiving platelet-rich plasma (PRP) injections to determine if pain interference and confidence completing activities in the presence of neck pain could be improved. Materials and methods A multiple-baseline, single-case experimental design was used to evaluate the 6-week effect of physiotherapy or usual care in two groups of three participants each. Results All six participants demonstrated a significant reduction in pain interference, and three participants showed improved confidence to perform daily activities when in pain. Weighted Tau-U demonstrated a significant reduction of pain interference with large to very large effect sizes (> 0.75) for both interventions in all participants irrespective of treatment allocation with no significant group difference demonstrated. Similar effects were demonstrated for the confidence to perform daily activities with neck pain (ES > 0.46), although this was only evident in three participants (two PT and one UC). Generalisation measures also showed improvements in pain and disability, psychological and quality of life outcomes. No adverse events were reported. Conclusions Both physiotherapy and usual care demonstrated improvements in pain interference and confidence to perform activities of daily living with neck pain in people with chronic WAD following cervical facet joint PRP. Trial Registration The trial was registered with ClinicalTrials.gov (Protocol Number: NCT03949959).

Novel Risk Factors for Cervical Facet Joint Degeneration in the Subaxial Cervical Spine: Correlation with Cervical Sagittal Alignment and Bone Mineral Density

The impact of cervical sagittal alignment on cervical facet joint degeneration (CFD) and risk factors for CFD in patients with Degenerative cervical myelopathy (DCM) were investigated in the current study. A total of 250 surgical patients with DCM were recruited. Clinical data and radiographical characteristics including CFD, cervical sagittal balance parameters, Hounsfield unit (Hu) value, disc degeneration (DD), modic change were collected. The detailed correlation between these characteristics and CFD was analyzed. Characteristics including CFD were compared among various cervical alignment types and different CFD groups. Finally, risk factors for CFD were revealed via logistic regression. CFD was prevalent in DCM patients. Age, cervical sagittal vertical axis (cSVA), range of motion (ROM), T1 slope (T1S), thoracic inlet angle (TIA), DD, Hu value, and modic change were correlated with CFD segmentally and globally (p<0.05). Lordosis&sigmoid had significantly higher CFD prevalence (p<0.05). Further, the threshold of average CFD for the severe CFD group was determined to be 1.625 (AUC,0.958). Additionally, 167 patients with average CFD (<1.625) and 83 patients with FD≥1.625 were classified into the mild CFD group and severe CFD group respectively. Finally, multivariate analysis was performed and age, cSVA, Hu value, modic change and DD were determined to be the independent risk factors for CFD. The load distribution tends to shift to a more shear-like pattern in sigmoid&kyphosis types or individuals with a higher cSVA, thereby promoting the CFD. Aging, cervical malalignment, low bone mineral density, disc degeneration, and modic change were revealed to have high risks for CFD.

A possible correlation between facet orientation and development of degenerative cervical spinal stenosis

BackgroundPrevious studies have demonstrated the relationship between sagittal facet orientation and cervical degenerative spondylolisthesis. However, the associations between facet orientation and cervical spinal stenosis (CSS) have rarely been studied.MethodsOne hundred twenty patients with CSS (CSS group) and 120 healthy participants (control group) were consecutively enrolled. The cervical facet angles and anteroposterior diameter (A-P diameter) of spinal canal at each subaxial cervical levels were measured using axial magnetic resonance imaging. The intersection angle of the midsagittal line of the vertebra to the facet line represents the orientation of the facet joint.ResultsThe facet angles on the right side at C2- C3 and C3-C4 in CSS group and at C2- C3 in control group had significantly higher values than those of the other sides. Besides, the facet angles and A-P diameter of spinal canal in CSS group were significantly smaller than those in control group at all levels (p < 0.05).ConclusionsOur study demonstrated that patients with CSS have smaller axial cervical facet joint angles compared to the healthy individuals. Further studies are needed to elicit the specific underlying mechanism between sagittalization of the cervical facet joints and the pathology of CSS.

Facet joint disorders: from diagnosis to treatment.

One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.

The Effect of Two Years of Secukinumab Treatment on Bone Metabolism in Patients with Radiographic Axial Spondyloarthritis: Results from Daily Clinical Practice.

Our objective was to explore bone-related outcome and bone turnover markers (BTM) during 2 years of secukinumab treatment in patients with radiographic axial spondyloarthritis (r-axSpA) in daily clinical practice. Included were consecutive r-axSpA outpatients from the Groningen Leeuwarden axSpA (GLAS) cohort treated with secukinumab for 2 years. At baseline and 2 years, spinal radiographic damage was assessed using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS; 0-72), cervical facet joint involvement according the "de Vlam" scoring method (0-15) and radiographic vertebral fractures (VF) using the "Genant" method (grade 0-3). At all visits, BTM reflecting collagen resorption (serum type I collagen C-telopeptide; sCTX), collagen formation (procollagen type 1 N-terminal peptide; PINP) and bone mineralization (bone-specific alkaline phosphatase; BALP) were measured and expressed in Z-scores to correct for the normal influence of age and gender. 17 r-axSpA patients were included; 53% male, mean age was 47±15 years, mean Ankylosing Spondylitis Disease Activity Score (ASDAS) 3.9±1.2, and 53% was biological naïve. The median 2-year progression rates were 1.1 for mSASSS and 0.5 for facet joints, which was less than the smallest detectable change. One traumatic VF (grade 3) occurred. Serum levels of sCTX and PINP remained stable during secukinumab treatment and BALP decreased significantly after 2 years, with median 0-2 year change in Z-scores of +0.1, -0.4, and -1.2, respectively. This explorative study of r-axSpA patients treated with secukinumab in daily clinical practice showed low radiographic spinal progression during 2 years of follow-up. Collagen resorption and formation markers remained stable, whereas mineralization marker BALP decreased significantly after 2 years. Our results are in line with the results of in vitro studies demonstrating that inhibition of IL17-A resulted in suppression of osteogenic differentiation with significant decrease in mineralization.

BIOMECHANICS OF FACET JOINTS: SYNCHRONIZED SPATIO-TEMPORAL AND MECHANICAL ANALYSIS

AbstractObjectivesWhile spinal fusion is known to be associated with adjacent disc degeneration, little is known on the role of the facet joints in the process, and whether their altered biomechanics following fusion plays a role in further spinal degeneration. This work aimed to develop a model and method to sequentially measure the effects of spinal fusion on lumbar facet joints through synchronisation of both motion analysis, pressure mapping and mechanical analysis.MethodsParallel measurements of mature ovine lumbar facet joints (∼8yr old, n=3) were carried out using synchronised load and displacement measurements, motion capture during loading and pressure mapping of the joint spaces during loading. Functional units were prepared and cemented in PMMA endcaps. Displacement-controlled compression measurements were carried out using a materials testing machine (3365, Instron, USA) at 1 mm/min up to 950 N with the samples in a neutral position, while motion capture of the facet joints during compression was carried out using orthogonal HD webcams (Logitech, Switzerland) to measure the displacement of key facet joint features. The pressure mapping of load transfer during displacement was carried out using a flexible pressure sensor (6900 series, Tekscan, USA). Each sample was imaged at an isotropic resolution of 82 microns using a μCT scanner (XtremeCT, Scanco, Switzerland) to quantify the curvature within the facet joints.ResultsRelative facet joint displacement under load, in a neutral position, showed more displacement (2.36 ±1.68 mm) compared to the cross-head when under compression (2.06 ±1.19 mm). Motion capture indicated the relative displacement of the facet joints was more posterior with some lateral motion. For five of the six facet joints, pressure measurement was possible only on 24±7 % of the surface due to the large change in curvature. Partially measured loads through the facets was 10.5 ±1.1 N.ConclusionsThe relative displacement of the lumbar facet joints compared to the crosshead displacement was consistent with previous studies of cervical facet joints, despite the differences in anatomical geometry between cervical and lumbar joints. The difficulties in accurately measuring the load transfer through the facet joints was due to the age of the tissue and the degree of curvature of the facet joints. Synchronisation of the biomechanical data will provide a setup to assess the effect of interventions such as spinal fusion, with curvature-related issues unlikely to occur in human spines.Declaration of Interest(a) fully declare any financial or other potential conflict of interest