Cervical Spine Facet Joints Research Articles

Septic Arthritis of Cervical Spine Facet Joints: A Case Report and Review of Imaging.

BACKGROUND Septic arthritis of the facet joint (SAFJ) has been considered a rare type of spinal infection. However, because of the aging of the population, the increase in compromised hosts, and the increase in MRI use in recent years, the number of reports has been increasing. We report the clinical progress of a rare case of septic arthritis of the cervical facet joint (SACFJ) with some imaging considerations, and we compare our findings with existing reports of SACFJ. CASE REPORT A 73-year-old Japanese woman presented with fever, paralytic symptoms, and paresthesia of the upper limbs. Here, we report a case of SACFJ in which MRI findings allowed early diagnosis, and a favorable course was obtained by conservative treatment with antibiotics. Although MRI performed 93 days after the initiation of treatment showed a slight residual signal change in the facet joints, no symptoms had recurred by the sixth month after hospital discharge. CONCLUSIONS If a patient develops neurological symptoms such as paralysis with fever and increased inflammatory response, the physician must consider the possibility of pyogenic spondylitis, including SACFJ, and order an MRI. Epidural abscess is almost inevitable in SACFJ, and surgical treatment, including abscess drainage, is required if spinal cord or paralytic symptoms progress. For patients with SACFJ, as well as pyogenic spondylitis, MRI may not be useful in determining treatment efficacy.

Morphometric Computed Tomography-Based Analysis of Cervical Pedicle and Facet Joints in South Indian Population

Title: Morphometric CT based analysis of cervical pedicle and facet joints in South Indian population.
 Aim: To evaluate individual morphometric variations of the cervical spine pedicles and facet joints by computed tomography among patients attending a tertiary care centre.
 Methodology: A retrospective cross-sectional study was carried out among 25 patients undergoing CT study of the cervical spine at Saveetha Medical College and Hospitals, Thandalam. Various measurements of the cervical pedicles and cervical facet joints were obtained and analysed as mean, standard deviation, and range using Statistical Package for the Social Sciencessoftware.
 Results: Among the 25 subjects, 56% were males and 44% were females with mean age of 59.9 and 55.2 respectively. Pedicle length (PL) and Pedicle height (PH) was comparatively smaller in women than in men. Pedicle isthmus (PI) and Lateral pedicle distance (LPD) of C7 was the greatest in both genders. Pedicle axial length (PAL) was equal in both genders with left side being more than the right. Maximum Superior Pedicle distance (SPD) was found to be at C5 level in both genders. Sagittal angulation showed lesser values in females and the Transverse angulation was the lowest at C7 level in both genders. Facet tropism showed a decreasing pattern from C3 to C7 in both genders.
 Conclusion: This study helps the surgeon to understand variations in the morphometrics of the study population and will be useful in the determination of a safe treatment modality.

Extracting cervical spine popping sound during neck movement and analyzing its frequency using wavelet transform

With the excessive use of smartphones, cervical spine pain is becoming increasingly prevalent. A denoised cervical spine popping sound can aid in monitoring and estimating the state of the cervical spine. However, cervical spine popping sounds that are collected when a subject performs neck movements is contaminated by constant noise. Therefore, a denoising algorithm called Wavelet Transform-Based Stationary-Nonstationary (WTST-NST) is adopted to remove the noise. The input signal is decomposed using wavelet transform to obtain the wavelet coefficients. The wavelet coefficients are then separated into two parts, the nonstationary part and the stationary part, using stationary-nonstationary filtering technology. Finally, the wavelet coefficients of the nonstationary part are reconstructed to obtain the denoised cervical spine popping sound. In addition, the frequency components of the sound are analyzed using the multiresolution analysis of the wavelet transform. The experimental results demonstrate that the implementation of the WTST-NST algorithm in the sound analysis of cervical spine facet joints efficiently reduces the overlapped noise, producing an almost pure cervical spine popping sound. Furthermore, the frequency components of cervical spine popping sounds during the smartphone use period are significantly higher than that in the non-use period and are significantly associated with self-reported neck and upper back pain during the smartphone use period. Therefore, the WTST-NST algorithm preserved almost all the features of the sampled input signal. The denoised cervical spine popping sound can be used to quickly and conveniently monitor the status of the cervical spine during the smartphone use period.

Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation.

A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.

Biomechanics Among Various Techniques of the Cervical Laminoplasty

The nature of cervical spine motions consists of multiple components of the cervical spine, intervertebral disc, ligaments, and adjacent facet joints. Cervical spinal stenosis is disabling and this chronic degenerative disorder commonly occurs in middle age-elderly persons. Surgical options for those spinal cord disorders generally are the anterior or posterior approach. Historically, a conventional multi-level laminectomy was performed to decompress the spinal cord but there is a high rate of late biomechanical complications such as segmental instability, and kyphosis. Laminoplasty was developed to relieve the spinal cord compression and maintain the posterior elements. Lately, there are various techniques of the cervical laminoplasty, the biomechanical impact of these techniques will be described.

Biomechanics Among Various Techniques of the Cervical Laminoplasty

The nature of cervical spine motions consists of multiple components of the cervical spine, intervertebral disc, ligaments, and adjacent facet joints. Cervical spinal stenosis is disabling and this chronic degenerative disorder commonly occurs in middle age-elderly persons. Surgical options for those spinal cord disorders generally are the anterior or posterior approach. Historically, a conventional multi-level laminectomy was performed to decompress the spinal cord but there is a high rate of late biomechanical complications such as segmental instability, and kyphosis. Laminoplasty was developed to relieve the spinal cord compression and maintain the posterior elements. Lately, there are various techniques of the cervical laminoplasty, the biomechanical impact of these techniques will be described.

Histological Osteoarthritic Changes in the Human Cervical Spine Facet Joints Related to Age and Sex.

Cross-sectional autopsy study. Quantify histological changes in the lower cervical spine facet joints with regard to age and sex using systematic random sampling of entire joints. Neck pain is a common debilitating musculoskeletal condition and one of the highest ranked causes of years lived with disability. The cause of neck pain is multifactorial and osteoarthritis is one potential cause. The cervical spine facet joints have been implicated in the etiology of chronic neck pain. Hence, a detailed description of their anatomy and age- and sex-related changes is needed. The lower four cervical spine segments (C4-C7 included) were obtained from 72 subjects during autopsy; 29 women (median age 53 years [22-77]) and 43 men (median age 38 years [20-78]). A total of 1132 articular facets were embedded in toto in hard plastic and sliced into 3-mm thick sections from where 10 μm thick histological sections were produced. Morphological variables were evaluated microscopically and histomorphometric variables were retrieved using random sampling methods. Data were analyzed with a linear regression model. Significant associations were found between increasing age and in particular splitting, fissures, osteophytes, thickness of the calcified cartilage, and subchondral bone plate. The thickness of the calcified cartilage and subchondral bone plate increased with increasing age, whereas the hyaline cartilage thickness decreased. Males had more extensive degenerative changes in the cartilage. Using semiquantitative histological methods, degenerative findings were observed at all spinal levels involving the articular cartilage and the osseous structures of the cervical spine facet joints similar to those observed in larger weight-bearing joints. In particular, the thickening of the calcified cartilage and the subchondral bone identified the osteocartilaginous junction as an important area in osteoarthritis. These findings may be relevant for the pathogenesis of osteoarthritis. 3.

Isolated cervical spine facet joint tumoral calcinosis

Isolated cervical spine facet joint tumoral calcinosis

Incorporation of Lower Neck Shear Forces to Predict Facet Joint Injury Risk in Low-Speed Automotive Rear Impacts

Lower neck shear force remains a viable candidate for a low-velocity automotive rear-impact injury criterion. Data were previously reported to demonstrate high correlations between the magnitude of lower neck shear force and lower cervical spine facet joint motions. The present study determined the ability of lower neck shear force to predict soft-tissue injury risk in simulated automotive rear impacts. Rear-impact tests were conducted at two velocities and with two seatback orientations using a Hybrid III anthropomorphic test device (ATD) and stock automobile seats from 2007 model year vehicles. Higher velocities and more vertical seatback orientations were associated with higher injury risk based on computational modeling simulations performed in this study. Six cervical spine injury criteria including NIC, Nij, Nkm, LNL, and lower neck shear force and bending moment, increased with impact velocity. NIC, Nij, and shear force were most sensitive to changes in impact velocity. Four metrics, including Nkm, LNL, and lower neck shear force and bending moment, increased for tests with more vertical seatback orientations. Shear force was most sensitive to changes in seatback orientation. Peak values for shear force, NIC, and Nij occurred approximately at the time of head restraint contact for all four test conditions. Therefore, of the six investigated metrics, lower neck shear force was the only metric to demonstrate consistency with regard to injury risk and timing of peak magnitudes. These results demonstrate the ability of lower neck shear force to predict injury risk during low velocity automotive rear impacts and warrant continued investigation into the sensitivity and applicability of this metric for other rear-impact conditions.

Non-fatal injuries to the cervical spine facet joints after a fatal motor vehicle crash

Injuries to the lower cervical spine facet joints may be identified in people killed in road traffic crashes. However, many of these injuries are not identified on diagnostic imaging procedures despite histological evidence of injury. This case report illustrates possible non-lethal pathological conditions in the facet joints following fatal road traffic trauma. The cervical spine segments C4 to C7 were removed en bloc and examined with magnetic resonance imaging, computed tomography and conventional radiology. The specimen was fixated in alcohol, embedded in methylmethacrylate, and divided into 3 mm thick parasaggital slices from where 10 microm thick sections were produced and evaluated with light microscopy. Injuries identified on microscopy included haemarthrosis, capsular avulsion, synovial fold contusions and subchondral fractures. None of the injuries were detected on diagnostic imaging or at routine autopsy. Discrete injuries to the cervical spine facet joints were identified using supplemental histological procedures in this case report. Post-mortem diagnostic imaging did not reveal these injuries and future studies should investigate the nature, prevalence and clinical relevance of such lesions.

Imaging Occult Lesions in the Cervical Spine Facet Joints

Discrete injuries in the lower cervical spine facet joints have been reported in studies of motor vehicle crash victims. We conducted a detailed investigation of these joints from 20 motor vehicle crash fatalities and 22 decedents due to nontraumatic causes, using conventional radiology, computed tomography, and magnetic resonance imaging to examine whether the diagnostic imaging procedures could identify injuries in the facet joints. The diagnostic imaging procedures identified facet joint fractures in 4 of the 19 trauma cases with computed tomography having the highest sensitivity and obtaining good correlation with findings from the microscopical evaluation. No diagnostic imaging procedure could reliably evaluate the integrity of the synovial folds or the joint spaces for bleeding despite microscopical evidence of such findings in these structures in a large proportion of the motor vehicle crash fatalities. This study emphasizes the need for scientific evidence of validity and reliability of advanced diagnostic imaging procedures in forensic settings, in particular, with regard to occult soft tissue lesions, and cautions uncritical use of negative results from these procedures until such evidence has been produced.

The characteristics of bony ankylosis of the facet joint of the upper cervical spine in rheumatoid arthritis patients

This study investigated the bony ankylosis of the upper cervical spine facet joints in patients with a cervical spine involvement due to rheumatoid arthritis (RA) using computed tomography (CT) and then examined the characteristics of the patients showing such ankylosis. Forty-six consecutive patients who underwent surgical treatment for RA involving the cervical spine were reviewed. The radiographic diagnoses included atlanto-axial subluxation in 30 cases, vertical subluxation (VS) in 10 cases, VS + subaxial subluxation in 3 cases and cervical spondylotic myelopathy in 3 cases. The patients were classified into two groups, those developing bony ankylosis or not and then the differences in the patient characteristics between the two groups was investigated. Furthermore, cervical spine disorders and surgeries were also evaluated in patients who demonstrated such bony ankylosis. The CT reconstruction image demonstrated bony ankylosis in 12 patients (group BA), and the remaining 34 cases (group NB) showed no bony ankylosis. The level at which bony ankylosis occurred was atlanto-occipital joint (AOJ) in eight cases, atlanto-axial joint (AAJ) in two cases and AOJ, AAJ in two cases. No differences were observed between the two groups (age P > 0.54, gender P > 0.39, duration of RA P > 0.72). There was a significant difference between two groups in the patients showing obvious neurological impairment (P = 0.017). In BA group, arthrodesis or decompression was adapted for a caudal region of bony ankylosis. In conclusion, bony ankylosis of the facet joint of the upper cervical spine was detected in 12 of 46 RA patients with involvement of the cervical spine who thus required surgery. These findings showed that the patients demonstrating such ankylosis showed severe cervical myelopathy. In addition, we suggest that the occurrence of bony ankylosis was a risk factor for instability of AAJ, and subaxial instability or stenosis.

Pathoanatomy of the lower cervical spine facet joints in motor vehicle crash fatalities

Non-lethal injuries to the cervical spine facet joints have previously been described in decedents from motor vehicle crashes and in clinical settings these joints have been identified as potential culprits in chronic neck pain syndromes. The aim of this study was to conduct a detailed examination of the lower cervical spine facet joints in a forensic cohort of motor vehicle crash victims and controls using comparable data from medicolegal autopsy, stereomicroscopy and histological evaluations. Injuries to the cervical spine facet joints were common in the trauma cases and included facet fractures, haemarthrosis, and disruption and bleeding in the synovial folds. The injuries could not be reliably verified on stereomicroscopic evaluation, and routine autopsy procedures did not reveal any of the injuries to the facet joints. Despite the presence of these pathoanatomical lesions in road traffic crash fatalities their prevalence and potential clinical implications in survivors from motor vehicle crashes is unknown.

Degenerative and traumatic changes in the lower cervical spine facet joints

Objective: The aim of this study was to examine anatomical variables of the lower cervical spine facet joints with regard to age, gender, and exposure to trauma.Methods: The lower four cervical spine segments (C4–C7 included) were obtained from 40 subjects during autopsy: 12 females and 28 males (median age 35 years, range 20–49). Through an available 636 unique facets (318 joints), 1830 randomly obtained observation lines were defined. Each of these lines resembled a 3‐mm‐thick parasaggital slice through a facet from which 10‐µm‐thick histological sections were produced and evaluated microscopically. Inter‐ and intraobserver agreement was tested on four randomly selected facets from each subject.Results: Significant age‐, gender‐, and trauma‐related changes in the bone, cartilage, and soft tissues were observed, including subchondral sclerosis, fibrillation and splitting of cartilage, and cartilage length differences. Females were less affected by changes in the cartilage than males. Two synovial folds were present in all but one joint. Moderate interobserver and good intraobserver agreement were achieved.Conclusions: This study provides knowledge of the anatomy of the cervical spine facet joints. The findings support existing knowledge that males are more commonly affected by degenerative changes than females and that these changes are common from a young age. Histomorphometry confirms the presence of synovial folds in all of the facet joints. Following spinal trauma, pathological lesions may be produced in the facet joints and/or accentuate already existing pathology. The information provided in this study may have relevance for patients with neck pain.

Examination of Cervical Spine Histological Sections—A Technical Note

AbstractThe cervical spine facet joints have a central role in chronic pain syndromes following whiplash injuries. In order to improve our understanding of these pain syndromes, a detailed knowledge of the cervical spine anatomy and morphology is needed. Hence, a detailed examination of the cervical spine articular structures is needed and for this purpose we present a specialized histological method that may be employed in post-mortem studies.

Whiplash syndrome: kinematic factors influencing pain patterns.

The overall, local, and segmental kinematic responses of intact human cadaver head-neck complexes undergoing an inertia-type rear-end impact were quantified. High-speed, high-resolution digital video data of individual facet joint motions during the event were statistically evaluated. To deduce the potential for various vertebral column components to be exposed to adverse strains that could result in their participation as pain generators, and to evaluate the abnormal motions that occur during this traumatic event. The vertebral column is known to incur a nonphysiologic curvature during the application of an inertial-type rear-end impact. No previous studies, however, have quantified the local component motions (facet joint compression and sliding) that occur as a result of rear-impact loading. Intact human cadaver head-neck complexes underwent inertia-type rear-end impact with predominant moments in the sagittal plane. High-resolution digital video was used to track the motions of individual facet joints during the event. Localized angular motion changes at each vertebral segment were analyzed to quantify the abnormal curvature changes. Facet joint motions were analyzed statistically to obtain differences between anterior and posterior strains. The spine initially assumed an S-curve, with the upper spinal levels in flexion and the lower spinal levels in extension. The upper C-spine flexion occurred early in the event (approximately 60 ms) during the time the head maintained its static inertia. The lower cervical spine facet joints demonstrated statistically greater compressive motions in the dorsal aspect than in the ventral aspect, whereas the sliding anteroposterior motions were the same. The nonphysiologic kinematic responses during a whiplash impact may induce stresses in certain upper cervical neural structures or lower facet joints, resulting in possible compromise sufficient to elicit either neuropathic or nociceptive pain. These dynamic alterations of the upper level (occiput to C2) could impart potentially adverse forces to related neural structures, with subsequent development of a neuropathic pain process. The pinching of the lower facet joints may lead to potential for local tissue injury and nociceptive pain.

Cervical spine vertebral and facet joint kinematics under whiplash.

Whiplash injuries sustained during a rear-end automobile collision have significant societal impact. The scientific literature on whiplash loading is both diverse and confusing. Definitive studies are lacking to describe the local mechanisms of injury that induce either acute or chronic pain symptoms. A methodology has been presented to quantify the kinematics of the cervical spine components by inducing controlled whiplash-type forces to intact human head-neck complexes. The localized facet joint kinematics and the overall segmental motions of the cervical spine are presented. It is anticipated that the use of this methodology will assist in a better delineation of the localized mechanisms of injury leading to whiplash pain.

Finite element modeling approaches of human cervical spine facet joint capsule

The human cervical spine facet joint capsule was modeled using four nonlinear finite element approaches: slideline, contact surface, hyperelastic, and fluid models. Slideline elements and contact surface definitions were used in the first two models to simulate the synovial fluid between the articulating cartilages. Incompressible solid elements approximated the synovial fluid in the hyperelastic model. Hydrostatic fluid elements idealized the synovial fluid in the fluid model. The finite element analysis incorporated geometric, material and contact nonlinearities. All models were subjected to compression, flexion, extension, and lateral bending. The fluid model idealization better approximates the actual facet joint anatomy and its behavior than the gap assumption in the slideline and contact surface models, and the solid element simulation in the hyperelastic model.