Degenerative Changes Of Facet Joints Research Articles

Endplate and Facet Joint Changes in Cervical Spondylotic Myelopathy

Modic changes (MC) of the vertebral endplates and facet joint degeneration are common causes of neck pain. No previous study has shown the prevalence of and relationship between MC and facet joint changes in cervical spondylotic myelopathy (CSM). The objective of this article was to study the endplate and facet joint changes in CSM. Magnetic resonance imaging of the cervical spine in 103 patients with CSM was retrospectively evaluated. The scans were evaluated by 2 raters, who classified spinal segments according to the Modic classification and the degree of facet degeneration. In patients <50 years old, there were no MC in 61.5%. In patients with MC, Modic type II at C4-C5 was observed most frequently. MC were found in 71.4% of patients ≥50 years old. In patients with MC, Modic type II at C3-C4 was observed most frequently. Degenerative changes of the facet joints were found frequently in both patients <50 years old (77.5%) and patients ≥50 years (90.2%), and grade I degeneration was observed most frequently in both groups. There was a significant correlation between MC and facet joint changes. MC in the cervical spine are common magnetic resonance imaging findings in patients with CSM ≥50 years old. Degenerative facet joint changes are found in the majority of patients with CSM regardless of age. We found a significant correlation between MC and facet joint changes at the same level, indicating that both imaging findings are involved in a common pathophysiological pathway.

A novel in vivo large animal model of lumbar spinal joint degeneration

Background ContextDegenerative disc disease (DDD) is a common, widespread socioeconomic problem. Appropriate large animal models of DDD are required for improved understanding and to serve as preclinical test beds for therapeutic strategies. PurposeTo evaluate the effects of short and medium duration immobilization on the sheep lumbar intervertebral disc (IVD) and facet joints (FJs), and to establish a large animal model for DDD research. Study DesignAn in vivo sheep model evaluating the effect of short- and medium-term immobilization on disc degeneration. MethodsEighteen sheep were equally randomized into three groups: short-term (6-week) immobilization (n=6), medium-term (26-week) immobilization (n=6), and control (no surgery) (n=6). Immobilization of L3–L4 was achieved with pedicle screw and rod implantation, the IVD was kept intact, and the annulus and end plates were not disrupted. The IVD and FJs were assessed with planar radiography, computerized tomography (CT), magnetic resonance imaging (MRI), pure moment biomechanical testing, and histologic analysis. ResultsDisc height was reduced for 6- and 26-week immobilization groups. The MRI and histologic analysis demonstrated significant disc degeneration for both immobilized groups compared with control, but no statistical difference was detected between short- and medium-term duration. Progressive degenerative changes in FJs were observed with micro-CT and histologic end points. Immobilization significantly reduced lateral bending and flexion-extension range of motion. ConclusionsThe mechanical environment set up by immobilization alone is capable of inducing lumbar disc degeneration at both 6 and 26 weeks in sheep. Longer duration immobilization did not advance disc degeneration process beyond of that found with short duration. The present model produces a degenerative disc with intact annulus and without acute injury, more closely representing the scenario common in human disc degeneration. This provides a suitable large animal in vivo model for the evaluation of the new therapies for disc degeneration. Further studies would do well to examine the effect of remobilization after immobilization in this model.

Factors associated with lumbar disc hernia recurrence after microdiscectomy

IntroductionLumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. ObjectiveTo analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Materials and methodsLumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. Results177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. DiscussionPrevious studies show increased disc height and young patients as possible factors associated with recurrence. ConclusionIn our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence.

Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectomía

IntroductionLumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. ObjectiveTo analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Materials and methodsLumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. Results177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. DiscussionPrevious studies show increased disc height and young patients as possible factors associated with recurrence. ConclusionIn our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence.

Degenerative facet joint changes in lumbar percutaneous pedicle screw fixation without fusion

BackgroundAim of the study was to evaluate degenerative lumbar facet-joints changes after percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar fractures. Materials and methodsThirty patients underwent short PPSF without fusion. CT-scan was performed in the pre- and post-operative time at four, eight and 12 months. The six zygapophyseal joints adjacent the fracture's level were evaluated. ResultsAt four months patients showed no differences between pre- and post-operative joint radiographic aspect. At eight and 12 months, CT-scan demonstrated a progressive degeneration only in the middle joints respectively in 21.42% and in 76.92% of the cases. All 10 disrupted facet joints showed progressive degenerative changes at eight and 12 months. ConclusionLumbar percutaneous fixation without fusion induces little degenerations essentially collocated in the middle joints close to fracture level at eight and 12 months. In the proximal and distal joints adjacent the screws degenerative changes can be seen only when associated to pedicle-screw encroachment. Level of evidenceLevel IV retrospective study.

Trans‐facet Joint Approach to Pulsed Radiofrequency Ablation of the L5 Dorsal Root Ganglion in a Patient with Degenerative Spondylosis and Scoliosis

Mechanical low back pain secondary to degenerative facet joint changes is a common reason for referral to pain clinics. When these changes cause encroachment into the intervertebral foramen, radicular pain may result. While pulsed radiofrequency of the dorsal root ganglion can be used in this setting, the anatomic deformity may make the transforaminal approach difficult. We report a case where a trans-facet approach was used successfully and describe the technique.

Facet joint injection in lower back pain–is its continued use justified?

Facet joint injection in lower back pain–is its continued use justified?

Facet joint injection in lower back pain--is its continued use justified?

Facet joint injection in lower back pain--is its continued use justified?

Cervical Myelopathy Caused by Calcium Pyrophosphate Dihydrate Crystal Deposition in Facet Joints

This report illustrates a case of cervical myelopathy caused by degenerative changes of the facet joints in which calcium pyrophosphate dihydrate crystals were found histologically. To evaluate the treatment of this patient, which involved the principles of laminoplasty and posterolateral fusion, and to analyze surgical specimens and preoperative radiographs taken after the patient's surgery. Calcium pyrophosphate dihydrate deposition occurs in cartilage, ligaments, tendons, and joint capsules. Radiographic changes of the cervical facet joints caused by such deposition have already been reported in cadaveric studies. Cases with neurologic compromise rarely occur. Surgical specimens that were obtained from the cervical facet joints, i.e., capsule and synovium, were analyzed histopathologically. The preoperative radiographic study showed severe degenerative changes of the cervical facet joints, and analysis of the surgical specimens indicated the presence of calcium pyrophosphate dihydrate crystals. The cervical facet joints can be involved in calcium pyrophosphate dihydrate crystal deposition and this involvement may accelerate the degenerative changes of the facet joints.

The effect of spondylosis on the outcome of chemonucleolysis

In an attempt to understand the relation between the outcome of chemonucleolysis treatment of lumbar discs and the presence of spondylosis (degenerative process) of the lumbar spine, 40 cases of disc herniation with subsequent intradiscal chymopapain injection (chemonucleolysis) were reviewed. Thirty-eight patients had plain radiographs, 25 had myelography, 28 had computed tomography (CT), and 15 had both myelography and CT. A review of these examinations revealed that 24 patients had minimal or mild spondylosis (group 1) and 13 patients had moderate spondylosis (group 2). Only one patient had a severe spondylosis (group 3). Chemonucleolysis failed in 8/24 (33%) patients from the first group and 2/13 (15%) cases from the second group. Therefore, the presence or absence of even moderate spondylosis did not affect the treatment success rate. A review of the 11 failed cases revealed spinal canal stenosis in three cases and a large disc herniation in two (one case with a myelographic block). Another case had a sequestered disc fragment. In two further cases, the disc herniation was far lateral with complete occlusion of the lateral foramen; another case exhibited severe degenerative changes of facet joints. In two other cases, treatment failure could not be explained by any radiographic finding. Of three patients with large disc herniation, only one responded successfully to intradiscal injection of chymopapain. Chemonucleolysis, however, failed in the only patient in the third group who had severe spondylosis of the facet joint.

LONG-TERM ANATOMIC AND FUNCTIONAL CHANGES IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS TREATED BY HARRINGTON ROD FUSION

One hundred patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent idiopathic scoliosis (2) completion of treatment before age 20, (3) a minimum follow-up of five years thereafter, (4) a minimum age of 22 years at final follow-up, and (5) operation performed by the senior author. Of these, 95 were personally examined. The surgical technique from 1968 to 1973 included a two-stage Harrington distraction, with fusion added at the second operation (52 patients). From 1973 to 1975, 48 patients were treated with a one-stage distraction and fusion after a week of preoperative Cotrel traction. Postoperatively, all patients were treated with a Milwaukee brace. A spinal examination and functional assessment, including a questionnaire and pain drawing, full standing anterior-posterior (AP), and lateral roentgenograms of the spine, was performed by independent observers. Eighty-five subjects without scoliosis served as a control group. The radiographic evaluation showed the usual nearly 50% permanent correction at the follow-up examination averaging nine years postoperatively. Lateral roentgenograms, however, demonstrated in 52% flattened or kyphotic cervical spines producing no significant complaints, non-significant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis. Fifteen of the 24 patients with distal hook insertion and fusion including L4 or L5 demonstrated retrolisthesis. All had significant low-back pain. Degenerative facet joint changes and disc space narrowing was noted in 11 patients, again with a distal hook purchase in L4 or L5. Compared to the controls, the operated patients, as a group, revealed no lessened activity or back pain at any location.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-Term Anatomic and Functional Changes in Patients with Adolescent Idiopathic Scoliosis Treated by Harrington Rod Fusion

One hundred patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent idiopathic scoliosis (2) completion of treatment before age 20, (3) a minimum follow-up of five years thereafter, (4) a minimum age of 22 years at final follow-up, and (5) operation performed by the senior author. Of these, 95 were personally examined. The surgical technique from 1968 to 1973 included a two-stage Harrington distraction, with fusion added at the second operation (52 patients). From 1973 to 1975, 48 patients were treated with a one-stage distraction and fusion after a week of preoperative Cotrel traction. Postoperatively, all patients were treated with a Milwaukee brace. A spinal examination and functional assessment, including a questionnaire and pain drawing, full standing anterior-posterior (AP), and lateral roentgenograms of the spine, was performed by independent observers. Eighty-five subjects without scoliosis served as a control group. The radiographic evaluation showed the usual nearly 50% permanent correction at the follow-up examination averaging nine years postoperatively. Lateral roentgenograms, however, demonstrated in 52% flattened or kyphotic cervical spines producing no significant complaints, non-significant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis. Fifteen of the 24 patients with distal hook insertion and fusion including L4 or L5 demonstrated retrolisthesis. All had significant low-back pain. Degenerative facet joint changes and disc space narrowing was noted in 11 patients, again with a distal hook purchase in L4 or L5. Compared to the controls, the operated patients, as a group, revealed no lessened activity or back pain at any location.(ABSTRACT TRUNCATED AT 250 WORDS)