Facet Joint Osteoarthritis Research Articles

Kinetic magnetic resonance imaging analysis of abnormal segmental motion of the functional spine unit

The authors conducted a retrospective observational study using kinetic MR imaging to investigate the relationship between instability, abnormal sagittal segmental motion, and radiographic variables consisting of intervertebral disc degeneration, facet joint osteoarthritis (FJO), degeneration of the interspinous ligaments, ligamentum flavum hypertrophy (LFH), and the status of the paraspinal muscles. Abnormal segmental motion, defined as > 10 degrees angulation and > 3 mm of translation in the sagittal plane, was investigated in 1575 functional spine units (315 patients) in flexion, neutral, and extension postures using kinetic MR imaging. Each segment was assessed based on the extent of disc degeneration (Grades I-V), FJO (Grades 1-4), interspinous ligament degeneration (Grades 1-4), presence of LFH, and paraspinal muscle fatty infiltration observed on kinetic MR imaging. These factors are often noted in patients with degenerative disease, and there are grading systems to describe these changes. For the first time, the authors attempted to address the relationship between these radiographic observations and the effects on the motion and instability of the functional spine unit. The prevalence of abnormal translational motion was significantly higher in patients with Grade IV degenerative discs and Grade 3 arthritic facet joints (p < 0.05). In patients with advanced disc degeneration and FJO, there was a lesser amount of motion in both segmental translation and angulation when compared with lower grades of degeneration, and this difference was statistically significant for angular motion (p < 0.05). Patients with advanced degenerative Grade 4 facet joint arthritis had a significantly lower percentage of abnormal angular motion compared to patients with normal facet joints (p < 0.001). The presence of LFH was strongly associated with abnormal translational and angular motion. Grade 4 interspinous ligament degeneration and the presence of paraspinal muscle fatty infiltration were both significantly associated with excessive abnormal angular motion (p < 0.05). This kinetic MR imaging analysis showed that the lumbar functional unit with more disc degeneration, FJO, and LFH had abnormal sagittal plane translation and angulation. These findings suggest that abnormal segmental motion noted on kinetic MR images is closely associated with disc degeneration, FJO, and the pathological characteristics of interspinous ligaments, ligamentum flavum, and paraspinal muscles. Kinetic MR imaging in patients with mechanical back pain may prove a valuable source of information about the stability of the functional spine unit by measuring abnormal segmental motion and grading of radiographic parameters simultaneously.

Association between disc degeneration and degenerative spondylolisthesis? Pilot study

The aim of this pilot study was to test the generally believed hypothesis that intervertebral disc degeneration is a prerequisite for degenerative spondylolisthesis (DS). This cross-sectional study was an ancillary project to the Framingham Study. A sample of 3529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 188 individuals were randomly enrolled in this study. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA) and DS were evaluated. We used the multiple logistic regressions to evaluate the association between DS as a dependent variable and FJOA, disc narrowing, age, sex and BMI as independent variables. There were 23 individuals (24 spinal segments) affected by DS (15 female, 8 male), mean age 62.0 +/- 6.8 years. In segments with DS, FJOA was observed and rated "severe" at 20 (83.3%) segments, "moderate" at 3 (12.5%) levels, and "mild" at 1 (4.2%) level. Intervertebral disc height was normal in 6 (25.0%), slightly decreased in 6 (25.0%), moderately decreased in 5 (20.8%) and severely decreased in 7 (29.2%) of the segments. Three (12.5%) segments with DS had severe FJOA but no apparent disc degeneration. In 9 (37.5%) segments with DS we found no or mild disc degeneration and severe FJOA. In a multiple regression analysis age, sex and FJOA, but not disc narrowing, showed significant associations with DS. The results of our study did not support the theory that disc degeneration necessarily precedes vertebral subluxation in DS.

Radiographic Parameters of Segmental Instability in Lumbar Spine Using Kinetic MRI

To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.

Facet Joint Osteoarthritis and Low Back Pain in the Community-Based Population

Cross-sectional study. To evaluate the association between lumbar spine facet joint osteoarthritis (FJ OA) identified by multidetector computed tomography (CT) and low back pain (LBP) in the community-based Framingham Heart Study. The association between lumbar FJ OA and LBP remains unclear. This study was an ancillary project to the Framingham Heart Study. A sample of 3529 participants of the Framingham Heart Study aged 40 to 80 underwent multidetector CT imaging to assess aortic calcification. One hundred eighty-eight individuals were consecutively enrolled in this ancillary study to assess radiographic features associated with LBP. LBP in the preceding 12 months was evaluated using a self-report questionnaire. FJ OA was evaluated on CT scans using a 4-grade scale. The association between FJ OA and LBP was examined used multiple logistic regression models, while adjusting for gender, age, and BMI. CT imaging revealed a high prevalence of FJ OA (59.6% of males and 66.7% of females). Prevalence of FJ OA increases with age. By decade, FJ OA was present in 24.0% of <40-years-olds, 44.7% of 40- to 49-years-olds, 74.2% of 50- to 59-years-olds, 89.2% of 60- to 69-year-olds, and 69.2% of >70-years-olds. By spinal level the prevalence of FJ OA was: 15.1% at L2-L3, 30.6% at L3-L4, 45.1% at L4-L5, and 38.2% at L5-S1. In this community-based population, individuals with FJ OA at any spinal level showed no association with LBP. There is a high prevalence of FJ OA in the community. Prevalence of FJ OA increases with age with the highest prevalence at the L4-L5 spinal level. At low spinal levels women have a higher prevalence of lumbar FJ OA than men. In the present study, we failed to find an association between FJ OA, identified by multidetector CT, at any spinal level and LBP in a community-based study population.

Intra-articular injection of collagenase induced experimental osteoarthritis of the lumbar facet joint in rats

We aimed to establish an animal model to investigate primary osteoarthritis of the lumbar facet joints after collagenase injection in rats and its effects on chondrocyte apoptosis. We hypothesized that osteoarthritic-like changes would be induced by collagenase injection and that apoptosis of chondrocytes would increase. Collagenase (1, 10, or 50 U) or saline (control) was injected into the lumbar facet joints. The histology and histochemistry of cartilage, synovium, and subchondral bone were examined at 1, 3, and 6 weeks after surgery. Apoptotic cells induced by 1 U of collagenase were quantified using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL) assay. Degeneration of the cartilage and changes to the synovium and subchondral bone were dependent on both the doses of collagenase and the time after surgery. There were significantly more apoptotic chondrocytes in collagenase-treated joints than in control (P < 0.001 at 1 and 3 weeks and P < 0.05 at 6 weeks). Thus, lumbar facet joints subjected to collagenase developed osteoarthritic-like changes that could be quantified and compared. This model provides a useful tool for further study on the effects of compounds that have the potential to inhibit enzyme-associated damage to cartilage.

Poster 208: Treatment of Thoracic Facet Osteoarthritis With a 5% Lidocaine Patch: A Case Report

Setting: Tertiary care academic medical center. Patient: A 74-year-old man with thoracic facet joint osteoarthritis. Case Description: The patient presented with chronic mid thoracic anterior radiating back pain, quality described as burning, aggravated by physical activity including walking, and relieved by heat, ice, and massage therapy. Physical examination revealed intact strength and sensation in all upper and lower myotomes; reflexes that were +2 and symmetric at biceps, triceps, and brachioradialis; and negative Hoffman and Spurling signs. Palpation revealed right rhomboid major and latissimus dorsi tenderness, with focal tenderness over T5-6 facet joints. Radiographs revealed facet osteoarthritis on T5-6 and T6-7 and magnetic resonance imaging showed T6-7 disk protrusion without foraminal narrowing. The patient’s initial treatments included nonsteroidal anti-inflammatory drugs, physical therapy, and thoracic facet steroid injections without any relief of the mid back pain. The patient was prescribed 5% lidocaine patches (Lidoderm), with instructions to apply them to the affected area for 12 hours on and 12 hours off. Assessment/Results: At 4 weeks, the patient reported significant pain relief with numeric pain scores before and after lidocaine patch of 7/10 and 0/10, respectively. The patient reported no unfavorable side effects and further conveyed improved function in daily activities and movement. Discussion: The U.S. Food and Drug Administration approved Lidoderm for postherpetic neuralgia. No published studies exist for thoracic facet osteoarthritis treatment with the lidocaine patch. The lidocaine patch provided more pain relief for thoracic joint osteoarthritis than analgesics and other physical interventions. Conclusions: Conservative medical management for thoracic joint osteoarthritis is limited to oral medications, physical therapy, and thoracic facet steroid injections. Lidocaine patch may provide a safe alternative for pain relief as monotherapy or in combination with other treatments.

The Significance of Increased Fluid Signal on Magnetic Resonance Imaging in Lumbar Facets in Relationship to Degenerative Spondylolisthesis

Retrospective radiographic review of consecutive patients with universally applied standard. To define MRI findings at the facet joints that may suggest abnormal sagittal plane translation seen on standing lateral flexion-extension (SLFE) radiographs. MRI findings, including facet joint orientation, facet joint osteoarthritis, and the presence of synovial cysts, have all been linked with degenerative spondylolisthesis (DS). MRI can also detect facet joint effusion; however, there has not been a study specifically addressing the association of facet fluid signal to degenerative spondylolisthesis (DS). MRI and SLFE films of all patients seen at a single institution for an orthopedic spine consultation over a 2-year period were analyzed. The presence of facet effusions, synovial cysts, increased intensity within the interspinous ligament, degenerative changes at the facets, and anterior sagittal plane translation were all recorded. The data were analyzed to determine if there was a significant association between the presence of DS and the following: facet effusion, degenerative changes of the facets, synovial cysts, increased signal in the interspinous ligament, age, and gender. There were 139 patients without DS at (NegDS) and 54 with DS (PosDS) on SLFE films at L4-L5 (n = 193). PosDS patients were more likely to be older (P < 0.0001), female (P = 0.0042), have synovial cysts (P < 0.0001), have higher osteoarthritis grade (P < 0.0001), and have larger facet effusion size (P < 0.0001). For both groups, facet joint effusions were also found to be significantly larger in patients with Grade 2 or less osteoarthritis, than in patients with Grade 3 osteoarthritis. Twenty-two percent of the listheses were not detectable on supine MRI. Large (> 1.5 mm) facet effusions are highly predictive of degenerative spondylolisthesis at L4-L5 in the absence of measurable anterolisthesis on supine MRI. A clinically measurable facet effusion (> or = 1 mm) suggests the need for SLFE films to diagnose degenerative spondylolisthesis that can be missed with supine positioning on MRI.

The short-term therapeutic effect of recombinant human bone morphogenetic protein-2 on collagenase-induced lumbar facet joint osteoarthritis in rats

To determine whether an intra-articular injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) alleviates cartilage degradation in a rat model of osteoarthritis (OA) of the lumbar facet joint. The right-side facet joint OA model was created by an intra-articular injection of collagenase (type II) 2 weeks before treatment. The OA rats were divided into four groups: (1) no treatment, or intra-articular injection of either (2) saline, (3) rhBMP-2 10 ng, or (4) rhBMP-2 100 ng. The left-side facet joint served as the normal control. At 3 and 6 weeks after treatment, histological analyses were performed on the cartilage, synovium, subchondral bone and bone marrow. The cartilage and synovium were graded using a modified Mankin score and a synovium score system. Extracellular type II collagen was evaluated by immunohistochemistry. Intra-articular injection of collagenase causes OA-like changes in the facet joint. OA rats treated with rhBMP-2 at both dosages tested showed reduced severity of their cartilage lesions compared with untreated and saline-treated groups. There was a statistically significant difference in the modified Mankin score compared to the untreated and saline-treated groups. However, some rhBMP-2-treated rats at the higher dose (100 ng) showed, as a side effect, joint space obliteration caused by cartilage overgrowth. Also OA rats treated with 100 ng of rhBMP-2 displayed a significant synovium reaction at 3 weeks compared with that in other groups. Immunohistochemical analysis showed that treatment with rhBMP-2 significantly increased the content of type II collagen. This study demonstrates the potential efficacy of rhBMP-2 in the alleviation of arthritic changes in a rat model of OA of the lumbar facet joint. However, treatment with a high dosage of rhBMP-2 caused adverse side effects in some animals.

Surgical Treatment of the Atlantoaxial Osteoarthritis

Atlantoaxial facet joint osteoarthritis is rare, often undiagnosed because it may be misdiagnosed as occipital neuralgia, or degenerative cervical spondylosis. Unilateral occipitocervical pain aggravated by head rotation is a specific symptom. Conservative treatment is usually effective. But when the patient complains of intractable neck pain localized to occipitocervical junction and unresponsive to medical therapy, surgical treatment should be considered. Though a few reports of surgically treated atlantoaxial osteoarthritis has been published, surgical outcome is favorable. A case of a surgically treated atlantoaxial osteoarthritis is presented with a review of the literatures.

Do MRI findings correlate with mobility tests? An explorative analysis of the test validity with regard to structure

To find out whether segmental magnetic resonance imaging (MRI) findings such as intervertebral disc degeneration (DD) and facet joint osteoarthritis (FJO) are associated with motion deficiencies as seen in common mobility tests and observed range of motion (ROM). A total of 112 female subjects, nurses and office workers, with and without low back pain, were examined by clinical experts, and lumbar mobility was measured including modified Schober, fingertip-to-floor distance (FTFD) and ZEBRIS motion analysis. An MRI of the lumbar spine was made. Mobility findings were correlated with segmental morphologic changes as seen on MRI at the levels of L1-2 through L5-S1. Only a few statistically significant correlations between MRI findings and the results of the mobility tests could be found. Lateral bending was weakly and negatively correlated to DD and FJO but only on the level of L5-S1. The FTFD showed a weak positive correlation to endplate changes on the level of L4-5. When ROM is observed by clinical experts, there are several significant relationships between MRI findings and the observed motion. There is a highly significant segmental correlation between DD and disc form alteration as seen on MRI on the level of single motion segments. Pain history and current pain level did not moderate any association between MRI and mobility. There is no clear relationship between the structural changes represented by MRI and the measured mobility tests used in this study. Our findings suggest that close observation of spinal motion may provide at least equal information about the influence of spinal structures on motion than the commonly used measured mobility tests do.

Imaging in rheumatology: degenarative diseases of the spine

Degeneration of the spine is a common reason for pain in the musculoskeletal system. Radiography is an important tool for diagnosis and differential diagnosis. Cost efficacy and economy of time are advantages in using conventional x-rays. Although narrowing of intervertebral disc spaces, irregular ossification of the vertebral end-plate as well as osteophytes, facet joint osteoarthritis and spondylolisthesis can be observed, early changes in the discs or the subdiscal bone can not be detected by x-rays. Moreover, 3-dimensional imaging is not possible. Computer tomography (CT) and magnetic resonance imaging (MRI) are reliable for identifying disorders of the spine and soft-tissue. Differentiation between inflammation, trauma and tumor is possible. There is still a problem with the relationship between the information obtained by x-rays or MRI and clinical symptoms. Therefore, interpretation of radiological examinations assumes a knowledge of clinical symptoms and the different kinds of diseases which are possible.

Magnetic Resonance Imaging of the Lumbar Spine

Cross-sectional magnetic resonance imaging (MRI) study. To find out whether different patterns of lumbar disc degeneration related to different physical work types (static vs. dynamic) can be found. The association of lumbar disc degeneration with physical workload as well as the association of disc degeneration with low back pain (LBP) has been debated controversially. Nevertheless, many of the mainly invasive treatment concepts are based on disc degeneration models. An MRI study was performed in female subjects aged 45 to 62 years with persistent LBP and in age-matched controls. Subjects (n = 109) were selected from nursing and administrative professions. A questionnaire was used to assess the subjects' exposure to physical workplace factors. Disc degeneration, disc herniation, nerve root compromise, high intensity zones, endplate changes, and facet joint osteoarthritis were evaluated based on sagittal T1- and T2-weighted as well as axial T2-weighted images. The two occupational groups could clearly be distinguished by the physical workplace factors: administrative work was associated with predominantly sitting postures whereas nursing work was associated with frequent walking, pushing, pulling, and lifting. Except for endplate (Modic) changes at L5-S1, MRI findings did not differ between the four groups, namely, nurses and secretaries with and without LBP. When analyzing the MRI findings within the two vocational groups, nerve root compromise and endplate changes in the lower lumbar spine were found to be significant (P < 0.05) risk factors for LBP. Disc degeneration, disc herniation, nerve root compromise, and facet joint osteoarthritis were present in more than 50% of the intervertebral spaces studied. These findings give evidence that in subjects performing nonheavy work, patterns of lumbar disc degeneration are not associated with the job type and characteristic physical loadings.

Therapeutic Efficacy of Facet Joint Blocks

The objective of our study was to investigate outcome predictors of short- and medium-term therapeutic efficacy of facet joint blocks. Forty-two patients with chronic lower back pain who were undergoing facet joint blocks at one (n = 29) or two (n = 13) levels were analyzed. All patients underwent MRI or CT of the lumbar spine within 5 months before the facet joint blocks. The facet joint blocks were performed under fluoroscopic guidance. A small amount (< 0.3 mL) of iodinated contrast agent, 0.5 mL of local anesthetics and 0.5 mL of steroids, were injected. The initial pain response was prospectively assessed using a visual analogue scale. Additional data, including short-term effect (> 1 week) and medium-term effect (> 3 months), were collected by a structured telephone interview. CT and MRI were reviewed with regard to the extent of facet joint abnormalities. Multiple logistic regression analyses were conducted to identify outcome predictor for efficacy of facet joint blocks. A positive immediate effect was seen in 31 patients (74%). A positive medium-term effect was found in 14 patients (33%). Pain alleviated by motion (p = 0.035) and the absence of joint-blocking sensation (p = 0.042) predicted pain relief. However, the extent of facet joint osteoarthritis on MRI and CT was not a significant predictor for outcome (p = 0.57-0.95). Facet joint blocks appear to have a beneficial medium-term effect in one third of patients with chronic lower back pain and may therefore be a reasonable adjunct to nonoperative treatment. However, outcome appears to depend on clinical, not on morphologic, imaging findings.

Injection Studies in Spinal Disorders

Spinal injections have an important role in many centers in the diagnostic assessment and treatment of patient with various spinal disorders. In the literature, many studies describe the application, techniques, and potential benefit of spinal infections. It is well accepted morphologic alterations and pain correlate weakly because many imaging findings in patients with spinal symptoms can be found in asymptomatic individuals. Accordingly, one rationale for spinal injections is to provoke or eliminate pain presumably caused by the target spinal structure; this ostensibly allows a physician to make a better assessment of whether a particular morphologic alteration does or does not cause symptoms. Another rationale is to use spinal injections to support conservative treatment in patients who have from nerve root compromise, spinal stenosis, or facet joint osteoarthritis. Despite the widespread use of these spinal injections, their application is based widely on anecdotal experience and evidence that is not evidence based. We highlight the need for prospective randomized trials on the clinical efficiency of spinal injections and stress the importance for future considerations of cost effectiveness to justify their further application. Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.

脊柱管内椎間関節嚢腫の治療経験

The results of treatment in patients with symptomatic facet cyst are reviewed. Six patients with neurogenic sign were treated. All cysts were associated with facet joint osteoarthritis. The connection between cyst and facet joint was revealed with arthrography. Four patients were treated conservatively and acquired neurogenic recovery. On the follow-up MR images, one cyst decreased in size, one cyst remained unchanged, and one cyst disappeared. Two patients were treated with cyst excision in surgical treatment. The symptoms disappeared. Histological findings showed that the cystic wall was composed of fibrous connective tissues including hemosiderin, but without synovial lining cell. No recurrence was found on the follow-up MR images.

Radiological Evaluation of Percutaneous Endoscopic Lumbar Discectomy: A Three-Year Follow-Up Study

Materials and Methods: We retrospectively reviewed 30 patients (32 cases) who were observed for a minimum of 3 years after they underwent PELD. The authors investigated the postoperative radiological changes after PELD and the related clinical outcomes. All the patients received plain X-rays, CT and MRI both preoperatively and at the final follow-up. The radiological parameters were evaluated, including the disc height, the disc signal intensity, the subchondral marrow signal intensity, the sagittal plane instability and the facet joint osteoarthritis. Results: The average amount of removed disc was 1.363 g and a significant correlation was detected between the narrowing of disc height and the amount of removed disc. Although the disc height and the disc height ratio were significantly decreased (- 0.97 mm and 86.9%, respectively), the angle of sagittal rotation was well maintained. There were 18 (56.3%) cases of disc signal changes, six cases (18.8%) of subchondral marrow signal changes, and three cases (9.4%) of facet joint osteoarthritis. The success rate was 90.6%. Conclusion: Although disc height narrowing was observed, there was no postoperative instability and the overall clinical outcome was satisfactory. Our results show that PELD is a useful and minimal invasive procedure for the selected patients who are suffering with lumbar disc herniation.

Retrospective study of 77 patients harbouring lumbar synovial cysts: Functional and neurological outcome

Synovial cysts represent an uncommon and probably underestimated pathological entity of the degenerative lumbar spine. The authors report a retrospective analysis of the clinical presentation, radiological studies and operative findings in 77 patients surgically treated for symptomatic lumbar synovial cysts at their institution. Between January 1992 and June 1998, a total of 77 patients presenting with symptomatic lumbar synovial cysts were operated on in the author's department. Operative procedure, complications, results and pathological findings were correlated with preoperative assessment. There were 41 men and 36 women with an average age of 63 years (range 44-90 years). On the basis of their symptom complex on presentation, two populations were identified: patients who presented with a single radicular pain (group I = 51 patients), and patients who presented with bilateral neurogenic claudication (group II = 26 patients). Neurological examination on presentation demonstrated motor deficit (12%), sensory loss (26%) and reflex changes (35%). Degenerative disc disease and facet joint osteoarthritis was a frequent finding in patients with pre-operative MRI. Facet joint orientation was >45 degrees in 76.6% of patients. Preoperative spondylolisthesis was found in 48% on radiological studies. All the patients were treated surgically with resection of the cyst. No fusion was performed as a first line procedure. However subsequent fusion was necessary in one patient who developed symptomatic spondylolisthesis. Mean follow-up period was of 45 months ranging from 18 to 105 months. Only one recurrence occurred during the follow-up period. An excellent or good functional outcome was seen in 97.4% of cases, and 89% of the patients with motor deficit recovered. Surgical resection of lumbar synovial cysts is an effective treatment associated with very low morbidity. Synovial cysts are associated with increased grade and frequency of facet joint asteoarthritis but not with increased grade or frequency of degenerative disc disease compared with patients without cysts. In the author's opinion, at the present time, there is no reliable criterion which allows the development of a symptomatic spinal instability to be predicted in patients with a preoperative spondylolisthesis and therefore fusion as a first line procedure is still debatable.

Degenerative mechanics of the lumbar spine

This paper reviews both the normal biomechanical behavior of the lumbar motion segment and changes in that behavior with disc degeneration. Each level of the spine consists of a disc anteriorly and two facet joints posteriorly. A complex ligamentous structure also contributes to the mechanics of the spine. Degenerative changes include intervertebral disc (nuclear) degeneration, facet joint osteoarthritis, vertebral body degeneration, and ligament degeneration. The goal of this review is to discuss the effect of disc degeneration on the biomechanical behavior of the spine, specifically the load-bearing and kinematic behavior after degeneration.

Discogenic lumbar pain: association with MR imaging and CT discography

Objective: To correlate MR and CT discography findings with pain response at provocative discography in patients with discogenic back pain. Materials and methods: Forty-seven patients aged 25–54 years who underwent MR imaging and subsequent CT discography (97 discs) were included in this study. MR images were retrospectively evaluated regarding disc degeneration, endplate abnormalities, facet joint osteoarthritis, and high intensity zone. During discography concordant pain was regarded as positive, whereas discordant pain and no pain were regarded as negative. MR and CT discographic findings were analyzed on the base of concordant pain using the Chi-square test. Results: Concordant pain was significantly common in the following ( P < 0.05): grade 4 or 5 disc degeneration [88% (30/34) in concordant pain versus 48% (30/63) in discordant pain and no pain], high intensity zone [56% (19/34) versus 30% (19/63)], combination of above two findings [53% (18/34) versus 25% (16/63)], fissured and ruptured disc at discogram [94% (32/34) versus 57% (36/63)], and contrast beyond inner annulus at CT discogram [97% (33/34) versus 57% (36/63)]. Conclusion: Typical MR findings with concordant pain at discography include grade 4 or 5 disc degeneration and presence of a high intensity zone. Typical CT discography findings with concordant pain were fissured/ruptured discs and contrast extending into/beyond the outer annulus on CT.

Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging.

A retrospective review of 303 MRI scans of the lumbar spine was conducted. To determine the prevalence of lumbar facet joint synovial cysts arising from the joints anteriorly and posteriorly. To examine the association of these cysts with facet joint osteoarthritis and degenerative disc disease. Sporadic reports of such cysts exist as do limited studies describing the prevalence of symptomatic anterior facet joint synovial cysts. However, the overall prevalence of lumbar facet joint synovial cysts has not been formally studied, and the mechanism of formation of these cysts is not fully understood. One observer undertook a review of MRI of the lumbar spine from one facility in a series of 303 patients referred mostly for back pain or radiculopathy. The presence of lumbar facet joint synovial cysts, their relationship to the facet joint, the degree of associated facet joint osteoarthritis, the presence of spondylolisthesis, and the degree of associated disc degeneration were recorded. Seven anterior cysts (prevalence = 2.3%) were identified, only two of which did not clearly cause nerve root compression. Twenty-three posterior cysts in 22 patients (prevalence = 7.3%) were identified. Statistically significant associations with increased frequency and severity of facet joint osteoarthritis and with spondylolisthesis were demonstrated compared to patients without cysts. Both anterior and posterior lumbar facet joint synovial cysts are rare. Posterior cysts are more common than anterior cysts. Both types of cysts are related to facet joint osteoarthritis but not to disc disease.