Facet Joint Degeneration Research Articles

Long-Term Radiographic and Clinical Outcomes in Patients Undergoing Transforaminal Endoscopic Lumbar Discectomy: A Propensity Score Matching Study.

Our study aims to investigate the long-term clinical and radiographic effects of transforaminal endoscopic lumbar discectomy (TELD) on lumbar disc herniation. Radiographic and clinical data of patients undergoing TELD in our institution from January 2015 to January 2019 were retrospectively collected. LDH outpatients who had not received surgical treatment during the same period were 1:1 matched by propensity score matching as the conservative group. The radiographic parameters of the two groups at baseline and at the last follow-up (≥24 months) were analyzed. The study included 47 patients in the TELD group, matched with 47 patients in the conservative group. The disc height of the TELD group at the last follow-up was lower than that at the baseline (P < 0.001), and lower than that of the conservative group at the last follow-up (P < 0.05). The disc degeneration grade of the TELD group at the last follow-up was greater than that at the baseline, and greater than that of the conservative group at the last follow-up. There was no significant difference in the facet joint degeneration in the TELD group between the baseline and the last follow-up, and between the TELD group and the conservative group at the last follow-up (P > 0.05). The pain intensity and disability score in the TELD group at 3-month follow-up and at the last follow-up were significantly lower than those at the baseline (P < 0.001). Six patients in the TELD group required additional surgery during the follow-up period. Our long-term follow-up data shows that the disc height of the operated level was significantly reduced and the disc degeneration was significantly aggravated in TELD-treated patients; in contrast, the facet joint degeneration did not show significant aggravation.

Biological principles of adult degenerative scoliosis.

The global aging population has led to an increase in geriatric diseases, including adult degenerative scoliosis (ADS). ADS is a spinal deformity affecting adults, particularly females. It is characterized by asymmetric intervertebral disc and facet joint degeneration, leading to spinal imbalance that can result in severe pain and neurological deficits, thus significantly reducing the quality of life. Despite improved management, molecular mechanisms driving ADS remain unclear. Current literature primarily comprises epidemiological and clinical studies. Here, we investigate the molecular mechanisms underlying ADS, with a focus on angiogenesis, inflammation, extracellular matrix remodeling, osteoporosis, sarcopenia, and biomechanical stress. We discuss current limitations and challenges in the field and highlight potential translational applications that may arise with a better understanding of these mechanisms.

Tension Distension Sign (Acevedo’s Sign) for the Diagnosis of Lumbar Facet Syndrome: Technical Note

The treatment of low back pain has evolved from an understanding of its pathophysiology, biomechanics, and therapy. The events that characterize the degenerative cascade of modifications that produce pain are well described. Facet joints are early affected when there is a loss of intervertebral disc height and may present biomechanical overload that translates into pain. Clinical diagnosis of lumbar facet syndrome is not straightforward because there are no specific features other than pain triggered by hyperextension+forced rotation of the lumbar spine in a standing position to suspect it. This implies that its diagnostic confirmation depends on bone scintigraphy and selective anesthetic blockade of the dorsal and medial branches of the joint. In this technical note, we present a new clinical sign (Tension Distension Signo sign/Acevedo's sign) described since2004.

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.

Endoscopic Rhizotomy in Management of Facetogenic Chronic Lumbar Pain

Background Facet Arthritis causing Chronic Low Back Pain (CLBP) is an increasingly controversial field. The diagnosis of Facetogenic pain is still deemed difficult by many physicians, and its pathophysiology, as well as its management are still not quite understood. From the available literature, we can conclude that Lumbo-sacral Facet Arthritis is attributed to a degenerative process affecting the facet joint, which is described as the articulation between the superior articular process of one vertebrae and the inferior articular process of a vertebrae above. This degenerative process is commonly attributed to the „wear-and-tear' theory coming with age, highly comparative to the same degenerative process affecting any other joint. Aim of the Work to evaluate its effectiveness in controlling short term and long term pain caused by lumbar facet arthritis resulting in Chronic Low Back Pain (CLBP), and its effectiveness in decreasing disabilities caused by the debilitating symptoms of progressive arthritis in the lumbar facet joints. Patients and Methods was done to evaluate a novel technique, the Endoscopic Rhizotomy, as one of the minimally invasive procedures that is implemented in the management of Lumbar Facet Arthritis. All the available papers in literature describing this intervention from May 2000 to December 2020 were included. Results The initial search resulted in 468 articles from five databases including PubMed, Science Direct, Cochrane Library, Scopus, and Google Scholar. 16 studies are retrieved from additional databases. The total number before duplicates removal is 484 records. Conclusion that Endoscopic Rhizotomy is a very safe procedure, with a very low complication rate. We also concluded that Endoscopic Rhizotomy significantly relieves Facetogenic CLBP, with up to 3 years of pain relief. The procedure improved the subjective and objective quality of the patients. With comparison to the traditional Radiofrequency Ablation (RFA), Endoscopic Rhizotomy does not use radiation and allows direct visualization, in addition to being superior to RFA considering improving both pain and disability post-operative. It is considered a single day procedure, and the patient can return to work the 2nd day, fully-functioning. Without doubt, several factors, however, have to be taken into account when offering the patient such a procedure, as the presence of spinal deformities, instabilities, hypermobility, and the overall assessment of the patient‟s condition.

Risk Factors of Low Back Pain Aggravation After Tubular Microdiscectomy of Lumbar Disc Herniation

Although lumbar disc herniation (LDH) patients' sciatic symptoms such as leg pain can be improved by decompressive surgery, some patients report postoperative aggravated low back pain (LBP). However, the exact reason for this phenomenon remained unknown. We retrospectively analyzed the prospectively collected LDH data of patients who underwent tubular microdiscectomy between December 2015 and December 2020. The patients were divided into aggravated and non-aggravated group according to whether the postoperative LBP visual analogue scale (VAS) score was higher than the preoperative score. We analyzed the relationship of the clinical and radiologic parameters with aggravated LBP. Postoperative aggravated LBP cases accounted for 14.1% (57 of 404) of this series. Of the 57 patients, 88% (50 of 57) had mild postoperative LBP aggravation (1-2), and 12% (7 of 57) had severe LBP aggravation (>2). The preoperative LBP VAS score of the aggravated group was significantly lower than that of the non-aggravated group (P < 0.001), while the LBP VAS score and Oswestry Disability Index at final follow-up was significantly higher in the aggravated group (P < 0.05). Additionally, the proportion of preoperative moderate-to-severe multifidus fatty atrophy (MFA) and lumbar facet joint degeneration (LFJD) was significantly higher in the aggravated group. A multiple stepwise logistic regression analysis indicated that the preoperative LBP VAS score (P < 0.001, odds ratio 0.266, 95% CI 0.161-0.439) and MFA (P < 0.001, odds ratio 4.491, 95% CI 2.092-9.640) were the risk factors for postoperative aggravated LBP. A preoperative lower LBP VAS score and moderate-to-severe MFA were associated with postoperative aggravated LBP. This will provide important guidance for patient's preoperative assessment and education.

A retrospective cohort study on the significance of preoperative radiological evaluation of lumbar degenerative diseases for surgical reference.

Radiography has low radiation exposure and the ability to acquire information. Due to its cost-effectiveness and availability, preoperative radiographic imaging examination is considered to be a valuable method to evaluate the condition of patients with spinal disease. The aim of this cohort study is to analyze the impact of evaluating preoperative X-rays on the surgical management of lumbar degenerative diseases (LDD). We reviewed 49 patients with LDD underwent single-level posterior instrumented lumbar fusion (PILF) between November 2017 and October 2022 in this cohort study. The median iliac angle (MIA), iliac crest height, intervertebral facet joint degeneration, lumbosacral angle (LSA), L5/S1 intervertebral space angle (ISA), intervertebral foramen height (IFH) and intervertebral space height (ISH) were measured on preoperative radiographs. In addition, operative time, intraoperative blood loss and postoperative complications were used to evaluate the surgical management. Correlation analysis was used to determine the correlation between preoperative radiographic presentation and surgical managements. Multivariate linear regression analysis was used for determination of risk factors for surgical management. Correlation analysis showed that the median iliac angle, height of iliac crest, lumbosacral angle and intervertebral facet joint degeneration were significantly correlated with surgical managements (P<0.05). Height of iliac crest, intervertebral facet joint degeneration and lumbosacral angle were positively correlated with surgical management. Meanwhile, MIA was negatively correlated with surgical management. No significant difference was found between the IFH, ISA, ISH and surgical managements in posterior lumbar surgery (P>0.05). After multiple linear regression analysis, height of iliac crest, median iliac angle and intervertebral facet joint degeneration were independent influence factors for the single-level lumbar surgical managements. Some variables measured in radiograph shows that height of iliac crest, median iliac angle and intervertebral facet joint degeneration have a potential influence on surgical managements. The lumbosacral angle was positively associated with surgical management, but it was not statistically significant in multiple linear regression analysis (P>0.05). The above measurements in plain film can reflect the surgical procedure and have some guiding implications for the operation.

Comparing CT-Like Images Based on Ultra-Short Echo Time and Gradient Echo T1-Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard.

Several magnetic resonance (MR) techniques have been suggested for radiation-free imaging of osseous structures. To compare the diagnostic value of ultra-short echo time and gradient echo T1-weighted MRI for the assessment of vertebral pathologies using histology and computed tomography (CT) as the reference standard. Prospective. Fifty-nine lumbar vertebral bodies harvested from 20 human cadavers (donor age 73 ± 13 years; 9 male). Ultra-short echo time sequence optimized for both bone (UTEb) and cartilage (UTEc) imaging and 3D T1-weighted gradient-echo sequence (T1GRE) at 3 T; susceptibility-weighted imaging (SWI) gradient echo sequence at 1.5 T. CT was performed on a dual-layer dual-energy CT scanner using a routine clinical protocol. Histopathology and conventional CT were acquired as standard of reference. Semi-quantitative and quantitative morphological features of degenerative changes of the spines were evaluated by four radiologists independently on CT and MR images independently and blinded to all other information. Features assessed were osteophytes, endplate sclerosis, visualization of cartilaginous endplate, facet joint degeneration, presence of Schmorl's nodes, and vertebral dimensions. Vertebral disorders were assessed by a pathologist on histology. Agreement between T1GRE, SWI, UTEc, and UTEb sequences and CT imaging and histology as standard of reference were assessed using Fleiss' κ and intra-class correlation coefficients, respectively. For the morphological assessment of osteophytes and endplate sclerosis, the overall agreement between SWI, T1GRE, UTEb, and UTEc with the reference standard (histology combined with CT) was moderate to almost perfect for all readers (osteophytes: SWI, κ range: 0.68-0.76; T1GRE: 0.92-1.00; UTEb: 0.92-1.00; UTEc: 0.77-0.85; sclerosis: SWI, κ range: 0.60-0.70; T1GRE: 0.77-0.82; UTEb: 0.81-0.92; UTEc: 0.61-0.71). For the visualization of the cartilaginous endplate, UTEc showed the overall best agreement with the reference standard (histology) for all readers (κ range: 0.85-0.93). Morphological assessment of vertebral pathologies was feasible and accurate using the MR-based bone imaging sequences compared to CT and histopathology. T1GRE showed the overall best performance for osseous changes and UTEc for the visualization of the cartilaginous endplate. 1 TECHNICAL EFFICACY: Stage 2.

Interdisciplinary interventional and physiotherapy management of facet joint syndrome

Interdisciplinary interventional and physiotherapy management of facet joint syndrome

Symptomatic lumbar stenosis due to low-grade degenerative spondylolisthesis can effectively be treated with mere decompression.

Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine. We aim to establish the incidence of degenerative spondylolisthesis in spinal stenosis surgical candidates and to evaluate the incidence of failure of decompressive surgery without concomitant spondylodesis as initial treatment. Medical files of all operated patients for spinal stenosis between 2007 and 2013 were evaluated. Demographic characteristics, pre-operative radiological characteristics (level of stenosis, presence, and grade of spondylolisthesis), surgical technique, incidence, and indication for reoperation were summarised, as well as the type of reoperation. Patient satisfaction was classified as 'satisfied' or 'unsatisfied' after initial and secondary surgery. The follow-up was 6 to 12 years. Nine hundred thirty-four patients were included, and 253 (27%) had a spondylolisthesis. Seventeen percent of the spondylolisthesis patients receiving decompression were reoperated versus 12% of the stenosis patients (p=.059). Reoperation in the spondylolisthesis group concerned instrumented spondylodesis in 38 versus 10% in the stenosis group. The satisfaction percentage was comparable in the stenosis and the spondylolisthesis group two months after surgery (80 vs. 74%). Of the 253 spondylolisthesis patients, 1% initially received instrumented spondylodesis and 6% in a second operation. Lumbar stenosis with and without (low-grade) degenerative spondylolisthesis can usually effectively be treated with mere decompression. Instrumented surgery in a second surgical procedure does not lead to less satisfaction with surgical outcomes.

Evaluation of a blind technique for peri-articular injection in patients with lumbar facet syndrome: a retrospective study

Evaluation of a blind technique for peri-articular injection in patients with lumbar facet syndrome: a retrospective study

Lumbar spine epidural abscess and facet joint septic arthritis in a pediatric patient.

A 13-year-old girl presented with lower back pain that began 7 days earlier after a volleyball workout. She had no history of trauma or fever. On physical examination, a contraction of the left paravertebral muscles associated with pain on flexion-extension of the spine and a positive left Lasègue's sign were evident. She had no neurological deficits in the lower limbs. Chest and lumbosacral X-rays were unremarkable, and a laboratory investigation revealed neutrophilia and elevated C-reactive protein (75.7 mg/L; normal value < 5). Urine and blood cultures were carried out before starting ceftriaxone. She developed a fever (38.8 °C) 1 day after admission, and the blood culture was positive for methicillin-sensitive Staphylococcus aureus. A lumbosacral magnetic resonance imaging (MRI) scan was performed considering the clinical and microbiological evidence and suspecting an osteoarticular infection. The MRI revealed a small amount of interarticular fluid in the left L4-L5 hemivertebral region and a posterior spinal epidural abscess on the left side extending from L4 to L5-S1 (Fig. 1). The diagnosis was lumbar spine epidural abscess (SEA) and facet joint septic arthritis (SAFJ). As the girl did not present with neurological symptoms, no surgical treatment was indicated, and cefazolin was administered intravenously with rapid resolution of the fever and pain. She was discharged after 4 weeks of intravenous antimicrobial therapy, which was followed by 4 more weeks of oral antibiotic therapy with levofloxacin. The 3-month follow-up MRI showed complete regression of the epidural fluid and almost complete normalization of the signal abnormalities in the L4-L5 soft tissues (Fig. S1). Facet joint septic arthritis is a rare condition.1Mas-Atance J. Gil-García M.I. Jover-Sáenz A. Curià-Jové E. Jové-Talavera R. Charlez-Marco A. et al.Septi carthritis of a posteriorlumbarfacet joint in an infant: a case report.Spine (Phila Pa 1976). 2009; 34: E465-E468Crossref PubMed Scopus (10) Google Scholar Few pediatric cases have been described, mainly in immunosuppressed patients. The most commonly associated pathogen is S. aureus.2Cabet S. Perge K. Ouziel A. Vandergugten S. Guibaud L. Ferry T. et al.Septic arthritis of facet joint in children: a systematic review and a 10-year consecutive case series.Pediatr Infect Dis J. 2021; 40: 411-417Crossref PubMed Scopus (0) Google Scholar The mechanism of the spread of this infection is not understood, but contamination may originate from direct inoculation, contiguity, or hematogenous dissemination. In the present case, the patient had no history of lumbar or epidural injections, so the most likely origin was hematogenous dissemination. The coexistence of localized epidural, articular, and paravertebral abnormalities on an MRI examination acquired only a few days after symptom onset led us to speculate that the infection originated in the left L4-L5 zygoapophyseal joint and spread to contiguous tissues, both inside and outside the lumbar canal. The three most common presenting symptoms of spinal epidural abscess are back pain, fever, and neurological deficit; however, these symptoms do not always occur together, contributing to the delayed diagnosis, which is reported in 50%–75% of cases.3Reihsaus E. Waldbaur H. Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients.Neurosurg Rev. 2000; 23: 175-204Crossref PubMed Google Scholar Surgery is reserved for nonantibiotic responders or in cases of neurologic deficit. Lumbar SEA and SAFJ are clinical emergencies with significant morbidity and mortality, particularly when there is a delayed diagnosis. Therefore, early clinical suspicion, diagnosis, and treatment are essential to obtain a favorable outcome.4Davis D.P. Wold R.M. Patel R.J. Tran A.J. Tokhi R.N. Chan T.C. et al.The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.J Emerg Med. 2004; 26: 285-291Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar The authors declares that there is no conflict of interest regarding the publication of this paper. The following is the supplementary data to this article: Download .docx (2.14 MB) Help with docx files Multimedia component 1

Prevalence and abnormalities of intervertebral discs (ivd) at various levels in lumbosacral spine magnetic resonance imaging (mri)

Abstract Objectives: To use magnetic resonance imaging to identify the prevalence and various abnormalities inside the intervertebral disc at different levels in the lumbosacral spine. Methodology: Cross-sectional study was conducted in the Radiology Department of Hayatabad Medical Complex Peshawar, Pakistan for six months from January 2023 to June 2023. Patients with Intervertebral disc abnormalities were scanned using standard protocol sagittal T1WI, T2WI, T2W STIR, T2W myelo, and in axial T1WI and T2WI. SPSS version 26 was used for data analysis. Tests of significance were applied and a p-value less than or equal to 0.05 was taken as significant. Results: The most frequently affected levels were L4-L5 and L5-S1, with single-site engagement being 30.0% and multi-site involvement being 69.9%. Numbness was 69.9%, Tingling 30.0%, herniated nucleus pulposus 30%, Protrusion 23.5%, Extrusion 6%, Posterolateral 2.7%, Posterocentral 26.2%, Foraminal 3.1%, Canal stenosis (mild 42.2%, moderate 63.2%, severe 5.5%, Thecal sac 36.4%, Lateral recess 55.5%, Foramen 20.1%, Multiple locations 8.3%, Diffuse disc bulge 96.4% (most common on L4-S1), Asymmetric disc bulge 2.4% and Modic changes 21.1% (grade-I 4.2%, grade-II 15.5%, grade-III 1.4%). Ligamentum flavum hypertrophy was at 20.1%, Facet joint hypertrophy at 22%, High-intensity zone (HIZ) at 29.4%, and Annular tear at 26.8% were all abnormalities that were frequently found on the L4-L5 level. Conclusion: Middle-aged persons are at increased risk, females and older individuals showed higher Intervertebral disc abnormalities, and L4-L5 and L5-S1 are the two most afflicted regions. Keywords: [Annular tear, Disc Bulge, High-Intensity zone, Lumbosacral spine, Modic Changes]

Chronic Lower Back Pain in Weight Lifters

» Chronic lower back pain (LBP) is common in both nonathletes and weight lifters, but the diagnosis and treatment should be approached differently in these 2 populations based on the unique movement patterns causing the pain.» Injury rates of weight lifters are far less than those of contact sports, ranging from 1.0 to 4.4 injuries per 1,000 workout hours. However, the lower back was consistently one of the top 2 injury sites for weight lifters, accounting for anywhere from 23% to 59% of all injuries. LBP was most often associated with the squat or deadlift.» Guidelines for evaluating general LBP are applicable to weight lifters, including a thorough history and physical examination. However, the differential diagnosis will change based on the patient's lifting history. Of the many etiologies of back pain, weight lifters are most likely to be diagnosed with muscle strain or ligamentous sprain, degenerative disk disease, disk herniation, spondylolysis, spondylolisthesis, or lumbar facet syndrome.» Traditional recommended therapies include nonsteroidal anti-inflammatory drugs, physical therapy, and activity modification, which are often insufficient to resolve pain and prevent injury recurrence. Because most athletes will want to continue to lift weights, lifting-specific behavior modifications focused on improved technique and correcting mobility and muscular imbalances are important aspects of management in this patient population.

Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation

To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation. A retrospective analysis was performed on 138 patients who underwent L5S1 posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L4,5 facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L4,5 intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed. There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L4,5 intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (P<0.001), with no significant difference between the groups(P>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (P<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (P<0.0167, Bonferroni correction). Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.

Does Lumbar Interbody Fusion Modality Affect the Occurrence of Complications in an Osteoporotic Spine Under Whole-Body Vibration? A Finite Element Study

To evaluate the effects of 3 lumbar interbody fusion techniques on the occurrence of complications in an osteoporotic spine under whole-body vibration. A previously developed and validated nonlinear finite element model of L1-S1was modified to develop anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) models with osteoporosis. In each model, the lower surface of the sacrum was absolutely fixed, a follower load of 400N was applied through the axis of the lumbar spine, and an axial sinusoidal vertical load of ±40N (5 Hz) was imposed on the superior surface of L1, to perform a transient dynamic analysis. The maximal values of intradiscal pressure, shear stress on annulus substance, disc bulge, facet joint stress, and screw and rod stress, along with their dynamic response curves, were collected. Among these 3 models, the TLIF model generated the greatest screw and rod stress, and the PLIF model generated the greatest cage-bone interface stress. At the L3-L4 level, compared with the other 2 models, the maximal values and dynamic response curves of intradiscal pressure, shear stress of annulus ground substance, and disc bulge were all lower in the ALIF model. However, the facet contact stress at the adjacent segment in the ALIF model was higher than that in the other 2 models. In an osteoporotic spine under whole-body vibration, TLIF has the highest risk of screw and rod breakage, PLIF has the highest risk of cage subsidence, and ALIF has the lowest risk of upper adjacent disc degeneration, but the highest risk of adjacent facet joint degeneration.

Abstract #1403692: Discrepancy Between Dual-Energy X-ray Absorptiometry and Quantitative Computed Tomography in Analyzing Bone Mineral Density in a Patient with Primary Hyperparathyroidism, Fractures and Degenerative Joint Disease - A Case Report and Review of Literature

Primary hyperparathyroidism is associated with lower bone mineral density (BMD). Dual-energy x-ray absorptiometry (DXA) is the gold standard to measure BMD and a T-score of less than -2.5 is an indication for parathyroidectomy. However, DXA has limitations in skeletal evaluation of patients with primary hyperparathyroidism and degenerative joint disease (DJD). The use of quantitative computed tomography (QCT) should be considered for these patients to accurately assess their BMD to guide proper management. 87-year-old female with a past medical history of primary hyperparathyroidism and DJD. She has a previous history of two left femoral fractures and underwent surgical repair. She was not considered for parathyroidectomy based on her age, serum calcium, and absence of renal and skeletal indications for surgery given that her BMD only reveals osteopenia. Patient experienced sudden-onset low back pain and MRI of the spine revealed L1 compression fracture and diffuse DJD. QCT showed severe osteoporosis with BMD of 21.8 mg/c (T-score equivalent of -5.64) while her DXA only showed osteopenia on the lumbar spine and right femoral neck with T-score of -1.4 and -2.3, respectively. Based on the history of vertebral fracture and QCT result, patient was referred for parathyroidectomy. Osteoporosis is a degenerative disease of the bone characterized by low BMD which predisposes patients to low-impact, fragility fractures. Regular assessment of BMD in patients with primary hyperparathyroidism is beneficial to evaluate the need for parathyroidectomy. While current guidelines suggest the use of DXA to assess BMD, it does not always reflect the accurate state of the bones. From the review of the literature, the difference of T-scores between DXA and QCT is due to an artifact from arthritic changes and degenerative disease. DXA evaluates cortical bone and findings can be influenced by degenerative changes and facet joint hypertrophy, which is strongly associated with the overestimation of the BMD. QCT, on the other hand, evaluates trabecular and cortical bone separately and is not affected by arthrosic changes and vascular calcifications. Clinicians should be aware of the discrepancy and should consider QCT instead of DXA for screening and diagnosing of osteoporosis in patients with primary hyperparathyroidism, DJD and history of fractures. If the skeletal assessment was done by QCT and not DXA, parathyroidectomy could have been done earlier preventing her vertebral fracture. Therefore, we suggest adding the option to perform QCT instead of DXA for the skeletal assessment of patients with asymptomatic hyperparathyroidism who has DJD.

CRITICAL EVALUATIONS OF INTRA-ARTICULAR PLATELET RICH PLASMA ALONE OR COMBINATION WITH MEDIAL BRANCH RADIOFREQUENCY NEUROTOMY IN PATIENTS WITH LUMBAR FACET JOINT ARTHROPATHY: A PROSPECTIVE OUTCOME STUDY

Background: Common cause of chronic low back pain is lumbar facet joint arthropathy. Radiofrequency ablation (RFA) of medial branch currently preferred treatment in facet joint pain syndrome. Platelet-rich plasma (PRP) is known to initiate mesenchymal tissue healing by concentration of several fundamental protein growth factors. Our aim in this study is to evaluate the effect of co-administration of autologous PRP in lumbar facet and RFA of the medial branch of the dorsal ramus for lumbar facet arthropathy. Methodology: This was a prospective randomised study with a blind assessor. Eighty-one consecutive patients who complained of low back pain secondary to lumbar facet joint arthropathy were randomly allocated into three-groups: Group RF: only RFA done. Group PR: received both PRP plus RFA. Group PL: received only PRP. Primary outcome of the study was assessment of pain intensity using visual analogue scale (VAS). Result: The patients who had both RFA and PRP therapy had significant decrease in VAS score as compared to its baseline in the immediate and long term follow up period ([Formula: see text] &lt; 0.001). However, for those who received only PRP, the decrease in VAS was more significant at 1 and 4 months. Similarly, there was a significant improvement in ODI score in patients who received both RFA and PRP ([Formula: see text] &lt; 0.001). There was a gradual improvement in ODI in PRP group at 4-month interval. Rescue analgesics requirement was reduced and patients were better satisfied in those who received both RFA and PRP therapy. ([Formula: see text] &lt; 0.05). Conclusion: The combined administration of RFA and PRP proved to provide better analgesia in both short-term follow up and long-term follow up than treatment with either method in patients with lumbar facet syndrome.

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome.

A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3-5], number of diagnostic blocks (37%, median 4, IQR 2-4), bilateral denervation (59%, median 4, IQR 2-4), technique and number of lesions (66%, median 4, IQR 3-5), and strategy after denervation failure (68%, median 4, IQR 3-4). Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence.

CT IR Cyst Lumbar Rupture Efficacy (CIRCLE): A case series (P5-4.004)

<h3>Objective:</h3> Is CT IR synovial cyst lumbar rupture effective in symptomatic lumbar synovial cyst to avoid surgical intervention in 1 year? <h3>Background:</h3> Synovial cysts are associated with facet joint degeneration and can cause of radiculopathy, back pain, and neurogenic claudication. Although definitive surgical removal of the cyst has been the preferred treatment in surgical literature, percutaneous facet synovial cyst rupture under fluoroscopy has been offered to symptomatic patients, with varying degree of effectiveness. CT guided rupture has been sparsely studied. <h3>Design/Methods:</h3> <h3>Method of Data Collection:</h3> Electronic chart review, use of SlicerDicer EPIC application with data analysis, review of imaging modalities including MRI and CT <h3>Study Population:</h3> Adult patients (18 years old and greater) with lumbar synovial cysts resulting in radicular pain and have undergone cyst rupture via CT guidance for 1 year between 6/2015–6/2022 Characteristics reported include patient demographics, Clinical/neurological examination before and after procedure, Pain, MRI characteristics of cyst, other pain medication used, Patient past medical history, how many IR procedures done in 1 year, complications from procedure <h3>Results:</h3> Obtained 6 suitable patients for the study and 1 out of 6 patients had undergone surgical intervention. <h3>Conclusions:</h3> CT IR guided lumbar cyst rupture resulted in short term, mild to moderate improvement of radicular symptoms with 5 patients receiving multiple treatments with 1 patient undergoing surgery in less than 1 year. Characteristics of patients showed cysts were in L4–5 to L5-S1 location, pain as per visual analog scale score 8–10/10, in which afterward cyst rupture improved to &gt;4. Neurological examinations prior and post rupture were overall benign with no adverse events, except one undergoing surgery within 1 year. This patient showed foot adductor weakness prior to procedure, radicular sensory symptoms post laminectomy. This analysis may indicate that there is efficacy in undergoing lumbar cyst rupture to alleviate radicular symptoms for 1 year. <b>Disclosure:</b> Dr. Bernardo has nothing to disclose. Dr. Misra has nothing to disclose.