Distinguishing Pars Injuries From Facet Arthritis Using Spect

Abnormal uptake in the pars interarticularis is usually due to a stress injury or spondylolysis. Facet lesions are usually arthritic although fractures and osteoid osteomas may be present. Lesions in the vertebral arch must be accurately localized to differentiate between these disorders. SPECT is particularly useful in lesion location because multiple projections can be reconstructed 1 . It is difficult to distinguish a pars injury from facet arthritis in the coronal and transverse...

Technique

Spinal Facet Joint Injections

It is important, among other items, to inquire as to the allergy history of the patient, prior to proceeding with any invasive injection of the facet joint. Specifically, providone iodine based skin preparation agents, iodine-based arthrography contrast agents, local anesthetic agents, steroids, and agents used for preserving various pharmaceuticals may all be present for utilization during portions of this procedure. Specific investigation as to whether there is a history of latex allergy...

Radicular Pain

Great Toe Extension Test

Radicular pain can be created by compression or irritation of the nerve root in the lateral recess or from zygapophysial joint hypertrophy. Extruded disc material within the neural foramen compresses the ipsilateral exiting nerve root and is most often seen at the C4-5 and C5-6 levels in the cervical region and at the L3-4 and L4-5 levels in the lumbar region. The disc can bulge initially, and later the disc can herniate through the fibers of the annulus centrally or laterally. Radicular...

Facet Joint Disease

Low back pain may affect 60-85 of the population at least once, and 10-20 of these patients develop chronic discomfort 15,16 . Degenerative disc and facet disease often accompany one another. These processes mechanically alter the spine and often reduce mobility. The underlying pathology is often osteoarthritis at the facet joints. The cartilage lining the facets can form fissures, sites of fraying, and erosions. These changes can lead to bone hypertrophy, sclerosis, and osteophyte formation....

Sacroilitis

Straight Leg Raise Test

Sacroiliac arthritis can cause buttock or low back pain. Inflammation of the synovial compartment resulting from erosion and laxity of the ligaments can decrease the fluidity of the pelvic girdle and cause a faulty posture or gait. Degeneration of the sacroiliac joints has primary or secondary causes. The primary causes commonly affect many joints and include rheumatoid arthritis, ankylosing spondylitis, Reiter's disease, and osteoarthritis. Secondary causes of sacroiliac dysfunction include...

Articular Facet Osteoarthritis

Articular facet osteoarthritis is a common cause of low back pain in adults. The facets can be a direct source of pain, as the synovial linings and joint capsules are richly innervated 12 . Sciatica can be caused by nerve root compression due to facet hypertrophy, focal osteophytes, subluxation, or expansion of the joint capsule due to effusion 1 . SPECT imaging is more sensitive than planar imaging in detecting facet joint lesions 13-15 and can be used in selecting appropriate patients for...

Facet Joint Degeneration

Ligamenta Flava Mineralization

Low back pain is extremely common and is one of the leading causes of disability in North America. It is the second leading cause of physician visits in the United States. In a substantial percentage of cases in the adult population, there is at least some minor abnormality of disc, endplate, or facet joints. However, the correlation between the specific symptoms and diagnostic testing is often less than gratifying, even when the imaging findings are quite striking. The explanation for this...

Anterior Muscles Of The Spine

Anterior Scalene Mri

The anterior muscles of the spine are less well developed because they are assisted in their primary action of flexion by gravity. In the cervical region, the anterior spinal muscles include the longus colli, longus capitis muscles, and the rectus capitis anterior and lateralis muscles. The lateral attachments of these muscles overlie the transverse processes of cervical vertebrae and must be considered during an anterior approach to the intervertebral discs, the uncovertebral joints, or the...

Articulating Processes And Spinal Movement

Intervertebral Foramen Mri

The orientation of the vertebral articulating processes determines the movements that are permitted in each Fig. 3. T2-weighted sagittal MRI showing normal vertebral body signal and normal intervertebral discs. Fig. 3. T2-weighted sagittal MRI showing normal vertebral body signal and normal intervertebral discs. region of the spine 2 . The articulating processes in the cervical region are oriented in nearly a coronal plane, and permit flexion extension, rotation, and lateral bending. The...

Joints Of The Vertebral Arch

Disc Bulge

The joints of the vertebral arch are the paired zygapophyseal joints between opposed superior and inferior articular processes Greek zygon, yoke . They are sometimes referred to as apophyseal joints to indicate that they are outgrowths, or offshoots, of the arch Greek apophysis, an offshoot . Clinically, they are the facet joints Fig. 10 . As synovial joints, they are subject to all of the degenerative changes associated with synovial joints, such as osteoarthritis. The fibrous capsules of the...