Facet Joint Degeneration

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 lack of correlation relates, in part, to the numerous potential etiologies for such pain syndromes. Causes include annular tear,

Vertebral Body Necrosis

Fig. 3. (A,B) Plain radiographs obtained in extension and flexion reveal vertebral collapse and an intravertebral vacuum cleft, which are characteristic of Kummell's disease (vertebral avascular necrosis). Note the positional change of vertebral height and size of the the vacuum cleft. Axial CT (C) and coronal CT reformation (D) confirm the presence of intravertebral gas. Note also that the axial CT image more accurately quantifies the degree of retropulsion as compared with the plain radiographs. (E) Sagittal STIR demonstrates high T2 signal fluid that has

Fig. 3. (A,B) Plain radiographs obtained in extension and flexion reveal vertebral collapse and an intravertebral vacuum cleft, which are characteristic of Kummell's disease (vertebral avascular necrosis). Note the positional change of vertebral height and size of the the vacuum cleft. Axial CT (C) and coronal CT reformation (D) confirm the presence of intravertebral gas. Note also that the axial CT image more accurately quantifies the degree of retropulsion as compared with the plain radiographs. (E) Sagittal STIR demonstrates high T2 signal fluid that has cr

Kummell Cyst Mri

replaced the gas within a vertebral vacuum cleft due to prolonged supine positioning. This MR appearance should prompt correlation with plain radiographs or CT to confirm the diagnosis of Kummell's disease.

replaced the gas within a vertebral vacuum cleft due to prolonged supine positioning. This MR appearance should prompt correlation with plain radiographs or CT to confirm the diagnosis of Kummell's disease.

disc protrusion/extrusion (which may have both a mechanical and chemical irritation effect), spinal stenosis, facet arthropathy, osteophytic nerve root compression, spondylolysis (with or without spondylolisthesis), vertebral compression fracture, sacral insufficiency fracture, discitis/osteomyelitis, spinal tumor (either primary or metastatic), arachnoiditis, and postoperative scar. The clinical differential diagnosis may also include causes of back pain unrelated to the spine, such as abdominal aortic aneurysm, retroperitoneal lymphadenopathy, or renal colic. A detailed discussion of the neurophysiologic basis of back pain and radiculopathy is beyond the scope of this text. The reader is referred to an excellent review of the complex relationship between the somatic and autonomic nervous system and the nature of referred pain by Jinkins et al. (13).

Facet arthropathy is one of the many causes of back pain with or without radiculopathy. Facet disease degeneration can result in nerve root compression due to stenosis of the central spinal canal, lateral recess, or neural foramen. This may result from osteophyte formation, hypertrophy/redundancy of the ligamentum flavum, or the formation of a synovial cyst (Fig. 4). Again the precise mechanism of pain development is not well understood, but it is likely related to both mechanical and inflamma-

Ligamenta Flava Mineralization

Fig. 4. (A) Axial CT filmed on bone windows demonstrates prominent left-sided facet joint degeneration at C2-3. (B) Soft tissue windows is just caudal to image (A) at the C3 level. It reveals an extradural mass with mural calcification that causes moderate spinal canal stenosis. The findings are typical for a synovial cyst. This case was confirmed surgically.

Fig. 4. (A) Axial CT filmed on bone windows demonstrates prominent left-sided facet joint degeneration at C2-3. (B) Soft tissue windows is just caudal to image (A) at the C3 level. It reveals an extradural mass with mural calcification that causes moderate spinal canal stenosis. The findings are typical for a synovial cyst. This case was confirmed surgically.

tory factors. Support for an inflammatory component lies in the relief of symptoms with injection of corticosteroid and local anesthetic into the facet joint. In this way, a facet joint injection acts as both a diagnostic test and a therapeutic intervention. Similarly, a synovial cyst may be aspirated under image guidance and may even resolve with injection of the adjacent joint.

One advantage of CT over MRI is the ability readily to distinguish soft tissue structures from bone or osteophyte. CT accurately characterizes facet joint degeneration with

Arachnoiditis Mri Images

(C, D) Axial CT scans from a different patient demonstrate gas within a synovial cyst, indicating communication with the adjacent facet joint.

(C, D) Axial CT scans from a different patient demonstrate gas within a synovial cyst, indicating communication with the adjacent facet joint.

its accompanying joint misalignment, bony overgrowth, sclerosis, and subchondral cyst formation. CT also readily detects soft tissue mineralization, which can be found in the ligamentum flavum, posterior longitudinal ligament, the wall of a synovial cyst, or in the thecal sac in the rare case of arachnoiditis ossificans. Sagittal reformations are very useful in the assessment of neural foraminal stenosis. CT accurately characterizes spondylolisthesis, which may be secondary to facet joint degeneration or spondylolysis. The ability to detect central canal and lateral recess stenosis is comparable to that of MRI. The high spatial resolution also extends to evaluation of surgical hardware. CT, often following an initial plain film evaluation, is the pre ferred method for evaluating the integrity of a surgical construct, which may be diminished by hardware malposition or fracture (14).

Arthritis Relief and Prevention

Arthritis Relief and Prevention

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Responses

  • pia
    Can the facet joint at c3/4 be artificailly replaced?
    7 years ago

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