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Facet joint destruction causes postoperative spinal instability, resulting in poor clinical outcomes after lumbar decompression surgery. However, the effect of facet joint destruction on radiographic and clinical outcomes after microendoscopic laminectomy (MEL) is unknown. Therefore, the current study aimed to examine the effect of facet joint resection on radiographic and clinical outcomes after single-level MEL surgery. This study included 116 patients with lumbar spinal canal stenosis (LSCS) who underwent single-level (L4/5) MEL surgery. Eligible patients were divided into the following groups: group P (facet joint preservation rate = 100%) (n = 70); group PR (50% ≤ the facet joint preservation rate <100%) (n = 27); and group R (the facet joint preservation rate <50%) (n = 19). The demographic characteristics of the patients, surgical data, preoperative and 1-year postoperative radiographic measurements, and clinical outcomes were compared among the 3 groups. Moreover, preoperative and postoperative radiographic and clinical outcomes were compared after adjusting the demographic characteristics of the patients and surgical data by the inverse probability weighting method with propensity scores. The 3 unweighted groups did not significantly differ in terms of demographic characteristics, surgical data, and preoperative and postoperative radiographic and clinical outcomes. Even after adjusting for the demographic characteristics and surgical data, the preoperative and postoperative radiographic and clinical outcomes were comparable among the 3 weighted groups. The extent of facet joint resection might have a minimal impact on radiographic and clinical outcomes at 1 year after single-level MEL surgery. [ABSTRACT FROM AUTHOR]

Facet joint violation by pedicle screws may lead to adjacent-segment disease and postoperative pain. Previous studies have reported the incidence of rostral facet joint violation using various pedicle screw insertion techniques. However, the incidence of facet joint violations with robotic guidance has not been determined. To investigate and compare the incidence of rostral facet joint violation by pedicle screws under robotic guidance and computerized tomography (CT) navigation guidance. Retrospective matched cohort. All patients who underwent robotic-assisted lumbar fusion at a major spine center up until 2023 were retrospectively identified and matched 1:3 to patients undergoing CT navigation guidance based by on age, sex, rostral vertebral level, and length of construct. Inclusion criteria consisted of age greater than 18 years, bilateral pedicle screw fixation, and presence of a postoperative CT scan of the lumbar spine or abdomen/pelvis at any point in the postoperative period. Rostral facet joint violations. Descriptive statistics were used to compare cohorts: frequencies, chi-squared analysis for categorical variables, and t-test for continuous variables. A total of 408 rostral pedicle screws were implanted in 204 patients (Robot: 102; Navigation: 306). Overall, 13 (12.3%) rostral facet joint violations were observed in the robot cohort and 75 (24.5%) in the navigation cohort (p=.01). Specifically, fewer robotic violations were observed at the L2 (3.5% vs 32.1%, p=.003) and L3 levels (3.9% vs 18.1%, p=.08) compared to navigation. No difference was observed at L4 and L5. Bilateral violations are significantly reduced with robotic approaches (5.3% vs 14.4%, p=.03). Lastly, more facet joint violations were observed during open approaches (robot: 18.8%, navigation: 27.3%) than percutaneous approaches (robot: 11.6%, navigation: 7.1%) in both groups (p<.001). The rate of L4 facet violations was 18.8% in the robotic cohort and 27.3% in the navigation cohort. The rate of L5 facet violations was 31.3% in the robotic cohort and 29.2% in the navigation cohort. Use of robotic assistance in lumbar pedicle screws significantly reduced the rate of rostral facet joint violations compared to navigation guidance at L2 and L3 levels, but not at L4 and L5, with facet violations approaching nearly one-third of the patients at L5 screws. Rostral facet violations can play a significant role in adjacent segment degeneration and disease. Technical factors and trajectory issues likely play a role and addressing these components should minimize unintended facet violation and proximal adding on. [ABSTRACT FROM AUTHOR]

Abstract Introduction Artificial cervical disc replacement (ACDR) is a widely accepted surgical procedure in the treatment of cervical radiculopathy and myelopathy. However, some research suggests that ACDR may redistribute more load onto the facet joints, potentially leading to postoperative axial pain in certain patients. Earlier studies have indicated that facet tropism is prevalent in the lower cervical spine and can significantly increase facet joint pressure. The present study aims to investigate the changes in the biomechanical environment of the cervical spine after ACDR using different prosthese when facet tropism is present. Methods A C2-C7 cervical spine finite element model was created. Symmetrical, moderate asymmetrical (7 degrees tropism), and severe asymmetrical (14 degrees tropism) models were created at the C5/C6 level by adjusting the left-side facet. C5/C6 ACDR with Prestige LP, Prodisc-C vivo, and Mobi-C were simulated in all models. A 75 N follower load and 1 N⋅m moment was applied to initiate flexion, extension, lateral bending, and axial rotation, and the range of motions (ROMs), facet contact forces(FCFs), and facet capsule stress were recorded. Results In the presence of facet tropism, all ACDR models exhibited significantly higher FCFs and facet capsule stress compared to the intact model. In the asymmetric model, FCFs on the right side were significantly increased in neutral position, extension, left bending and right rotation, and on both sides in right bending and left rotation compared to the symmetric model. All ACDR model in the presence of facet tropism, exhibited significantly higher facet capsule stresses at all positions compared to the symmetric model. The stress distribution on the facet surface and the capsule ligament in the asymmetrical models was different from that in the symmetrical model. Conclusions The existence of facet tropism could considerably increase FCFs and facet capsule stress after ACDR with Prestige-LP, Prodisc-C Vivo, and Mobi-C. None of the three different designs of implants were able to effectively protect the facet joints in the presence of facet tropism. Research into designing new implants may be needed to improve this situation. Clinical trials are needed to validate the impact of facet tropism.

Abstract Background Posterolateral decompression and fusion with internal fixation is a commonly used surgical approach for treating degenerative lumbar spinal stenosis (DLSS). This study aims to evaluate the impact of preserving a portion of the unilateral facet joint during decompression on surgical outcomes and long-term recovery in patients. Methods This study analyzed 73 patients with DLSS accompanied by bilateral lower limb neurological symptoms who underwent single-level L4/5 posterolateral decompression and fusion surgery from January 2022 to March 2023. Patients were categorized into two groups based on the type of surgery received: Group A comprised 31 patients who underwent neural decompression without facet joint preservation, while Group B consisted of 42 patients who underwent neural decompression with preservation of partial facet joints on one side. Regular follow-up evaluations were conducted, including clinical and radiological assessments immediately postoperatively, and at 3 and 12 months thereafter. Key patient information was documented through retrospective chart reviews. Results Most patients in both groups experienced favorable surgical outcomes. However, four cases encountered complications. Notably, during follow-up, Group B demonstrated superior 1-year postoperative interbody fusion outcomes (P

Objective: The aim of this study was to investigate the effect of osteoporosis (OP) on the outcomes of facet medial branch radiofrequency thermocoagulation (RFT). Materials and Methods: Thirty-six patients with chronic lower back pain due to lumbar facet joint syndrome (LFJS) who underwent facet medial branch RFT were retrospectively reviewed. The patients were divided into two groups: Group I (without OP, n=19) and group II (with OP, n=16). Pre-intervention and post-intervention evaluations of the patients were assessed at 1, 6, and 12th months by visual analog scale (VAS). Results: In both groups, VAS scores 1st, 6th, and 12th months after intervention were lower than those at baseline (p=0.001). There were no significant difference between the groups in terms of VAS score improvement. Conclusion: Lumbar facet medial branch RFT is an effective and safe treatment method in both the short and long-term in patients with LFJS. OP therapy had no effect on RFT treatment results.

Introduction: Artificial cervical disc replacement (ACDR) is a widely accepted surgical procedure in the treatment of cervical radiculopathy and myelopathy. However, some research suggests that ACDR may redistribute more load onto the facet joints, potentially leading to postoperative axial pain in certain patients. Earlier studies have indicated that facet tropism is prevalent in the lower cervical spine and can significantly increase facet joint pressure. The present study aims to investigate the changes in the biomechanical environment of the cervical spine after ACDR using different prosthese when facet tropism is present. Methods: A C2-C7 cervical spine finite element model was created. Symmetrical, moderate asymmetrical (7 degrees tropism), and severe asymmetrical (14 degrees tropism) models were created at the C5/C6 level by adjusting the left-side facet. C5/C6 ACDR with Prestige LP, Prodisc-C vivo, and Mobi-C were simulated in all models. A 75 N follower load and 1 N⋅m moment was applied to initiate flexion, extension, lateral bending, and axial rotation, and the range of motions (ROMs), facet contact forces(FCFs), and facet capsule stress were recorded. Results: In the presence of facet tropism, all ACDR models exhibited significantly higher FCFs and facet capsule stress compared to the intact model. In the asymmetric model, FCFs on the right side were significantly increased in neutral position, extension, left bending and right rotation, and on both sides in right bending and left rotation compared to the symmetric model. All ACDR model in the presence of facet tropism, exhibited significantly higher facet capsule stresses at all positions compared to the symmetric model. The stress distribution on the facet surface and the capsule ligament in the asymmetrical models was different from that in the symmetrical model. Conclusions: The existence of facet tropism could considerably increase FCFs and facet capsule stress after ACDR with Prestige-LP, Prodisc-C Vivo, and Mobi-C. None of the three different designs of implants were able to effectively protect the facet joints in the presence of facet tropism. Research into designing new implants may be needed to improve this situation. Clinical trials are needed to validate the impact of facet tropism. [ABSTRACT FROM AUTHOR]

The present study described a modified technique of atlantoaxial arthrodesis in patients with atlantoaxial instability (AAI) along with the postoperative clinical and radiological results. Five patients underwent this method for their AAI concurrent with C1 arch hypoplasia and/or the development of odontoid pannus causing myelopathy. After thorough exposure of the posterior surface of the C1-2 complex, the bilateral C2 nerve roots were sectioned to allow for easier access to the C1/2 facet joints. To prepare a suitable grafting bed, the C1/2 facet capsule was opened, and then the articular cartilaginous and synovial tissues were thoroughly removed. After being properly fashioned to match the gap between the C1/2 facet joint spaces, the structural bone grafts from the iliac crest were directly inserted into the facet joint spaces. To alleviate cord compression caused by concomitant odontoid pannus and/or hypoplastic C1 arch, C1 laminectomy was necessitated in all cases. Subsequently, posterior screw-rod instrumental fixation was conducted. All 5 patients underwent this procedure successfully. Clinical and radiological follow-up data of all patients indicated favorable relief of clinical symptoms and early rigid C1-2 stability. The sequelae of C2 nerve resection were not remarkable. No other neural or vascular damage associated with this technique was observed. Modified atlantoaxial arthrodesis via intraarticular autografting using the structural iliac bone combined with posterior instrumentation appears to be an efficient alternative treatment method for AAI patients with concurrent pathologies, even when the C1-2 posterior arches are unavailable for the grafting bed. [ABSTRACT FROM AUTHOR]

Background: Posterolateral decompression and fusion with internal fixation is a commonly used surgical approach for treating degenerative lumbar spinal stenosis (DLSS). This study aims to evaluate the impact of preserving a portion of the unilateral facet joint during decompression on surgical outcomes and long-term recovery in patients. Methods: This study analyzed 73 patients with DLSS accompanied by bilateral lower limb neurological symptoms who underwent single-level L4/5 posterolateral decompression and fusion surgery from January 2022 to March 2023. Patients were categorized into two groups based on the type of surgery received: Group A comprised 31 patients who underwent neural decompression without facet joint preservation, while Group B consisted of 42 patients who underwent neural decompression with preservation of partial facet joints on one side. Regular follow-up evaluations were conducted, including clinical and radiological assessments immediately postoperatively, and at 3 and 12 months thereafter. Key patient information was documented through retrospective chart reviews. Results: Most patients in both groups experienced favorable surgical outcomes. However, four cases encountered complications. Notably, during follow-up, Group B demonstrated superior 1-year postoperative interbody fusion outcomes (P < 0.05), along with a trend towards less interbody cage subsidence and slower postoperative intervertebral disc height loss. Additionally, Group B showed significantly reduced postoperative hospital stay (P < 0.05). Conclusion: Under strict adherence to surgical indications, the posterior lateral lumbar fusion surgery, which preserves partial facet joint unilaterally during neural decompression, can offer greater benefits to patients. [ABSTRACT FROM AUTHOR]

Background Zygapophysial joints (Z joints) can be a source of back pain and of neck pain, but the cause of pain is not known. Some authors attribute the pain to osteoarthritis but without citing evidence. Objectives The present review was undertaken to determine if there was sufficient evidence of association between spinal pain and osteoarthritis of Z joints to justify osteoarthritis being held to be the cause of pain. The null hypothesis was that osteoarthritis of Z joints does not cause back pain or neck pain. Eligibility criteria Relevant studies were ones that provided primary data on the association between pain and osteoarthritis of Z joints. These could be population studies, diagnostic studies, or case-control studies. Sources of evidence The database of PubMed was searched using the terms: Lumbar or cervical, zygapophysial or facet, pain, and osteoarthritis or degeneration or degenerative. Charting methods Data pertinent to the research question were extracted from original articles and tabulated for reporting. Odds ratios for associations were calculated, as were the prevalence rates of osteoarthritis in subjects with pain, and conversely the prevalence rates of pain in subjects with osteoarthritis. Results The searches retrieved 11 population studies, 4 diagnostic studies, and 3 cases control studies. No study showed any positive association between osteoarthritis of Z joints and pain. All studies found pain to be independent of the presence or severity of osteoarthritis. Osteoarthritis was as common in subjects with no pain as in subjects with pain. The null hypothesis was not refuted. Conclusion The published evidence does not support the belief that osteoarthritis causes Z joint pain. All the evidence contradicts this belief. [ABSTRACT FROM AUTHOR]

Lumbar medial branch radiofrequency neurotomy (RFN), a common treatment for chronic low back pain due to facet joint osteoarthritis (FJOA), may amplify paraspinal muscle atrophy due to denervation. This study aimed to investigate the asymmetry of paraspinal muscle morphology change in patients undergoing unilateral lumbar medial branch RFN. Data from patients who underwent RFN between March 2016 and October 2021 were retrospectively analyzed. Lumbar foramina stenosis (LFS), FJOA, and fatty infiltration (FI) functional cross-sectional area (fCSA) of the paraspinal muscles were assessed on preinterventional and minimum 2-year postinterventional MRI. Wilcoxon signed-rank tests compared measurements between sides. A total of 51 levels of 24 patients were included in the analysis, with 102 sides compared. Baseline MRI measurements did not differ significantly between the RFN side and the contralateral side. The RFN side had a higher increase in multifidus FI (+4.2% [0.3-7.8] vs +2.0% [-2.2 to 6.2], P 5 0.005) and a higher decrease in multifidus fCSA (-60.9 mm² [-116.0 to 10.8] vs -19.6 mm² [-80.3 to 44.8], P = 0.003) compared with the contralateral side. The change in erector spinae FI and fCSA did not differ between sides. The RFN side had a higher increase in multifidus muscle atrophy compared with the contralateral side. The absence of significant preinterventional degenerative asymmetry and the specificity of the effect to the multifidus muscle suggest a link to RFN. These findings highlight the importance of considering the long-term effects of lumbar medial branch RFN on paraspinal muscle health. [ABSTRACT FROM AUTHOR]

Background: Facet fractures are frequently associated with clinically observed cervical facet dislocations (CFDs); however, to date there has only been one experimental study, using functional spinal units (FSUs), which has systematically produced CFD with concomitant facet fracture. The role of axial compression and distraction on the mechanical response of the cervical facets under intervertebral motions associated with CFD in FSUs has previously been shown. The same has not been demonstrated in multi‐segment lower cervical spine specimens under flexion loading (postulated to be the local injury vector associated with CFD). Methods: This study investigated the mechanical response of the bilateral inferior C6 facets of thirteen C5‐C7 specimens (67±13 yr, 6 male) during non‐destructive constrained flexion, superimposed with each of five axial conditions: (1) 50 N compression (simulating weight of the head); (2‐4) 300, 500, and 1000 N compression (simulating the spectrum of intervertebral compression resulting from neck muscle bracing prior to head‐first impact and/or externally applied compressive forces); and, (5) 2 mm of C6/C7 distraction (simulating the intervertebral distraction present during inertial loading of the cervical spine by the weight of the head). Linear mixed‐effects models (α = 0.05) assessed the effect of axial condition. Results: Increasing amounts of intervertebral compression superimposed on flexion rotations, resulted in increased facet surface strains (range of estimated mean difference relative to Neutral: maximum principal = 77 to 110 με, minimum principal = 126 to 293 με, maximum shear = 203 to 375 με) and angular deflection of the bilateral inferior C6 facets relative to the C6 vertebral body (range of estimated mean difference relative to Neutral = 0.59° to 1.47°). Conclusions: These findings suggest increased facet engagement and higher load transfer through the facet joint, and potentially a higher likelihood of facet fracture under the compressed axial conditions. [ABSTRACT FROM AUTHOR]

Background: Degeneration of both intervertebral discs (IVDs) and facet joints in the lumbar spine has been associated with low back pain, but whether and how IVD/joint degeneration contributes to pain remains an open question. Joint degeneration can be identified by pairing T1 and T2 magnetic resonance imaging (MRI) with analysis techniques such as Pfirrmann grades (IVD degeneration) and Fujiwara scores (facet degeneration). However, these grades are subjective, prompting the need to develop an automated technique to enhance inter‐rater reliability. This study introduces an automated convolutional neural network (CNN) technique trained on clinical MRI images of IVD and facet joints obtained from public‐access Lumbar Spine MRI Dataset. The primary goal of the automated system is to classify health of lumbar discs and facet joints according to Pfirrmann and Fujiwara grading systems and to enhance inter‐rater reliability associated with these grading systems. Methods: Performance of the CNN on both the Pfirrmann and Fujiwara scales was measured by comparing the percent agreement, Pearson's correlation and Fleiss kappa value for results from the classifier to the grades assigned by an expert grader. Results: The CNN demonstrates comparable performance to human graders for both Pfirrmann and Fujiwara grading systems, but with larger errors in Fujiwara grading. The CNN improves the reliability of the Pfirrmann system, aligning with previous findings for IVD assessment. Conclusion: The study highlights the potential of using deep learning in classifying the IVD and facet joint health, and due to the high variability in the Fujiwara scoring system, highlights the need for improved imaging and scoring techniques to evaluate facet joint health. All codes required to use the automatic grading routines described herein are available in the Data Repository for University of Minnesota (DRUM). [ABSTRACT FROM AUTHOR]

Study Design: Systematic review of the literature and subsequent meta-analysis for the development of a new guideline. Objectives: This manuscript summarizes the recommendations from a new clinical guideline published by the German Spine Society. It covers the current evidence on recommendations regarding the indication, test blocks and use of radiofrequency denervation. The guidelines aim is to improve patient care and efficiency of the procedure. Methods: A multidisciplinary working group formulated recommendations based on the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Results: 20 clinical questions were defined for guideline development, with 87.5% consensus achieved by committee members for one recommendation and 100% consensus for all other topics. Specific questions that were addressed included clinical history, examination and imaging, conservative treatment before injections, diagnostic blocks, the injected medications, the cut-off value in pain-reduction for a diagnostic block as well as the number of blocks, image guidance, the cannula trajectories, the lesion size, stimulation, repeat radiofrequency denervation, sedation, cessation or continuation of anticoagulants, the influence of metal hardware, and ways to mitigate complications. Conclusion: Radiofrequency (RF) denervation of the spine and the SI joint may provide benefit to well-selected individuals. The recommendations of this guideline are based on very low to moderate quality of evidence as well as professional consensus. The guideline working groups recommend that research efforts in relation to all aspects of management of facet joint pain and SI joint pain should be intensified. [ABSTRACT FROM AUTHOR]

Accurate knowledge of anatomy is an important prerequisite for carrying out interventions and achieving good results. In particular, risks and complications can be avoided if perils are known. It is important to recognize and clearly communicate transitional anomalies in the bony spine. Curved structures must be correctly interpreted during fluoroscopy and projection on the two-dimensional screen. When injecting facet joints, attention must be paid to the small intra-articular volume and possible communication between the joint space and adjacent spaces. Controlling the depth of the needle in the spinal canal is important for interlaminar injections; an oblique setting can be helpful here. Exact knowledge of possible courses of the neighboring arteries is necessary in order to avoid intra-arterial injections and thus potentially serious complications. Finally, knowledge about the nerves is important in order to be able to place targeted injections in the right place. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effect of osteoporosis (OP) on the outcomes of facet medial branch radiofrequency thermocoagulation (RFT). Materials and Methods: Thirty-six patients with chronic lower back pain due to lumbar facet joint syndrome (LFJS) who underwent facet medial branch RFT were retrospectively reviewed. The patients were divided into two groups: Group I (without OP, n=19) and group II (with OP, n=16). Pre-intervention and post-intervention evaluations of the patients were assessed at 1, 6, and 12th months by visual analog scale (VAS). Results: In both groups, VAS scores 1st, 6th, and 12th months after intervention were lower than those at baseline (p=0.001). There were no significant difference between the groups in terms of VAS score improvement. Conclusion: Lumbar facet medial branch RFT is an effective and safe treatment method in both the short and long-term in patients with LFJS. OP therapy had no effect on RFT treatment results. [ABSTRACT FROM AUTHOR]

Min Cheol Chang,1 Seoyon Yang2 1Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea; 2Department of Rehabilitation Medicine, School of Medicine, Ewha Woman’s University Seoul Hospital, Seoul, Republic of KoreaCorrespondence: Seoyon Yang, Department of Rehabilitation Medicine, School of Medicine, Ewha Woman’s University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea, Tel +82-10-2787-2052, Fax +82-50-4225-2052, Email seoyonyang@gmail.comObjective: Bone single-photon emission computed tomography (SPECT) preferentially localizes areas exhibiting greater bone remodeling and enhanced perfusion, which helps identify areas of pain and inflammation in the lumbar facet joints (LFJs). Herein, we investigated the treatment outcome of intraarticular (IA) corticosteroid injection in patients with LFJ-origin lower back pain (LBP) depending on the presence of increased LFJ uptake on bone SPECT.Methods: We retrospectively recruited 38 patients with LFJ-origin LBP. Of the 38 patients, 22 patients showed increased uptake on bone SPECT (SPECT+ group), and 16 patients did not show increased uptake on bone SPECT (SPECT- group). A numeric rating scale (NRS) was used to assess pain reduction 1 month after treatment with a corticosteroid injection. Treatment was considered successful when the posttreatment NRS score was ≥ 50% lower than the pretreatment NRS score.Results: The NRS scores of the SPECT+ group at the 1-month follow-up were significantly lower than those of the SPECT- group. Additionally, the degree of change in the NRS scores was larger in the SPECT+ group than that in the SPECT- group. In addition, 18 of the 22 patients (81.8%) in the SPECT+ group underwent successful treatment. Eight of the 16 patients (50%) in the SPECT- group underwent successful treatment. The ratio of successful treatment was significantly higher in the SPECT+ group than in the SPECT- group.Discussion: Bone SPECT could help predict the therapeutic outcome after IA LFJ corticosteroid injection and determine the treatment plan for patients with LFJ-origin LBP.Keywords: facet joint, lumbar spine, corticosteroid, injection, single-photon emission computed tomography, pain

While MRI image features and inflammatory biomarkers are frequently used for guiding treatment decisions in patients with lumbar disc herniation (LDH) and low back pain (LBP), our understanding of the connections between these features and LBP remains incomplete. There is a growing interest in the potential significance of MRI image features and inflammatory biomarkers, both for quantification and as emerging therapeutic tools for LBP. To investigate the evidence supporting MRI image features and inflammatory biomarkers as predictors of LBP and to determine their relationship with pain intensity. Prospective cohort study. All consecutive patients with LDH who underwent discectomy surgery at our institution from February 2020 to June 2023 at the author's institution were included. MRI image features in discogenic, osseous, facetogenic, and paraspinal muscles, as well as inflammatory biomarkers in serum (including CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), PCT (procalcitonin), TNF (tumor necrosis factor), interleukin-1 beta (IL-1β), and IL-6), and paraspinal muscles (including TNF, IL-1β, IL-6, IL-10, and transforming growth factor beta 1 (TGF-β1)). A series of continuous patients diagnosed with LDH were categorized into acute LBP (<12 weeks), chronic LBP (≥12 weeks), and nonLBP groups. MRI image features and inflammatory biomarkers relation to pain intensity was assessed using the independent t-test, Chi-squared tests, Spearman rank correlation coefficient, and logistic regression test. Compared to the nonLBP group, the chronic LBP group exhibited a higher incidence of intervertebral disc (IVD) degeneration (≥ grade 3) and high-fat infiltration in paraspinal muscles, alongside a significant reduction in the cross-sectional area (CSA) and fatty degeneration of the multifidus muscle. Furthermore, there was a greater expression of IL-6 in serum and TNF in paraspinal muscles in the chronic LBP group and a greater expression of CRP and IL-6 in serum and TNF in paraspinal muscles in the acute LBP group. CSA and fatty degeneration of multifidus muscle were moderately negatively correlated with chronic LBP scores. The expression of TNF and IL-6 in serum and the expression of TNF in the multifidus muscle were moderately correlated with preoperative LBP. IVD degeneration and high-fat infiltration were identified as risk factors for chronic LBP. The results provide evidence that IVD degeneration, high-fat infiltration, and the reduction of CSA in paraspinal muscles were associated with the development of chronic LBP in patients with LDH, and these associations are linked to inflammatory regulation. This deepens our understanding of the etiology and pathophysiology of LBP, potentially leading to improved patient stratification and more targeted interventions. [ABSTRACT FROM AUTHOR]

Study Design. Anatomical study. Objective. This study aimed to elaborate on the anatomical characteristics of the medial branch of the lumbar dorsal rami and to discuss its possible clinical significance. Summary of Background Data. Radiofrequency ablation targeting the medial branch of the lumbar dorsal rami has been increasingly used in the clinical management of facetogenic low back pain (FLBP). Nonetheless, attention is also being given to complications such as atrophy of the lumbar soft tissues and muscles. Therefore, a more detailed understanding of the innervation pattern on the facet joint may improve the precision of nerve ablation therapy for FLBP. Methods. An anatomical study of eight human specimens was carried out. The anatomic characteristics of the medial branch were observed and recorded. Results. The medial branch originates from the lumbar dorsal rami, running close to the root of the posterolateral side of the superior articular process of the inferior cone. When passed through the mamillo-accessory ligament, it turns direction to the medial and caudal side, running in the multifidus muscle. In our study, each medial branch sent out two to five branches along the way. All the medial branches in L1-L4 gave off one to two small branches when crossing the facet joint and innervated the joint of the lower segment. Nineteen medial branches (23.75%) gave off recurrent branches to innervate the joint at the upper segment. Conclusion. The anatomical features of the medial branch remain similar in each lumbar segment. There are two types of joint branches, including the articular fibers that emanate from the medial branch as it runs along the medial border of the facet joint and the recurrent branch from the medial branch that innervates the upper facet joint. Moreover, an anastomotic branch was found in the medial branches between different segments. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review of a prospective randomized trial. Objectives: To compare outcome scores and fusion rates in patients with and without pedicle screw-associated facet joint violation (FJV) after a single-level lumbar fusion. Methods: Clinical outcomes data and computed tomography (CT) imaging were reviewed for 157 patients participating in a multicenter prospective trial. Post-operative CT scans at 12-months follow-up were examined for fusion status and FJV. Patient-reported outcomes (PROs) included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for leg and low back pain. Chi-square test of independence was used to compare proportions between groups on categorical measures. Two-sample t-test was used to identify differences in mean patient outcome scores. Logistic regression models were performed to determine association between FJV and fusion rates. Results: Of the 157 patients included, there were 18 (11.5%) with FJV (Group A) and 139 (88.5%) without FJV (Group B). Patients with FJV experienced less improvement in ODI (P =.004) and VAS back pain scores (P =.04) vs patients without FJV. There was no difference in mean VAS leg pain (P =.4997). The rate of fusion at 12-months for patients with FJV (27.8%) was lower compared to those without FJV (71.2%) (P =.0002). Patients with FJV were 76% less likely to have a successful fusion at 12-months. Conclusion: Pedicle screw-associated violation of the adjacent unfused facet joint during single-level lumbar fusion is associated with less improvement in back pain, back pain-associated disability, and a lower fusion rate at 1-year after surgery. [ABSTRACT FROM AUTHOR]

This study aimed to quantify the change in pressure on the cage during compression manipulation in lumbar interbody fusion. While the procedure involves applying compression between pedicle screws to press the cage against the endplate, the exact compression force remains elusive. We hypothesize that an intact facet joint might serve as a fulcrum, potentially reducing cage pressure. Pressure on the intervertebral disc cage was measured during compression manipulation in 4 donor cadavers undergoing lumbar interbody fusion. Unilateral facetectomy models with both normal and parallel compression and bilateral facetectomy models were included. A transforaminal lumbar interbody fusion cage with a built-in load cell measured the compression force. Pressure data from 14 discs indicated a consistent precompression pressure average of 68.16 N. Following compression, pressures increased to 125.99 N and 140.84 N for normal and parallel compression postunilateral facetectomy, respectively, and to 154.58 N and 150.46 N for bilateral models. A strong linear correlation (correlation coefficient: 0.967, P < 0.0001) between precompression and postcompression pressures emphasized the necessity of sufficient precompression pressure for achieving desired postcompression outcomes. None of the data showed a decrease in compression force to the cage with the compression maneuver. Both normal and parallel compression maneuvers effectively increased the pressure on the cage, irrespective of the facet joint resection status. Compression manipulation consistently enhanced compressive force on the cage. However, when baseline pressure is low, the manipulation might not yield significant increases in compression force. This underlines the essential role of meticulous precompression preparation in enhancing surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control. Materials and methods: A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months). Results: Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD − 1.01; 95% CI − 1.98 to -0.04; p = 0.04), medium (MD − 1.42; 95% CI − 2.41 to − 0.43; p = 0.005), and long term (MD − 1.12; 95% CI − 1.57 to − 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD − 0.94; 95% CI − 1.73 to − 0.14; p = 0.02) and long term (SMD − 0.74; 95% CI − 1.09 to − 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07–0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06–0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection. Conclusions: RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine facet contact forces above, below, and at surgical index levels induced by artificial disc implantation and compare the results from spiked versus keeled baseplates comprising the arthroplasty device. Methods: Human specimens from C2 to C7 were subjected to flexion, extension, and lateral bending prior to, and following random allocation to spiked or keeled cervical arthroplasty at the index (C5-C6), inferior (C6-C7), and superior (C4-C5) levels. Thin film force sensors were inserted unilaterally into the corresponding facets prior to intact testing. Force data was normalized to the minimum forces recorded during each loading mode under each condition, reported as (Max/Min) force ratio and subjected to a 1-way ANOVA with Dunnett's post-hoc tests for comparison to intact specimens. Results: Under flexion, compared to intact, all levels displayed a significant reduction in force ratio following a 1- and 3-level implantation for the spiked baseplate device. An increase in force ratio was observed at the index level for a 2-level implantation but was mitigated with the completion of a superior device insertion. No statistical differences were noted for keeled devices. In extension, the spiked baseplate device reduced the force ratio for 1- and 2-level implantations. A 3-level insertion did not alter facet force ratios. For the keeled device, no statistical changes were noted. Lateral bending associated with spiked devices resulted in statistically reduced or nonsignificant changes in facet loading ratios. The keeled devices did not display significant changes to facet force ratios. Conclusions: Implantation of multilevel disc devices can reduce or sustain unaltered facet loading conditions. In general, 3-level arthroplasty statistically reduced or does not increase facet force ratios compared to intact values. The use of spiked versus keel device baseplates is a clinical selection involving anterior/posterior placement and endplate degeneration conditions.

Abstract Background Facet fractures are frequently associated with clinically observed cervical facet dislocations (CFDs); however, to date there has only been one experimental study, using functional spinal units (FSUs), which has systematically produced CFD with concomitant facet fracture. The role of axial compression and distraction on the mechanical response of the cervical facets under intervertebral motions associated with CFD in FSUs has previously been shown. The same has not been demonstrated in multi‐segment lower cervical spine specimens under flexion loading (postulated to be the local injury vector associated with CFD). Methods This study investigated the mechanical response of the bilateral inferior C6 facets of thirteen C5‐C7 specimens (67±13 yr, 6 male) during non‐destructive constrained flexion, superimposed with each of five axial conditions: (1) 50 N compression (simulating weight of the head); (2‐4) 300, 500, and 1000 N compression (simulating the spectrum of intervertebral compression resulting from neck muscle bracing prior to head‐first impact and/or externally applied compressive forces); and, (5) 2 mm of C6/C7 distraction (simulating the intervertebral distraction present during inertial loading of the cervical spine by the weight of the head). Linear mixed‐effects models (α = 0.05) assessed the effect of axial condition. Results Increasing amounts of intervertebral compression superimposed on flexion rotations, resulted in increased facet surface strains (range of estimated mean difference relative to Neutral: maximum principal = 77 to 110 με, minimum principal = 126 to 293 με, maximum shear = 203 to 375 με) and angular deflection of the bilateral inferior C6 facets relative to the C6 vertebral body (range of estimated mean difference relative to Neutral = 0.59° to 1.47°). Conclusions These findings suggest increased facet engagement and higher load transfer through the facet joint, and potentially a higher likelihood of facet fracture under the compressed axial conditions.

Abstract Background Degeneration of both intervertebral discs (IVDs) and facet joints in the lumbar spine has been associated with low back pain, but whether and how IVD/joint degeneration contributes to pain remains an open question. Joint degeneration can be identified by pairing T1 and T2 magnetic resonance imaging (MRI) with analysis techniques such as Pfirrmann grades (IVD degeneration) and Fujiwara scores (facet degeneration). However, these grades are subjective, prompting the need to develop an automated technique to enhance inter‐rater reliability. This study introduces an automated convolutional neural network (CNN) technique trained on clinical MRI images of IVD and facet joints obtained from public‐access Lumbar Spine MRI Dataset. The primary goal of the automated system is to classify health of lumbar discs and facet joints according to Pfirrmann and Fujiwara grading systems and to enhance inter‐rater reliability associated with these grading systems. Methods Performance of the CNN on both the Pfirrmann and Fujiwara scales was measured by comparing the percent agreement, Pearson's correlation and Fleiss kappa value for results from the classifier to the grades assigned by an expert grader. Results The CNN demonstrates comparable performance to human graders for both Pfirrmann and Fujiwara grading systems, but with larger errors in Fujiwara grading. The CNN improves the reliability of the Pfirrmann system, aligning with previous findings for IVD assessment. Conclusion The study highlights the potential of using deep learning in classifying the IVD and facet joint health, and due to the high variability in the Fujiwara scoring system, highlights the need for improved imaging and scoring techniques to evaluate facet joint health. All codes required to use the automatic grading routines described herein are available in the Data Repository for University of Minnesota (DRUM).

Study Design A retrospective cohort study. Purpose To analyze the association between preoperative adjacent facet joint osteoarthritis (FJOA) and outcomes of lumbar interbody fusion (LIF). Overview of Literature Whether preoperative adjacent FJOA is associated with the incidence of radiological adjacent segment degeneration (RASD) and low back pain (LBP) relief after lumbar fusion remains unknown. Methods The study included patients who underwent LIF. The demographic characteristics and radiographic and surgical data were collected and evaluated. The included patients were divided into control group and FJOA group based on the preoperative adjacent facet joint Pathria grade. Preoperative and last follow-up LBP Visual Analog Scale (VAS) score, leg pain (LP) VAS, Oswestry Disability Index (ODI) and RASD were evaluated and compared. The improvement rates in VAS and ODI were calculated and compared between the two groups. Logistic regression was used to analyze the risk factors of LBP relief and incidence of RASD. Results In total, 197 patients (control group, 86; FJOA group, 111) were included, and the median follow-up was 46 months. The VAS and ODI in both groups significantly improved after surgery. At the last follow-up, the FJOA group had higher VAS and lower VAS improvement rates of LBP than the control group (p

Abstract Background Previous studies have demonstrated the relationship between sagittal facet orientation and cervical degenerative spondylolisthesis. However, the associations between facet orientation and cervical spinal stenosis (CSS) have rarely been studied. Methods One hundred twenty patients with CSS (CSS group) and 120 healthy participants (control group) were consecutively enrolled. The cervical facet angles and anteroposterior diameter (A-P diameter) of spinal canal at each subaxial cervical levels were measured using axial magnetic resonance imaging. The intersection angle of the midsagittal line of the vertebra to the facet line represents the orientation of the facet joint. Results The facet angles on the right side at C2- C3 and C3-C4 in CSS group and at C2- C3 in control group had significantly higher values than those of the other sides. Besides, the facet angles and A-P diameter of spinal canal in CSS group were significantly smaller than those in control group at all levels (p

Facet joint arthrosis causes pain in approximately 7 % of the U.S. population, but current treatments are palliative. The objective of this study was to elucidate structure-function relationships and aid in the development of future treatments for the facet joint. This study characterized the articular surfaces of cervical, thoracic, and lumbar facet cartilage from skeletally mature (18-24 mo) Yucatan minipigs. The minipig was selected as the animal model because it is recognized by the U.S. Food and Drug Administration (FDA) and the American Society for Testing and Materials (ASTM) as a translationally relevant model for spine-related indications. It was found that the thoracic facets had a ∼2 times higher aspect ratio than lumbar and cervical facets. Lumbar facets had 6.9-9.6 times higher % depth than the cervical and thoracic facets. Aggregate modulus values ranged from 135 to 262 kPa, much lower than reported aggregate modulus in the human knee (reported to be 530-701 kPa). The tensile Young's modulus values ranged from 6.7 to 20.3 MPa, with the lumbar superior facet being 304 % and 286 % higher than the cervical inferior and thoracic superior facets, respectively. Moreover, 3D reconstructions of entire vertebral segments were generated. The results of this study imply that structure-function relationships in the facet cartilage are different from other joint cartilages because biochemical properties are analogous to other articular cartilage sources whereas mechanical properties are not. By providing functional properties and a 3D database of minipig facet geometries, this work may supply design criteria for future facet tissue engineering efforts.

Lumbar facet syndrome is a cause of pain. The diagnosis iconfirmation is achieved through a selective block. Although this procedure is standardized under fluoroscopic or computed tomography (CT) guidance, the current use of ultrasound may provide an alternative to its implementation. A systematic literature search was conducted. "ultrasound-guided lumbar" and "lumbar facet joint." Twenty articles were included. Five randomized clinical trials, 4 observational studies, 2 clinical trials, 1 retrospective study, 2 metanalysis and 5 cadaveric studies, and 1 feasibility study. The studies demonstrated a improvement in pain with ultrasound. However, no significant differences in these outcomes were found when comparing ultrasound with fluoroscopy or CT. It was also observed that the procedural time was longer with ultrasound. Finally, success rates in correctly locating the injection site ranged from 88% to 100% when confirmed with fluoroscopy or CT. Although the use of ultrasound for regional anesthesia is on the rise, there are no results that can replace those found with fluoroscopy or CT for performing the dorsal and medial branch block of the spinal root in the treatment of lumbar facet syndrome. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to understand how facet joint orientation (FJO) and facet joint tropism (FJT) affected severe intervertebral disc degeneration (IVDD) process at lower lumbar levels in patients with LBP. Methods: This study is a cross-sectional analysis of a retrospective database. Patients were evaluated in terms of IVDD, FJO, and FJT at all lumbar levels on magnetic resonance imaging. Results: In this study (n: 123) facet joints were aligned more coronal in men than in women at upper lumbar levels. Men had less FJT compared to women, significantly at L2-L3 and L3-L4 levels. Severe IVDD at L4-L5 was associated with more coronal aligned L1-L2 (29.0 ± 2.5° vs. 23.3 ± 2.3°, p = 0.006) and misaligned L5-S1 (8.3 ± 1.9° vs. 4.5 ± 1.7°, p = 0.008). Besides, severe IVDD at L3-L4 was associated with more coronal aligned L4-L5 (49.1 ± 3.2° vs. 41.4 ± 2.8°, p = 0.014). Conclusion: There is a close association between FJO/FJT with lumbar IVDD. Facet joint orientation and FJT do not affect the disc at only the corresponding level; the lumbar spine should be evaluated as a whole. [ABSTRACT FROM AUTHOR]

The facet joint injection is the most common procedure used to release lower back pain. In this paper, we proposed a deep learning method for detecting and segmenting facet joints in ultrasound images based on convolutional neural networks (CNNs) and enhanced data annotation. In the enhanced data annotation, a facet joint was considered as the first target and the ventral complex as the second target to improve the capability of CNNs in recognizing the facet joint. A total of 300 cases of patients undergoing pain treatment were included. The ultrasound images were captured and labeled by two professional anesthesiologists, and then augmented to train a deep learning model based on the Mask Region-based CNN (Mask R-CNN). The performance of the deep learning model was evaluated using the average precision (AP) on the testing sets. The data augmentation and data annotation methods were found to improve the AP. The AP50 for facet joint detection and segmentation was 90.4% and 85.0%, respectively, demonstrating the satisfying performance of the deep learning model. We presented a deep learning method for facet joint detection and segmentation in ultrasound images based on enhanced data annotation and the Mask R-CNN. The feasibility and potential of deep learning techniques in facet joint ultrasound image analysis have been demonstrated. [ABSTRACT FROM AUTHOR]

Background Septic arthritis of the spinal facet joints is increasingly recognized in the era of magnetic resonance imaging, but its epidemiology, clinical features, management, and prognosis are ill-defined. Methods We review 101 previously published cases and report 16 cases occurring at our institutions between 2006 and 2018. Results Most patients presented with fever (60%) and back or neck pain (86%). Radiation into the hip, buttock, or limb was present in 34%. The lumbosacral vertebral segments were involved in 78% of cases. Most cases (64%) were due to Staphylococcus aureus. Bacteremia was present in 66% and paraspinal muscle abscesses in 54%. While epidural abscesses were present in 56%, neurologic complications were seen in only 9%, likely because most abscesses arose below the conus medullaris. Neurologic complications were more common with cervical or thoracic involvement than lumbosacral (32% vs 2%, P <.0001). Extraspinal infection, such as endocarditis, was identified in only 22% of cases. An overall 98% of patients survived, with only 5% having neurologic sequelae. Conclusions Septic arthritis of the facet joint is a distinct clinical syndrome typically involving the lumbar spine and is frequently associated with bacteremia, posterior epidural abscesses, and paraspinal pyomyositis. Neurologic outcomes are usually good with medical management alone. [ABSTRACT FROM AUTHOR]

MicroRNA is attracting attention as a therapeutic target for osteoarthritis. We focused on joint capsules and synovium in lumbar facet joint osteoarthritis. The purpose of this study was to identify microRNAs that are upregulated in lumbar facet joint capsules and synovium with osteoarthritis. We included patients who underwent spinal fusion for degenerative lumbar spine diseases. We selected patients who had both early-stage and late-stage facet joint osteoarthritis in a single individual. We extracted joint capsule and synovium samples from these patients and isolated microRNAs. During the screening phase, we compared early-stage and late-stage osteoarthritis samples from the same individual. We identified microRNAs with >2-fold change in expression in 75% or more of patients with late-stage osteoarthritis using next generation sequencing. During the technical validation phase, the same samples were used for real-time polymerase chain reaction. We identified microRNAs with >2-fold change in expression in 62.5% or more of patients with late-stage osteoarthritis. Of 40 patients who underwent spinal fusion, we selected eight patients with both early-stage and late-stage facet joint osteoarthritis. During the screening phase, we identified eight upregulated microRNAs out of 2274 microRNAs in late-stage OA. In late-stage OA, two microRNAs (miR-133a-5p and miR-144-3p) were upregulated in seven patients and six microRNAs (miR-133a-3p, miR-133b, miR-206, miR-20a-5p, miR-301a-3p, and miR-32-5p) were upregulated in six patients. During the technical validation phase, we found significant upregulation of miR-144-3p expression in late-stage osteoarthritis compared with early-stage osteoarthritis. Expression of the other microRNAs was not significantly different according to the paired-t test. However, miR-133a-3p, miR-133b, and miR-206 were upregulated >2-fold in 62.5% or more of patients with late-stage osteoarthritis. Some of the microRNAs identified in this study might be involved in joint capsule degeneration or synovitis. [ABSTRACT FROM AUTHOR]

Objective: Lumbar facet joint (LFJ) syndrome is one of the common causes of low back pain (LBP). There are different views on percutaneous and endoscopic radiofrequency. The purpose of this systematic review and meta-analysis is to explore the therapeutic effect of radiofrequency ablation on LBP originating from LFJ and compare the therapeutic effect of percutaneous radiofrequency ablation and endoscopic neurotomy. Methods: We included randomized controlled trials which compared the efficiency of percutaneous radiofrequency ablation and conservative treatment (sham procedures, facet joint injection, physiotherapy, exercise, or oral medication) or compared the efficiency of percutaneous radiofrequency ablation and endoscopic neurotomy for LFJ syndrome. We searched in PubMed and Web of Science from inception to March 27, 2023. Meta-analysis was performed using RevMan 5.4 software. Results: A total of 11 randomized controlled trials were included. Among them, nine studies were used for evaluating efficiency of percutaneous radiofrequency ablation, and two studies were used for evaluating efficiency of endoscopic neurotomy. Pooled data from two studies reporting outcomes at 1 year did not show a benefit from facet joint denervation by comparing the percutaneous radiofrequency ablation and conservative treatment (standardized mean difference (SMD) = −0.87, 95% confidence interval (CI) [−2.10, 0.37], P = 0.17). There was no significant difference between percutaneous radiofrequency ablation and endoscopic neurotomy at 1-month follow-up (mean difference (MD) = −0.13, 95%CI [−0.18, −0.44], P = 0.41). At 12-month follow-up the pain relief in the endoscopic neurotomy was significantly better than that in the percutaneous radiofrequency ablation group (MD = 1.98, 95%CI [1.60, 2.36], P < 0.0001). Conclusion: The LBP was significantly relieved shortly after percutaneous radiofrequency ablation. Compared with percutaneous radiofrequency ablation, endoscopic neurotomy seems to have a longer effect. A longer follow-up period is needed to confirm its effectiveness. [ABSTRACT FROM AUTHOR]

Background. The development of the adjacent level syndrome and, as a consequence, adjacent segment degenerative disease are currently the most common complications of decompression and stabilization surgery with the development of segmental instability.The aim of the study. To conduct a comprehensive neuroimaging assessment of the proximal adjacent segment after rigid fixation and dynamic stabilization in degenerative lumbar disease.Materials and methods. We conducted a prospective multicenter study of the results of surgical treatment of 274 patients with degenerative-dystrophic diseases of the lumbar spine, who underwent monosegmental decompression and stabilization surgery using the TLIF (transforaminal lumbar interbody fusion) technique and open transpedicular rigid fixation, as well as open hemilaminectomy with stabilization of the operated segments with nitinol rods. The study included radiography, diffusion-weighted magnetic resonance imaging and computed tomography (dualenergy mode) of intervertebral discs and isolated facet degeneration of the upper adjacent level.Results and discussion. Combination of the initial proximal segment degeneration in the form of facet joints degeneration (density of cartilaginous plate – 163.5 ± 14.2 HU, density of external facet – 709.35 ± 13.6 HU, density of internal facet – 578.1 ± 12.1 HU), Pfirrmann III, IV grade degeneration of intervertebral disc and a measured diffusion coefficient of less than 1300 mm2/s cause high risks of developing adjacent segment degenerative disease, which regulates the use of monosegmental dynamic fixation with nitinol rods, or preventive rigid fixation of the adjacent segment.Conclusion. Using complex neuroimaging in the preoperative period makes it possible to predict the results of surgical treatment, take timely measures to prevent degenerative diseases of the adjacent segment, and to carry out dynamic monitoring of processes in the structures of the spinal motion segment.

ObjectivePathology of the facet and sacroiliac (SI) joints contributes to 15% to 45% and 10% to 27% of lower back pain cases, respectively. Although tissue engineering may offer novel treatment options to patients suffering from cartilage degeneration in these joints, the tribological characteristics of the facet and SI joints have not been studied in either the human or relevant large animal models, which hinders the development of joint-specific cartilage implants.DesignCartilage was isolated from the knee, cervical facet, thoracic facet, lumbar facet, and SI joints of 6 skeletally mature Yucatan minipigs (Sus scrofa). Tribological characteristics were assessed via coefficient of friction testing, interferometry, and immunohistochemistry for lubricin organization.ResultsCompared with the knee, the coefficient of friction was higher by 43% in the cervical facet, 77% in the thoracic facet, 37% in the lumbar facet, and 28% in the SI joint. Likewise, topographical features of the facet and SI joints varied significantly, ranging from a 114% to 384% increase and a 48% to 107% increase in global and local surface roughness measures, respectively, compared with the knee. Additionally, the amount of lubricin in the SI joint was substantially greater than in the knee. Statistical correlations among the various tribological parameters revealed that there was a significant correlation between local roughness and coefficient of friction, but not global roughness or the presence of lubricin.ConclusionThese location-specific tribological characteristics of the articular cartilages of the spine will need to be taken into consideration during the development of physiologically relevant, functional, and durable tissue-engineered replacements for these joints.

Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spine on degenerative changes in the adjacent intervertebral joints. Material and Methods. A retrospective cohort study included 46 patients (22 with cervical total disc arthroplasy – CTDA, and 24 with anterior cervical discectomy and fusion – ACDF) with symptoms of cervical spondylogenic compression myelopathy and/or radiculopathy. The degree of degeneration of facet joints adjacent to the operated segments was evaluated 12 months after surgical treatment. Degenerative changes in the cervical spine were assessed using CT according to the Okamoto classification. Vidar Dicom Viewer 3.2 software was used to view images and evaluate intervertebral joints. Statistical processing was performed using IBM SPSS Statistics 23. Data were presented as median and 25th and 75th percentiles – Me [Q1; Q3]. Results. The mean age of patients in both groups was 47 [39; 52] years (Mann – Whitney U-test, p = 0.047). In the ACDF group it was 48 [42; 55] years and in the CTDA group – 42 [36; 52] years. Comparison of degenerative changes in the ACDF group before and after treatment (Wilcoxon analysis) showed a statistically significant difference in the cranial (p = 0.023), and caudal (p = 0.001) joints, with the progression of degeneration degree. In the CTDA group, no difference between pre- and post-treatment degeneration degree (Wilcoxon analysis) was found in either cranial joints (p = 0.157) or caudal joints (p = 0.161). Conclusion. Surgeries to stabilize spinal segments in degenerative diseases undeniably affect the development of the adjacent level syndrome. However, the use of endoprosthetic technology makes it possible to aggravate the degree of degenerative changes in the intervertebral joints of adjacent segments to a lesser extent.

Background: Percutaneous approaches to the spine have been explored recently for various procedures, including transforaminal lumbar interbody fusion. It is known that facet decortication leads to higher rates of fusion, but effective percutaneous approaches have not been well documented. There are a set of instruments used in the cervical spine for percutaneous decortication, the CORUS™ Spinal System-X (DI# 00852776006508), which may be useful in this setting. Our aim was to investigate the feasibility of decorticating the lumbar facet joints with these instruments in cadavers to aid in minimally invasive lumbar fusion. Methods: We performed percutaneous facet joint decortication at each facet joint in the lumbar spine in two adult cadavers. We tested varying degrees of laterality for entry points and angulation for access at each level to optimize the innovative procedure. Results: When using the CORUS™ Spinal System-X to obtain percutaneous access for facet decortication in the lumbar spine, we successfully dissected down to the facet joint without neurovascular injury. At the L1-L2 and L2-L3 levels, access was best obtained at 4 cm from midline with an angulation of 10°. At the L3-L4 and L4-L5 level, access was best obtained at 4 cm from midline with an angulation of 20°. Conclusions: This study demonstrates that percutaneous lumbar facet joint decortication is feasible with the CORUS™ Spinal System-X instruments, and warrants further, comparative study in the clinical setting

Background: Many professional baseball players experience low back pain, a major cause of which is lumbar facet joint arthropathy. Purpose: To evaluate the relationship between the dominant hand side and facet joint morphology in baseball movement. Study design: Cross-sectional study; Level of evidence, 3. Methods: Participants were 25 Japanese professional baseball players (11 pitchers and 14 fielders) with low back pain and lower limb symptoms. Player age, hand dominance, and length of professional playing experience were recorded, and the lateral diameter of all lumbar facet joints was determined from the axial computed tomography scans. We defined the facet joints ipsilateral and contralateral to the dominant hand as dominant and nondominant, respectively. The nondominant-to-dominant (N/D) ratio of the lateral diameter was calculated, and differences between the pitchers and fielders were analyzed using the unpaired t test. Results: The average player age and length of professional playing experience were 26.9 years (range, 19-37 years) and 7.2 years (range, 1-15 years), respectively. The right hand was dominant in 9 pitchers and 5 fielders, while the left hand was dominant in 2 pitchers and 9 fielders. In pitchers, the average lateral facet joint diameter on the nondominant side was significantly larger than on the dominant side at all vertebral levels except L1 to L2 (P < .05 for all). The N/D ratio for each facet joint was 1.06 (L1-L2), 1.11 (L2-L3), 1.10 (L3-L4), 1.12 (L4-L5), and 1.12 (L5-S1). In fielders, the average lateral facet joint diameter on the dominant side was significantly larger than on the nondominant side at L3 to L4 (P < .05), with N/D ratios of 0.98 (L1-L2), 0.96 (L2-L3), 0.94 (L3-L4), 0.97 (L4-L5), and 0.98 (L5-S1). The N/D ratio was significantly larger in pitchers than in fielders at all levels (P < .05 for all). Conclusion: The facet joints of professional baseball players were enlarged asymmetrically, with different tendencies observed between pitchers and fielders. Although pitching and batting are movements that transmit the rotation from the lower limbs to the upper limbs, the effects of rotation and lateral flexion were associated significantly with facet joint hypertrophy. [ABSTRACT FROM AUTHOR]

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Background Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold. Objective Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements. Design Prospective randomized comparative trial. Methods Patients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models. Results Of 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48–85), 55% (95% CI 34–74), and 45% (95% CI 26–66) of participants met the NPRS responder definition, compared to 25% (95%CI 9–53), 25% (95% CI 9–53), and 17% (95% CI 5–45) in the FJI group at 3, 6, and 12 months, respectively (P  =  .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P  <  .05). Conclusions C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains. Trial registration details ClinicalTrials.gov (NCT03614793); August 3, 2018. [ABSTRACT FROM AUTHOR]

(1) Background: Lower back pain is often caused by lumbar facet joint syndrome. This study investigated the effectiveness of three different injection methods under ultrasound guidance in treating elderly patients with lumbar facet joint syndrome. The difficulty in performing these injections was also evaluated; (2) Methods: A total of 60 elderly patients with facet joint syndrome as the cause of lower back pain were recruited and divided into 3 groups. Group 1 received medial branch block (MBB). Group 2 received intra-articular facet joint injections. Group 3 received injection into the multifidus muscle portion that covers the facet joint. Five percent dextrose water (D5W) was used as the injectant. The visual analog scale (VAS) was used to measure the degree of lower back pain; (3) Results: Before the injection treatments, the VAS score averaged about 7.5. After three consecutive injection treatments (two weeks interval), the VAS score decreased significantly to an average of about 1 in all 3 groups, representing mild to no pain. Between group analyses also did not reveal significant statistical differences, suggesting that these procedures are equally effective; (4) Conclusions: Ultrasound-guided injection of the multifidus muscle may be a feasible option in treating elderly patients with lower back pain caused by facet joint syndrome as it is easier to perform as compared to MBB and intra-articular facet joint injection. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) with thoracic curvature primarily progresses from the thoracolumbar region, causing abnormal twisting and rotation of the spinal column. This results in unbalanced, asymmetric loads on each vertebrae and increased demands on the thoracic facet joints to withstand rotational stress from adjacent vertebrae. However, no studies have focused on the stress distribution on the facet joints of the thoracic spine in patients with AIS. This study aimed to investigate the mechanical loading and its distribution on the thoracic facet joints of AIS patients using finite element (FE) analysis and surgical specimens. FE models of the thoracic spine were created from a total of 13 female AIS patients (Lenke type 1, n = 4; Lenke type 2, n = 4; Lenke type 3, n = 5). A load of 200 N on the T3 vertebrae and 30 N each on the bilateral superior articular processes were applied vertically to quantify the contact force on the facet joints from T3 to T11. In addition, morphological and histological analyses were performed on the inferior articular processes obtained during surgery. FE analysis demonstrated that contact forces of the facet joint progressively increased from the mid to lower thoracic spine of the concave side, reaching a maximum around the apex. More than 91% of the load was transmitted by the facet joints at the concave side, resulting in facet joint subchondral sclerosis and hypertrophy. The apical facet joint in AIS helps counteract rotational stress between vertebrae and transfers most stress through the concave side. In conclusion, this study found that asymmetric load transfer in the facet joints leads to subchondral sclerosis and hypertrophy. These findings can enhance our understanding of the stress loading on facet joints and the resulting biological changes and help clarify the mechanisms involved in scoliosis progression. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

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 since 2004. [ABSTRACT FROM AUTHOR]

Lumbar facet joints have been identified as a potential source of chronic low back pain (LBP) in 15% to 45% of patients, with the prevalence of such pain varying based on specific populations and settings examined. Lumbar facet joint interventions are useful in the diagnosis as well as the therapeutic management of chronic LBP. Radiofrequency ablation (RFA) of medial branch nerves is recognized as a safe and effective therapy for chronic facet joint pain in the lumbosacral spine, and its efficacy has already been established. The use of RFA is currently widespread in the management of spinal pain, but it is noteworthy that there have been works in the literature reporting complications, albeit at a very low frequency. We present a case of third-degree skin burns following radiofrequency ablation (RFA) for the management of facet joint syndrome. Postoperatively, the patient's skin encircling the needle displayed a pallor and exhibited deterioration in conjunction with the anatomical anomaly. The affected area required approximately 5 months to heal completely. During RFA, heat can induce burns not only at the point of contact with the RF electrode but also along the length of the needle. Vigilant attention is necessary to ensure patient safety and to address any potential complications that may arise during the procedure, including the possibility of minor technical errors. [ABSTRACT FROM AUTHOR]