Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation / 中国骨伤

OBJECTIVE@#To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation.@*METHODS@#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.@*RESULTS@#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).@*CONCLUSION@#Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.

Correlation of the Risk Factors in Degenerative Lumbar Spondylolisthesis with MRI Imaging

@#Introduction: Degenerative spondylolisthesis burdens the future economy. Elderly individuals with this condition suffer from back pain, limb paralysis, reduced activity, and diminished quality of life. Surgery offers relief but is risky and expensive. As healthcare improves, the aging population grows, and spondylolisthesis incidence rises. Early detection and risk factor management are vital for prevention. Therefore, this study aimed to evaluate the correlation of the risk factors for degenerative lumbar spondylolisthesis. Methods: A retrospective observational study was done in Dr Soetomo General Academic Hospital, Surabaya from January 2018 to December 2019. Forty-five subjects with degenerative spondylolisthesis diagnosed by MR Imaging enrolled in this study. Intervertebral disc, facet joint, multifidus muscle, and ligamentum flavum at level L1 until level L5 were examined using MR imaging. Correlation analysis was measured using the Spearman correlation test and risk factor analysis was measured using the logistic regression test. Results: There are significant correlations between intervertebral disc degeneration, facet joint osteoarthritis, multifidus muscle fatty infiltration, and thickening of ligamentum flavum with degenerative spondylolisthesis. The risk factors at levels L3-4 and L5-S1 are intervertebral disc degeneration and L4-5 is multifidus muscle fatty infiltration and facet joint osteoarthritis. Conclusion: This study confirmed the risk factors that correlated with degenerative lumbar spondylolisthesis.

An ultrasound-guided robot assisted system for percutaneous facet joint puncture: an experimental study / 中华创伤骨科杂志

Objective:To evaluate the accuracy of an ultrasound-guided robot-assisted system for percutaneous facet joint puncture in an animal experiment by registration of ultrasound images and two-dimensional X-ray fluorescence images.Methods:Six specimens of fresh adult sheep lumbar spine were prepared and soaked in gelatin solution. The specimens contained a total of 48 facet joints with 24 ones respectively on the left and right sides. Half of the joints were assigned by the random number table method into a robot-assisted group which were subjected to percutaneous facet joint puncture assisted by the ultrasound-guided robot-assisted system while the contralateral ones into a freehand group which were subjected to percutaneous facet joint puncture by freehand. In the robot-assisted group, the left facet joints were 3 L 1, 3 L 2, 3 L 3 and 3 L 4 ones while the right facet joints were 2 L 1, 3 L 2, 5 L 3 and 2 L 4 ones. In this self-control animal experiment, both the robot-assisted punctures and the freehand punctures were carried out in the same specimen. The puncture success rate, puncture needle adjustment, positioning deviation, orientation deviation and operation time were recorded. Results:The positioning deviation and orientation deviation in the robot-assisted group [(2.21 ± 1.12) mm and 1.51° ± 0.47°] were significantly lower than those in the freehand group [(3.26 ± 1.44) mm and 2.24° ± 0.89°] ( P < 0.05). All the articular facet joint punctures were successfully accomplished for the first time in the robot-assisted group while those required multiple adjustments in the freehand group. In the robot-assisted group, the total operation time [(463.84 ± 34.93) s] was significantly longer than that in the freehand group [(298.40 ± 27.48) s], but the puncture time [(37.97 ± 6.87) s] was significantly shorter than that in the freehand group [(261.61 ± 33.15) s] ( P < 0.05). Conclusion:The ultrasound-guided robot-assisted system for percutaneous facet joint puncture can lead to accurate puncture with limited needle adjustments.

Flexion-lateral curvature-supination reduction for treatment of lower cervical dislocation with unilateral facet interlocking / 中华创伤骨科杂志

Objective:To investigate the efficacy of flexion-lateral curvature-supination reduction combined with primary anterior surgery for the treatment of lower cervical dislocation with unilateral facet inter-locking.Methods:A retrospective analysis was performed in the 32 patients who had been admitted to Department of Spine Surgery, Honghui Hospital for lower cervical dislocation with unilateral facet interlocking from November 2015 to October 2018. According to their treatments, they were divided into 2 groups. In the emergency group treated by flexion-lateral curvature-supination reduction combined with primary anterior surgery, there were 13 males and 3 females, aged from 24 to 63 years. In the traction group treated by cranial traction reduction combined with secondary anterior surgery, there were 12 males and 4 females, aged from 20 to 64 years. The operation time, intraoperative blood loss, hospital stay, bone graft fusion, American Spinal Injury Association (ASIA) grade and Japanese Orthopaedic Association (JOA) score were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P<0.05). All patients were followed up from 26 to 40 months. The hospital stay for the emergency group [(7.2±1.2) d] was significantly shorter than that for the traction group[(10.9±1.2) d] ( P<0.05). There was no significant difference in the operation time, blood loss, ASIA grade or JOA score between the 2 groups ( P>0.05). All patients achieved osseous fusion of intervertebral space. Conclusion:Compared with traditional methods, flexion-lateral curvature-supination reduction combined with primay anterior surgery shows no significant difference in the recovery of neurological function but leads to a shorter hospital stay.

The use of dexmedetomidine in puncture techniques for degenerative diseases of the lumbar spine / Uso de dexmedetomidina em técnicas de punção para doenças degenerativas da coluna lombar / Uso de dexmedetomidina en técnicas de punción para enfermedades degenerativas de la columna lumbar

ABSTRACT Objective To analyze the results of the use of dexmedetomidine (D) in the treatment of patients with degenerative diseases of the lumbar spine using puncture techniques. Methods The study included 77 patients who underwent surgical puncture for degenerative diseases of the lumbar spine with the use of alpha-2-adrenomimetic D: percutaneous laser denervation of the facet joints (n = 46) and posterolateral transforaminal endoscopic discectomy (n = 31). We assessed: the level of sedation using the Ramsay Sedation Scale (RSS) and the Richmond Agitation Sedation Scale (RASS); intraoperative dynamics of the cardiovascular and respiratory system parameters; the level of pain syndrome according to VAS. Results A high intraoperative level of sedation was determined, with RASS -2, -3 and Ramsay III, IV; when transferring a patient to a department (in 90 minutes) this parameter was RASS 0 and Ramsay II. There were no significant changes in central hemodynamics and respiratory depression. The minimum level of pain was determined immediately after surgery, at 30 and 60 minutes after surgery, and before transfer to the department (90 minutes): 6 (4;9); 10 (8;12); 12 (9;13); 16 (13;19) respectively. The absence of the need for additional analgesia on the first postoperative day was verified. Conclusion The use of D significantly reduces the level of pain, while maintaining the necessary verbal contact with the patient, and provides the necessary neurovegetative protection without respiratory depression or lowered hemodynamic parameters during the perioperative period. Level of evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome. Case series, retrospective study.

RESUMO Objetivo Analisar os resultados do uso de dexmedetomidina (D) no tratamento de pacientes com doenças degenerativas da coluna lombar com técnicas de punção. Métodos O estudo incluiu 77 pacientes submetidos à punção cirúrgica em doenças degenerativas da coluna lombar com o uso de um agonista alfa-2 adrenérgico: denervação percutânea das articulações facetárias com laser (n = 46) e discectomia endoscópica transforaminal posterolateral (n = 31). Foram avaliados o nível de sedação usando a Escala de Sedação de Ramsay (RSS) e a Escala de Sedação e Agitação de Richmond (RASS); a dinâmica intraoperatória dos parâmetros dos sistemas cardiovascular e respiratório; o nível de síndrome de dor de acordo com a EVA. Resultados Determinou-se um alto nível intraoperatório de sedação pela RASS (-2, -3) e pela Ramsay (III, IV). Ao transferir um paciente para outro setor (depois de 90 minutos), esse parâmetro era 0 em RASS e II em Ramsay. Não houve alterações significativas na hemodinâmica central e na depressão respiratória. O nível mínimo de dor foi determinado imediatamente após a cirurgia, 30 e 60 minutos depois da cirurgia e antes da transferência para o outro setor (90 minutos depois): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Constatou-se que não era necessária analgesia adicional no primeiro dia pós-operatório. Conclusões O uso de D reduz significativamente o nível de dor mantendo a comunicação verbal necessária com o paciente e fornece a proteção neurovegetativa necessária sem depressão respiratória e os parâmetros hemodinâmicos reduzidos durante o período perioperatório. Nível de evidência II; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença. Série de casos, Estudo retrospectivo.

RESUMEN Objetivo Analizar los resultados del uso de dexmedetomidina (D) en el tratamiento de pacientes con enfermedades degenerativas de la columna lumbar con técnicas de punción. Métodos El estudio incluyó a 77 pacientes con enfermedades degenerativas de la columna lumbar que se sometieron a punción quirúrgica mediante el uso de un agonista adrenérgico alfa-2: denervación percutánea de las articulaciones facetarias con láser (n = 46) y discectomía endoscópica transforaminal posterolateral (n = 31). Fueron evaluados el nivel de sedación mediante la Escala de Sedación de Ramsay (RSS) y la Escala de Sedación y Agitación de Richmond (RASS); la dinámica intraoperatoria de los parámetros de los sistemas cardiovascular y respiratorio; el nivel del síndrome de dolor según la EVA. Resultados Se determinó un alto nivel de sedación intraoperatoria en RASS (-2, -3) y por Ramsay (III, IV)Al transferir un paciente a otro sector (después de 90 minutos), este parámetro fue 0 en RASS y II en Ramsay. No hubo cambios significativos en la hemodinámica central y la depresión respiratoria.El nivel mínimo de dolor se determinó después de la cirugía, 30 y 60 minutos después de la cirugía y antes del traslado al otro sector (90 minutos después): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Se verificó que no era necesaria analgesia adicional el primer día postoperatorio. Conclusiones El uso de D reduce significativamente el nivel de dolor al mismo tiempo que se mantiene la necesaria comunicación verbal con el paciente y brinda la protección neurovegetativa necesaria sin depresión respiratoria y parámetros hemodinámico reducidos durante el período perioperatorio. Nivel de evidencia II; Estudios de pronóstico: Investigación del efecto de la característica de un paciente sobre el desenlace de la enfermedad. Serie de casos, Estudio retrospectivo.

Articulación facetaria lumbar: correlación anatómica, clínica e imagenológica / Lumbar facet joint: anatomical, clinical and imaging correlation

El dolor facetario lumbar es una de las principales causas de dolor lumbar; representa alrededor del 15-56%. La articulación facetaria estabiliza la columna vertebral, tiene un rol fundamental en el soporte, distribución del peso y regulación de los movimientos rotacionales de la columna. Por ello, el conocimiento de la anatomía y de la biomecánica de esta articulación ayuda a tener una mejor comprensión de su participación en la fisiopatología del dolor lumbar y, por ende, mejora su abordaje diagnóstico y terapéutico. Nosotros revisamos aquí los conceptos actuales de embriología, anatomía, biomecánica y la correlación clínica/imagenológica de los cambios asociados a la enfermedad degenerativa facetaria de la columna lumbar.

Low back pain is a very common reason for emergency room consultation, it is found in approximately 60% of adults, and, within it, facet lumbar pain is one of the main causes, accounting for about 15-56% of low back pain cases. The facet joint stabilizes the spine, helps to distribute loads and has a fundamental role in support, weight distribution, and rotational movements regulation of the spine. Consequently, knowledge of the anatomy and biomechanics of this joint is helpful to have a better understanding of their contribution to the low back pain pathophysiology and, therefore, improving diagnostic and therapeutic approaches. This paper aims to review the current concepts of embryology, anatomy, biomechanics, and clinical/imaging correlation of the changes associated with lumbar degenerative facet disease

The assessment of pain, flexibility and daily activity level in the patients who had facet tropism

Vernal keratoconjunctivitis(VKC)is a chronic bilateral inflammation of the conjunctiva, commonly associated with a personal or family history of atopy. It is characterized by severe itching, foreign body sensation, thick ropy discharge, photophobia and conjunctival injection. VKC has palpebral, limbal and mixed forms. The classical conjunctival sign in palpebral VKC is the presence of giant papillae, which are predominantly seen on the superior tarsal conjunctiva. The limbal form occurs in dark skinned individuals and the papillae tend to occur at the limbus and have a thick gelatinous appearance. Clinical findings and laboratory investigations support the presence of IgE mediated type1 hypersensitivity reaction. Involvement of CD4 T helper (Th2) driven type IV hypersensitivity has also been confirmed. There has been an increase in the prevalence of allergic disorders in recent years and exaggerated manifestations of these diseases have been recognized in patients living with Human immunodeficiency virus

Digital three-dimensional morphology of cervical joint facet in 7-12-year-old children / 中国组织工程研究

BACKGROUND: Lots of researches by domestic and foreign scholars have confirmed that the asymmetry of facet joint surface or the articular angles might cause the degeneration of the facet joints, and the articular spondylolisthesis. But most of the studies focus on the adult. It has been confirmed that the most common cause of the cervical disease, of the osteoarthritis, of the neurovascular compression or even the paralysis is the pathological changes of facet joint for people as they grow older. There are few studies on the facet joints in children. OBJECTIVE: To explore the cervical joint facet morphology development characteristics and age-related changes by collecting the CT scanning data of cervical vertebrae in children aged 7-12 years old, three-dimensional reconstruction and cervical facet joint morphology measurement and analysis. METHODS: Through collecting the data of multi-layers spiral CT scan of children in the First Affiliated Hospital and Second Affiliated Hospital of Inner Mongolia Medical University and Inner Mongolia International Mongolian Hospital from September 2013 to September 2015, 99 cases of cervical structures were selected. Then DICOM format of original data were imported in Mimics software for three-dimensional reconstruction. Morphological measurement was conducted on the three-dimensional model. The study was approved by the Ethical Committee of Inner Mongolia Medical University on March 11, 2015, approval No. YKD2015049. RESULTS AND CONCLUSION: (1) The length of children cervical joint facet was on a rise with age and a decreasing trend with ordinal number of vertebrae. (2) The width of children middle upper cervical joint facet showed “V” type. The width of children lower cervical joint facet increased with the increase of vertebral order. (3) The trend of distance between articular tubercles was “spike” shape. (4) The coronal angle of joint facet presented to be “V” shape. (5) The sagittal angle of joint facet was in inverted “V” shape. (6) In summary, there is no asymmetry of articular process in the morphological characteristics of cervical facet joints in 7-12-year-old children.

Facet joint injection versus percutaneous kyphoplasty for mild vertebral fragility fractures: Rapid analgesia and restoration of spinal stability / 中国组织工程研究

BACKGROUND: Percutaneous kyphoplasty (PKP) for the treatment of osteoporotic compression fractures has been widely recognized in clinical practice, but clinicians are still impelled to seek for new treatment regimens due to complications such as bone cement leakage and adjacent vertebral re-fracture. OBJECTIVE: To compare the therapeutic efficacy of facet joint injection (FJI) and PKP in the treatment of mild vertebral fragility fractures. METHODS: Forty-six patients with mild vertebral fragility fractures (osteoporotic fractures) were divided into FJI group and PKP group according to the treatment regimens. The two groups of patients were treated with FJI and PKP separately based on standardized anti-osteoporosis treatment. The data of each group were recorded before and 1 week, 1, 3, 6, and 12 months after treatment. The analgesic efficacy was evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI). Spine stability was evaluated by anterior vertebral height, kyphotic angle and lumbar spine density and the incidence of re-fracture were compared. The study protocol was implemented in line with the ethic requirements of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences in China. Informed consent was obtained from each patient. RESULTS AND CONCLUSION: Intragroup comparison: VAS and ODI scores of patients in both groups were significantly decreased in each period after treatment compared with the baseline (P 0.05). After treatment, the anterior vertebral body height and kyphosis angle in the PKP group were better than those in the FJI group (P 0.05). Standardized anti-osteoporosis treatment with either FJI or PKP can provide effective analgesia for patients with mild vertebral fragility fracture, and PKP has certain advantages in rapid analgesia and recovery of spinal stability.

CT multiple-level reconstruction for preoperational estimation of facet joint violation in lumbar percutaneous pedicle screw placement / 中国组织工程研究

BACKGROUND: Percutanoues pedicle screw internal fixation is widely used for treating lumbar disease. Because the surgery is guided by the C-arm, it is hard to control the position between screws and facet joint to cause the facet joint violation completely. Body mass index > 29.9 kg/m2, facet joint angle > 35°and age < 65 years old are considered as the high risk factors for percutaneous pedicle screw injury of articular processes. Due to the different positional relationship between the pedicle axis of the lumbar spine and the articular process joint, there is no related report on whether the destruction of the articular process joint by screws is different. OBJECTIVE: To investigate the significance of lumbar CT multi-planar reconstruction for preestimating facet joint violation in lumbar percutaneous pedicle screw placement. METHODS: One hundred patients with lumbar fracture and degenerative disease who underwent percutaneous pedicle screw placement were selected. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The position line of the oblique axial view, oblique sagittal view and oblique coronal view was adjusted to reconstruct the section of pedicle. A circle with the 6.5 mm of position line of the oblique coronal view as its center to check the relationship between the circle and facet joint served as preoperation group. CT examination was performed after surgery for evaluating the degree of facet joint violation by screws and served as postoperation group. The amount of screws which damage the facet joint of different vertebrae between two groups and the damage rate among vertebrae in each group were compared. RESULTS AND CONCLUSION: (1) Totally 478 screws were placed, 109 (22.8%) screws violated facet joints in the preoperation group, and the amount of circles which violated facet joint was 6 (6.8%), 9 (10.5%), 19 (18.3%), 30 (30.0%), and 45 (45.0%) from L1-L 5. (2) 115 (24.1%) screws violated facet joints in the postoperation group, the amount of circles which violated facet joint was 10 (11.4%), 7 (8.1%), 15 (14.4%), 26 (26.0%) and 41 (41.0%) from L1-L 5. (3) The P values of McNamara test of different vertebrae were 0.08 (L1), 0.22 (L2), 0.20 (L3), 0.05 (L4) and 0.08 (L5). There was no significant difference between two groups. (4) The results of Kappa test were 0.67 (L1), 0.80 (L2), 0.80 (L3), 0.87 (L4) and 0.92 (L5). The damage rate among vertebrae in each group had significant differences (P=0.000). (5) To conclude, the relationship between percutanoues pedicle screw and facet joint could be recognized by lumbar CT multiple level reconstruction, which provides a reliable method for preestimating the possibility of facet joint damage caused by the percutanoues pedicle screw.

Related factors and biomechanical characteristicsof lumbar facet joint degeneration / 中国组织工程研究

BACKGROUND: Lumbar facet joint degeneration has become the focus of scholars’ research in recent years. Understanding the risk factors of lumbar facet joint degeneration plays a key role in preventing and reducing the damage to spine health. Moreover, comprehending its anatomy has important guiding significance for the treatment of spine-related diseases and related operations. OBJECTIVE: To briefly describe the anatomy and histological characteristics of the lumbar facet joints, and summarize the risk factors of lumbar facet joints degeneration. METHODS: A computer-based search of CNKI, Wanfang database, VIP database, PubMed, Elsevier and Web of Science was performed with the search terms “lumbar facet joint, joint capsule, articular direction, eneurosis, osteoarthritis, biomechanics, low back pain, intervertebral disc degeneration, lumbar spondylolisthesis, lumbar degenerative scoliosis” for articles published from March 2018 to September 2019. Review, basic research and clinical research were screened by reading title and abstract. The studies with low relevance to the subject were excluded, and 60 studies were included in the final analysis. RESULTS AND CONCLUSION: (1) The main risk factors for lumbar facet joint degeneration include age, gender, abnormal stress, articular surface orientation, joint asymmetry, lumbar segment and disc degeneration. (2) When the joints degenerate, it can cause low back pain, disc degeneration, lumbar spondylolisthesis, degenerative scoliosis and other clinical diseases, which seriously affect people’s daily life and work, and reduce people’s living quality. Therefore, lumbar facet joints should not be ignored in the treatment of spine-related diseases.

Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis / 中国骨伤

OBJECTIVE@#To analyze the characteristics of lumbar spine-pelvic structure in degenerative lumbar spondylolisthesis and its significance in degenerative lumbar spondylolisthesis(DLS).@*METHODS@#The clinical data of 45 patients with simple degenerative L-segment lumbar spondylolisthesis (spondylolisthesis group) admitted from April 2015 to January 2017 were retrospectively analyzed, which were compared with 50 healthy people with complete physical examination data in the same period(control group). Statistical analysis of the lumbar spine-pelvic structure parameters of the subjects through imaging data was performed to analyze the characteristics of the spine-pelvis of DLS patients. The degenerative characteristicsof intervertebral disc and articular process joint were observed in degenerative lumbar spondylolisthesis. Use Spearson to analyze the correlation between observation items.@*RESULTS@#The facet joint angle, lumbar lordosis angle (LL), pelvic incidence angle(PI), pelvic tilt angle (PT), sacral slope angle (SS) in spondylolisthesis group of L-segment were (36.5±11.2)°, (44.2±7.3)°, (66.5±11.6)°, ( 22.2±10.0)°, (33.4±11.3)°, respectively, while in control group were (44.4±8.2)°, (36.7±8.5)°, (55.4± 13.2)°, (14.4±7.0)°, (42.3±13.1)°. PI, LL, PT of spondylolisthesis group were obviously larger than that of control group (< 0.05), the facet joint angle and SS of spondylolisthesis group were smaller than that of control group(<0.05). The correlation analysis showed that PI value was related to the PT and SS in two group. The degree of degeneration of intervertebral disc was related to the degree of spondylolisthesis. The degree of degeneration of L-S intervertebral disc and L facet jointin spondylolisthesis group was more serious (P <0.05).@*CONCLUSION@#Lumbar spinal pelvic structure of degenerative lumbar spondylolisthesis has undergone significant changes. Lumbar lordosis and pelvic dumping phenomenon in the mechanism of lumbar degeneration plays an important role. Lumbar facet joint degeneration and lumbar intervertebral disc degeneration are mutually promoted, and lumbar spondylolisthesis aggravates intervertebral disc and facet joint degeneration.

Bilateral Accessory C1 and C2 Facet Joints; Clinical, Neuroradiological and Peroperative Findings in an Adult with Quadriparesis

Objectives Accessory C1 and C2 facet joints are very rare. Only few cases were reported in the literature.We report a case of bilateral accessory facets in an adult with special attention to clinical, neuroradiological, as well as peroperative findings. Case report A 37-year-old male presented with progressive quadriparesis. Radiology revealed bilateral posterior accessory C1 and C2 facet joints compressing the spinal cord with craniovertebral junction (CVJ) instability. Both accessory C1 and C2 facets with the posterior arch of the C1 were removed. Lateral mass screws and plates fixation at the C1 and C2 level, as well as fusion, were performed. Postoperatively, the patient recovered well. Conclusion In accessory C1 and C2 facet joints, when symptomatic, neuroradiological findings can guide to the proper diagnosis, to pathological understanding, and, ultimately, to management strategy.

Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis

Background: Lumbar Spondylitis (LS) is a common term that denotes degenerative changes that develop in trauma-center patients, specific age groups, and head injury patients. A study done on Indian population reported 60% to 90% of radiological changes of L4 at L5-S1 levels in asymptomatic individuals. These degenerative changes in the lumbar spine may remain asymptomatic or can present as pure axial lumbar pain, lumbar radiculopathy, lumbar myelopathy, or lumbar myeloradiculopathy. So, the aim of the study was to check the effectiveness of hip flexor muscle strengthening, femoral nerve muscle stretching with facet joint mobilization for lumbar spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of two measures - RolandMorris Low Back Pain and Disability Questionnaire for disability and Visual Analog Scale (VAS). Goniometer was used for range motion of lumbar spine movements done in each group. The Subjects in Group-A were given hip flexor muscles strengthening with femoral nerve stretching for lumbar region for 45 minutes for 4 days in a week for four weeks where the subject were sitting. The Subjects in Group-B were given femoral nerve stretching with facet joint mobilization for 45 minutes for 4 days in a week for four weeks where the subjects were in supine and prone position and remain Sreenivasu Kotagiri, Neeti Mathur, Ashwin Kumar. Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis. IAIM, 2019; 6(9): 49-57. Page 50 relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and RMQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and RMQ. The overall study proved that hip flexor muscle strengthening, femoral nerve stretching with facet joint mobilization for lumbar spondylitis in improving Pain and decreasing the disability level in lumbar radiculopathy and reduce tightness subjects. Conclusion: The analysis obtained indicated that Group B (femoral nerve stretching with facet joint mobilization) showed more significant improvement when compared to Group A ( hip flexor muscles strengthening with femoral nerve stretching).

Effects of Facet Joint Arthroplasty at Different Positions under Lumbar Percutaneous Endoscopy on Range of Motion of Vertebral Bodies / 医用生物力学

Objective To evaluate the influence of facet joint arthroplasty at different positions under lumbar percutaneous endoscopy on range of motion (ROM) of vertebral bodies by using the three-dimensional (3D) finite element method. Methods The 3D finite element model of normal L3-5 segment was established, and lumbar percutaneous endoscopy was simulated by doing cylindrical excision of bone with diameter of 7.5 mm on the tip or basement of L5 facet joint, so as to obtain normal lumbar vertebra model, L5 facet joint model with shaped tip, L5 facet joint model with shaped basement, respectively. Given specific loading conditions, the ROMs of adjacent vertebral bodies for the 3 models under flexion, extension, left and right lateral flexion, left and right rotation were compared. Results When L5 facet joint tip was shaped, the ROMs of L4-5 under extension，left lateral flexion, right lateral flexion, left rotation and right rotation were obviously larger than those of the normal model, especially under left rotation. When the L5 facet joint basement was shaped, the ROMS of L4-5 under left and right rotation increased slightly compared with those of the normal model. However, the ROMs of L3-4 for both tip-shaped and basement-shaped L5 facet joint model showed no obvious changes under six different motions. Conclusions The influence of L5 facet joint with shaped tip on ROMs of L4-5 was relatively larger than that of L5 facet joint with shaped basement under lumber percutaneous endoscopy. There was no significant effect on the ROMs of L3-4 with L5 facet joint arthroplasty.

Angiopoietin-Like Protein 2 Induces Synovial Inflammation in the Facet Joint Leading to Degenerative Changes via Interleukin-6 Secretion

STUDY DESIGN: Experimental human study. PURPOSE: To determine whether angiopoietin-like protein 2 (ANGPTL2) is highly expressed in the hyperplastic facet joint (FJ) synovium and whether it activates interleukin-6 (IL-6) secretion in FJ synoviocytes. OVERVIEW OF LITERATURE: Mechanical stress-induced synovitis is partially, but significantly, responsible for degenerative and subsequently osteoarthritic changes in the FJ tissues in patients with lumbar spinal stenosis (LSS). However, the underlying molecular mechanism remains unclear. IL-6 is highly expressed in degenerative FJ synovial tissue and is responsible for local chronic inflammation. ANGPTL2, an inflammatory and mechanically induced mediator, promotes the expression of IL-6 in many cells. METHODS: FJ tissues were harvested from five patients who had undergone lumbar surgery. Immunohistochemistry for ANGPTL2, IL-6, and cell markers was performed in the FJ tissue samples. After cultured synoviocytes from the FJ tissues were subjected to mechanical stress, ANGPTL2 expression and secretion were measured quantitatively using real-time quantitative reverse-transcription–polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA), respectively. Following ANGPTL2 administration in the FJ synoviocytes, anti-nuclear factor-κB (NF-κB) activation was investigated using immunocytochemistry, and IL-6 expression and secretion were assayed quantitatively with or without NF-κB inhibitor. Moreover, we assessed whether ANGPTL2-induced IL-6 modulates leucocyte recruitment in the degenerative process by focusing on the monocyte chemoattractant protein-1 (MCP-1) expression. RESULTS: ANGPTL2 and IL-6 were highly expressed in the hyperplastic FJ synovium samples. ANGPTL2 was co-expressed in both, fibroblast-like and macrophage-like synoviocytes. Further, the expression and secretion of ANGPTL2 in the FJ synoviocytes increased in response to stimulation by mechanical stretching. ANGPTL2 protein promoted the nuclear translocation of NF-κB and induced IL-6 expression and secretion in the FJ synoviocytes. This effect was reversed following treatment with NF-κB inhibitor. Furthermore, ANGPTL2-induced IL-6 upregulated the MCP-1 expression in the FJ synoviocytes. CONCLUSIONS: Mechanical stress-induced ANGPTL2 promotes chronic inflammation in the FJ synovium by activating IL-6 secretion, leading to FJ degeneration and subsequent LSS.

The Prevalence of Asymptomatic Cervical and Lumbar Facet Arthropathy: A Computed Tomography Study

STUDY DESIGN: Case control study. PURPOSE: To determine the prevalence and degree of asymptomatic cervical and lumbar facet joint arthritis. We retrospectively reviewed 500 computed tomography (CT) scans of cervical facet joints obtained from 50 subjects. Moreover, 500 lumbar facet joints obtained from an additional 50 subjects were reviewed. OVERVIEW OF LITERATURE: Numerous reports in the literature indicate that joint arthritis is a major source of axial neck and low back pain. However, the diagnostic value of this condition, based on degenerative changes seen on radiological studies, remains controversial because significant imaging findings may not correlate with corresponding symptoms. The CT scan is a sensitive method for facet joint evaluation and may reveal degenerative abnormalities. Previous studies have described the prevalence of facet arthropathy in symptomatic patients, according to radiological findings; however, no study to date has assessed its prevalence in asymptomatic patients. METHODS: We retrospectively reviewed the neck and abdominal CT scans of patients had been examined for non-spinal pathologies (i.e., thyroid disease, rule out cancer, ascites). Electronic medical records were reviewed to exclude patients with histories of either neck or back pain. Arthritis severity was graded using a previously published four-point CT scale. RESULTS: The prevalence of asymptomatic cervical facet arthritis (grade 1–3) was 33% (grade 1, 19%; grade 2, 11%; and grade 3, 3%). Among asymptomatic patients, 37% had scalable lumbar facet join arthritis (grade 1, 24%; grade 2, 9%; and grade 3, 4%). There was a statistically significant difference (chi-square test, p<0.0001) in the number of older individuals with arthritic degeneration at the cervical and lumbar levels compared with that of younger individuals. The C6–C7 and L5–S1 levels were the most likely to show arthritic changes. CONCLUSIONS: Arthritic changes to the cervical and lumbar facet joints are prevalent among patients, and in some cases are asymptomatic. These findings were more common in older patients and at lower spinal levels.

Measuring Needle Angle and Depth for Lumbar Medial Branch Block Using Ultrasonography: An Evaluation of Efficiency Compared with Magnetic Resonance Imaging / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare accuracy of proper needle insertion angle between magnetic resonance imaging (MRI) and ultrasonography during lumbar medial branch nerve block procedure. MATERIALS AND METHODS: Between January 2015 and June 2016, 80 people who underwent MRI in the past 3 months with improved lumbar pain after sono-guided medial branch nerve block were enrolled for analysis (male, 39; female, 41; average age, 63.3 years). The insertion angle and depth between the spinous process and needle at each target points were measured at various levels (superior, inferior segment of each facet joints from L2–3 to L5–S1). The needle was positioned 1 cm apart from both lateral sides of the probe, locating spinous process in the middle. A comparative analysis was performed between an ultrasonography and an MRI. We determined the statistical correlation between the two methods. RESULTS: The average differences with respect to the distance between each level on a sono-guided medial branch nerve block were 1.28±1.07 mm in L2 (7 cases), 1.27±4.26 mm in L3 (25 cases), 1.63±5.89 mm in L4 (93 cases), 1.99±4.12 mm in L5 (141 cases), and 1.51±3.87 mm in S1 (66 cases). The average differences regarding the angle of each level were 1.69°±1.34° in L2 (7 cases), 2.03°±5.35° in L3 (25 cases), 1.49°±3.42° in L4 (93 cases), −1.55°±3.67° in L5 (141 cases), and 1.86°±4.83° in S1 (66 cases). All measurements followed a normal distribution (p < 0.05), showing statistical correlation without significant difference (p < 0.05). CONCLUSION: After measuring each level using an MRI prior to performing the procedure, a sono-guided lumbar medial branch nerve block can be performed with greater safety and efficacy, especially for beginners.

Scoring System for Factors Affecting Aggravation of Lumbar Disc Herniation

PURPOSE: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. MATERIALS AND METHODS: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. RESULTS: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. CONCLUSION: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.

Relationship between lumbar multifidus muscles and degeneration of facet joint with MRI / 实用医学杂志

Objectives To investigate the relationship between the degeneration of lumbar multifidus mus-cles and facet joint osteoarthritis(FJOA)by MRI. Methods This retrospective study included 248 patients with low back and leg pain,aged from 55 to 70.MRI was used to measure TCSA,FCSA,fCSA and FI% of the L4~5and L5~S1segments on the both sides of their multifidus muscle in the cross section in T2weighted image.All the cases were divided into three grades:grade 0~1,grade 2 and grade 3 according to their FJOA grades. The relationship between the FJOA grades at the same level and TCSA,FCSA and FI% of both sides was analyzed retrospectively. Results There were significant differences of the FI% of the multifidus muscle between both sides of the two seg-ments(P < 0.05);The TCSA,FCSA and fCSA of the left and right multifidus muscle all showed an increasing trend from L4~5to L5~S1segment and the difference was statistically significant(P<0.05);the FI% of two sides of multifidus muscle was negatively correlated with the right FJOA grade at L5~S1segment(P<0.05).There was a re-lationship between females and right FJOA grade at L5~S1segment(all P < 0.05). Whereas,no significant differ-ence was found in other parameters(all P>0.05).Conclusions There is no relationship between the cross-sec-tional area of the multifidus muscle and the FJOA grade. The higher FI% degree of multifidus muscle in the L5~S1 segment is accompanied with a lower grade of FJOA.The degeneration of multifidus muscle occurs earlier than the degeneration of articular process joints,so the earlier exercise of lumbar muscle is recommended.