Influence of weight-bearing on the 3D movement of lumbar facet joints in the sitting position.

OBJECTIVE: To analyze the motion characteristics of lumbar facet joints and to observe the effect of weight-bearing on lumbar facet joints in the sitting position. METHODS: Ten normal subjects (5 males and 5 females) were recruited and scanned by CT, and their lumbar 3D models were reconstructed by software. The images of flexion and extension of lumbar facet joints in the sitting position were collected without weight-bearing and weight-bearing 10 kg, and the 2D model was constructed by software. The 2D-3D model was matched to restore the flexion and extension motion changes of the subjects' lumbar spine in the sitting position. Coordinates were established in the middle of the vertebral body and copied to the facet joints. Measure and record the lumbar facet joint movement distance through coordinate system. The relevant data of facet joints were collected. RESULTS: In the L3/4 segment, after weight loading, the displacement of the left facet joint in the X axis became larger, while that in the Y axis and Z axis decreased. The displacement of the right facet joint in the X axis and Y axis increased, and the Z axis displacement decreased. The rotation angle of the bilateral facet joints also decreased. In the L4/5 segment, after loading, the displacements of the X, Y, and Z axis displacements of both sides increase, while the rotation angles of α and ß increase, while the rotation angle of γ decreases. In the L5/S1 segment, the displacements of the X, Y, and Z axes on the left side decrease. The displacement of the X and Y axes on the right side decreases, while the displacement on the Z axis increases. The rotation angles of α and γ increase, and the rotation angle of the ß axis decreases. CONCLUSION: When sitting, the flexion and extension distance and rotational displacement of lumbar facet joints are not affected by weight-bearing. In addition, there is asymmetry in the movement of the left and right facet joints, and weight bearing has no effect on the asymmetry of the motion.

Mechanical overloading-induced miR-325-3p reduction promoted chondrocyte senescence and exacerbated facet joint degeneration.

OBJECTIVE: Lumbar facet joint (LFJ) degeneration is one of the main causes of low back pain (LBP). Mechanical stress leads to the exacerbation of LFJ degeneration, but the underlying mechanism remains unknown. This study was intended to investigate the mechanism of LFJ degeneration induced by mechanical stress. METHODS: Here, mice primary chondrocytes were used to screen for key microRNAs induced by mechanical overloading. SA-ß-gal staining, qRT-PCR, western blot, and histochemical staining were applied to detect chondrocyte senescence in vitro and in vivo. We also used a dual-luciferase report assay to examine the targeting relationship of miRNA-325-3p (miR-325-3p) and Trp53. By using NSC-207895, a p53 activator, we investigated whether miR-325-3p down-regulated trp53 expression to reduce chondrocyte senescence. A mice bipedal standing model was performed to induce LFJ osteoarthritis. Adeno-associated virus (AAV) was intraarticularly injected to evaluate the effect of miR-325-3p on facet joint degeneration. RESULTS: We observed chondrocyte senescence both in human LFJ osteoarthritis tissues and mice LFJ after bipedally standing for 10 weeks. Mechanical overloading could promote chondrocyte senescence and senescence-associated secretory phenotype (SASP) expression. MicroRNA-array analysis identified that miR-325-3p was obviously decreased after mechanical overloading, which was further validated by fluorescence in situ hybridization (FISH) in vivo. Dual-luciferase report assay showed that miR-325-3p directly targeted Trp53 to down-regulated its expression. MiR-325-3p rescued chondrocyte senescence in vitro, however, NSC-207895 reduced this effect by activating the p53/p21 pathway. Intraarticular injection of AAV expressing miR-325-3p decreased chondrocyte senescence and alleviated LFJ degeneration in vivo. CONCLUSION: Our findings suggested that mechanical overloading could reduce the expression of miR-325-3p, which in turn activated the p53/p21 pathway to promote chondrocyte senescence and deteriorated LFJ degeneration, which may provide a promising therapeutic strategy for LFJ degeneration.

Correlation between the spinopelvic type and morphological characteristics of lumbar facet joints in degenerative lumbar spondylolisthesis.

OBJECTIVE: The correlation between the spinopelvic type and morphological characteristics of lumbar facet joints in patients with degenerative lumbar spondylolisthesis (DLS) was investigated. METHODS: One hundred forty-two patients with L4 DLS were enrolled (DLS group), and 100 patients with lumbar disc herniation without DLS were selected as the control group (i.e., non-lumbar spondylolisthesis [NL] group). Morphological parameters of L4-5 facet joints and L4-5 disc height and angle were measured on 3D reconstructed CT images; namely, the facet joint angle (FJA), pedicle-facet joint angle (PFA), facet joint tropism, and facet joint osteoarthritis (OA). The L4 slip percentage, sacral slope, and lumbar lordosis were measured on radiographs. Patients in the DLS and NL groups were divided into 4 subgroups according to Roussouly classification (types I, II, III, and IV). RESULTS: In the DLS and NL groups, as the spinopelvic type changed from type II to type IV, the facet joint morphology showed a gradual sagittal orientation in the FJA, a gradual horizontal orientation in the PFA, a gradual severity in OA, and a gradual increase in the slip percentage, but changes were completely opposite from type I to type II. Additionally, compared with the NL group, the facet joint morphology in the DLS group had more horizontal orientation in PFA, more sagittal orientation in the FJA, and the facet joint tropism and OA were more severe. CONCLUSIONS: Facet joint morphology was correlated with spinopelvic type in the slip segment of DLS. Facet joint morphology was part of the joint configuration in different spinopelvic types, not just the result of joint remodeling after DLS. Moreover, morphological changes of the facet joints and DLS interacted with each other. Additionally, morphological remodeling of the facet joints in DLS played an important role in spinal balance and should be taken into consideration when designing a surgical approach.

3D kinematic characteristics of lumbar facet joints in sitting position.

BACKGROUND: Recognizing the kinematic characteristics of lumbar facet joints is important for the prevention and treatment of lumbar degenerative diseases. Previous studies have been conducted in either the supine or standing position, and there are no measurements regarding the kinematic characteristics of the lumbar facet joints while sitting. The aim of this study was to measure and analyze lumbar facet joint motion characteristics while sitting. METHODS: Ten subjects (5 males and 5 females) performed the movements of flexion-extension, left bending-right bending, and left rotation-right rotation in a sitting position. Dual Fluoroscopic Image System and computed tomography technique were used to measure the displacement and rotation angle of the lumbar facet joints of the subjects for analysis. The movement characteristics of L3-S1 were measured. RESULTS: When the subjects were in sitting position, the lumbar vertebra mainly changed in Z-axis and α, ß angle when they performed flexion-extension activities. The displacement of the left facet joint was 4.65 ± 1.99 mm at L3-4, 1.89 ± 2.99 mm at L4-5, and 0.80 ± 2.27 mm at L5-S1 in the Z-axis, and the displacement of the right facet joint was 3.20 ± 2.61 mm at L3-4, 1.71 ± 3.00 mm at L4-5, and 0.31 ± 1.69 mm at L5-S1 in the Z-axis. The rotation in the α angle was 6.00 ± 4.49° at L3-4, 3.51 ± 5.24° at L4-5, and 0.97 ± 4.13° at L5-S1, which was significant different. The rotation in the ß angle was 2.30 ± 2.94°at L3-4, 0.16 ± 2.06° at L4-5, and 0.35 ± 1.74°at L5-S1, which was significant different. When the lumbar spine performed the activity of left bending-right bending, there were changes in rotation mainly in the Z-axis and ß angle. The displacement of left facet joint in the Z-axis was 1.34 ± 2.84 mm at L3-4, 2.11 ± 0.88 mm at L4-5, and 0.72 ± 0.81 mm at L5-S1; the rotation in the ß angle was 5.66 ± 2.70°at L3-4, 7.89 ± 2.59° at L4-5, and 1.28 ± 2.07° at L5-S1; when the lumbar spine performed the activity of left rotation-right rotation, there were changes in the ß angle. The rotation of ß angle was 4.09 ± 2.86° at L3-4, 2.14 ± 3.38° at L4-5, and 0.63 ± 1.85° at L5-S1. CONCLUSION: The lumbar facet joint motion in sitting position is different in each mode of motion. The horizontal displacement and rotation are predominant during flexion and extension activities, while there are different rotation in bending and rotation. The study shows the coupled motion of the lumbar facet joints while sitting, providing a new perspective on the kinematics of the lumbar spine and the etiology of lumbar degenerative diseases.

The effect of various weight-bearing activities on the motion of lumbar facet joints in vivo.

BACKGROUND: Lumbar facet joints (LFJs) are usually related to the pathogenesis of the spine. The purpose of this paper is to study the effects of lifting load on the motion of lower lumbar facet joints in vivo. METHODS: Ten healthy volunteers aged 25 ≤ 39 years, 5 males and 5 females, were recruited. Using a dual fluoroscopy imaging system (DFIS) combined with CT, firstly, the L3-S1 segment image scanned by CT was converted into a three-dimensional model. Then, the lumbar motion images of L3-S1 vertebrae taken by the DFIS under different loads (0 kg, 5 kg, 10 kg) and different body postures (maximum flexion and extension, maximum left and right bending, and maximum left and right torsion) were captured. Finally, in the Rhino software, the instantaneous motion state of the lumbar spine is reproduced by translation and rotation according to the anatomical structure of the lumbar spine and the previous images. With the help of computer software, a Cartesian coordinate system was placed in the center of each articular surface to measure the kinematics of the articular process and to obtain 6DOF data under different loads (0 kg, 5 kg, 10 kg) in the lumbar facet joints. RESULTS: In the flexion and extension of the trunk, weight bearing reduced the translational range in the mid-lateral direction. In the L3/4 segment, the lateral translational range of the left and right facet joints gradually decreased with increasing load, and the translational range at 0 kg was significantly greater than that at 10 kg (left side: 0 kg, 0.86° ± 0.57°, 10 kg, 0.24° ± 0.26°, p = 0.01; right side: 0 kg, 0.86° ± 0.59°, 10 kg, 0.26° ± 0.27°, p = 0.01). In the L5/S1 segment, the translation range of the LFJ at 0 kg was significantly greater than that at 10 kg (p = 0.02). Other bending and rotation movements were not found to cause differential changes in the 6DOF of the LFJ. In bending, the rotation range was the largest in the L3/4 segment (p < 0.05) and gradually decreased from top to bottom. At the same level, there were significant differences in the translation range of the left and right facets in the anterior posterior and craniocaudal directions (p < 0.05). CONCLUSION: Increasing the load has a significant impact on the coupled translational movement of lumbar facet joints. The asymmetric translational movement of the left and right facet joints may be a factor that accelerates the degeneration of facet joints.

Kinematic Characteristics and Biomechanical Changes of Lower Lumbar Facet Joints Under Different Loads.

OBJECTIVE: To explore the kinematic biomechanical changes and symmetry in the left and right sides of the facet joints of lumbar spine segments under different functional loads. METHODS: Participants (n = 10) performing standing flexion and extension movements were scanned using computed tomography (CT) and dual fluoroscopy imagine system. Instantaneous images of the L3 -S1 vertebrae were captured, and by matching a three-dimensional CT model with contours from dual fluoroscopy images, in vivo facet joint movements were reproduced and analyzed. Translations and rotations of lumbar vertebral (L3 and L4 ) facet joints of data were compared for different loads (0, 5, 10 kg). The participants performed flexion and extension movements in different weight-bearing states, the translations and angles changes were calculated respectively. RESULTS: From standing to extension, there were no statistical differences in rotation angles for the facet joint processes of different vertebral segment levels under different weight loads (P > 0.05). Mediolateral axis and cranio-caudal translations under different weight loads were not statistically different for vertebral segment levels (P > 0.05). Anteroposterior translations for L3 (1.4 ± 0.1 mm) were greater than those for L4 (1.0 ± 0.1 mm) under the different load conditions (P = 0.04). Bilaterally, mediolateral, anteroposterior, and cranio-caudal translations of the facet joints under different weights (0, 10 kg) for each segment level (L3 and L4 ) were symmetric (P > 0.05). From flexion to standing, there were no statistical differences in rotation angles for different weights (0, 5, 10 kg) for each level (L3 and L4 ) (P > 0.05). There were no statistical differences between mediolateral, anteroposterior, and cranio-caudal translations at each segment level (L3 and L4 ) under different loads (P > 0.05). Under the condition of no weight (0 kg), L3 mediolateral translations on the left side (1.7 ± 1.6 mm) were significantly greater (P = 0.03) than those on the right side (1.6 ± 1.6 mm). Left side (1.0 ± 0.7 mm) L4 mediolateral translations were significantly smaller (P = 0.03) than those on the right side (1.1 ± 0.7 mm). There were no statistical differences between different weights for either anteroposterior and cranio-caudal translations (P > 0.05). There were no statistical differences for mediolateral, anteroposterior, and cranio-caudal translations for 10 kg (P > 0.05). CONCLUSION: Lumbar spine facet joint kinematics did not change significantly with increased loads. Anteroposterior translations for L3 were greater than those for L4 of the vertebral segments are related to the coronal facet joint surface. Changes in facet surface symmetry indicates that the biomechanical pattern between facet joints may change.

Combination of 3.0T magnetic resonance imaging T2 mapping with texture analysis for evaluating the degeneration of lumbar facet joints. / 3.0Tç£å ±æŒ¯æˆåƒT2 mappingè”åˆçº¹ç†åˆ†æžè¯„ä¼°è °æ¤Žå°å ³èŠ‚é€€å˜ç¨‹åº¦.

OBJECTIVES: Quantitative magnetic resonance imaging has been successfully applied to assess the status of cartilage biochemical components. This study aimed to investigate the performance of 3.0T magnetic resonance imaging T2 mapping combined with texture analysis for evaluating the early degeneration of lumbar facet joints. METHODS: A total of 38 patients (20 in the asymptomatic group and 18 in the symptomatic group) were enrolled. All patients underwent 3.0T magnetic resonance imaging conventional sequences, water excitation three-dimensional spoiled gradient echo sequence (3D-WATSc), and T2 mapping scans. The bilateral L4/5 and L5/S1 lumbar facet joints were morphological graded using the Weishaupt criteria, T2 values, and texture parameters derived from T2 mapping of cartilage. The Kruskal-Wallis H test was used to compare the differences of parameters among different groups. Multivariate logistic regression analysis was used to obtain the independent predictive factors for evaluating the early degeneration of lumbar facet joints. Receiver operating characteristic (ROC) curve was performed and the area under curve (AUC) was calculated. Spearman correlation analysis was used to evaluate the correlation of the independent predictors of cartilage T2 value and texture parameters with the subjects' Japanese Orthopedic Association (JOA) score or Visual Analogue Scale (VAS) score. RESULTS: A total of 148 facet joints were selected, including 70 in Weishaupt 0 (normal) group, 58 in Weishaupt 1 group, and 20 in Weishaupt 2-3 group. T2 value, entropy, and contrast increased significantly as the exacerbation of facet joint degeneration (all P<0.05), while the inverse difference moment, energy, and correlation decreased (all P<0.05). Entropy among different groups was significantly different (all P<0.05), and the differences of T2 value, contrast, inverse difference moment, and energy between Weishaupt 0 and Weishaupt 1 groups, or Weishaupt 0 and Weishaupt 2-3 groups were statistically significant (all P<0.05). Multivariate logistic regression analysis suggested that T2 value and inverse difference moment were the independent predictors for evaluating early degeneration of facet joints. The combination of T2 value with inverse difference moment achieved the best performance in distinguishing Weishaupt 0 from Weishaupt 1 (AUC=0.85), with sensitivity and specificity at 92.7% and 76.5%, respectively. In the symptom group, the cartilage T2 value combined inverse difference moment was positively correlated with JOA score (r=0.475, P<0.05) and VAS score (r=0.452, P<0.05). CONCLUSIONS: 3.0T magnetic resonance imaging T2 mapping combined with texture analysis is helpful to quantitatively evaluate the early degeneration of lumbar facet joints, in which the T2 value and inverse difference moment show an indicative significance．.

Best practice in radiofrequency denervation of the lumbar facet joints: a consensus technique.

BACKGROUND: Radiofrequency denervation is used to treat selected people with low back pain. Recent trials have been criticised for using a sub-optimal intervention technique. OBJECTIVES: To achieve consensus on a best practice technique for administering radiofrequency denervation of the lumbar facet joints to selected people with low back pain. STUDY DESIGN: A consensus of expert professionals in the area of radiofrequency denervation of the lumbar facet joints. METHODS: We invited a clinical member from the 30 most active UK departments in radiofrequency pain procedures and two overseas clinicians with specific expertise to a 1 day consensus meeting. Drawing on the known anatomy of the medial branch, the theoretical basis of radiofrequency procedures, a survey of current practice and collective expertise, delegates were facilitated to reach consensus on the best practice technique. RESULTS: The day was attended by 24 UK and international clinical experts. Attendees agreed a best practice technique for the conduct of radiofrequency denervation of the lumbar facet joints. LIMITATIONS: This consensus was based on a 1 day meeting of 24 clinical experts who attended and took part in the discussions. The agreed technique has not been subject to input from a wider community of experts. CONCLUSIONS: Current best practice for radiofrequency denervation has been agreed for use in a UK trial. Group members intend immediate implementation in their respective trusts. We propose using this in a planned Randomised Controlled Trial (RCT) of radiofrequency denervation for selected people with low back pain.

Combination of 3.0T magnetic resonance imaging T mapping with texture analysis for evaluating the degeneration of lumbar facet joints / 中南大学学报(医学版)

OBJECTIVES@#Quantitative magnetic resonance imaging has been successfully applied to assess the status of cartilage biochemical components. This study aimed to investigate the performance of 3.0T magnetic resonance imaging T mapping combined with texture analysis for evaluating the early degeneration of lumbar facet joints.@*METHODS@#A total of 38 patients (20 in the asymptomatic group and 18 in the symptomatic group) were enrolled. All patients underwent 3.0T magnetic resonance imaging conventional sequences, water excitation three-dimensional spoiled gradient echo sequence (3D-WATSc), and T mapping scans. The bilateral L and L/S lumbar facet joints were morphological graded using the Weishaupt criteria, T values, and texture parameters derived from T mapping of cartilage. The Kruskal-Wallis test was used to compare the differences of parameters among different groups. Multivariate logistic regression analysis was used to obtain the independent predictive factors for evaluating the early degeneration of lumbar facet joints. Receiver operating characteristic (ROC) curve was performed and the area under curve (AUC) was calculated. Spearman correlation analysis was used to evaluate the correlation of the independent predictors of cartilage T value and texture parameters with the subjects' Japanese Orthopedic Association (JOA) score or Visual Analogue Scale (VAS) score.@*RESULTS@#A total of 148 facet joints were selected, including 70 in Weishaupt 0 (normal) group, 58 in Weishaupt 1 group, and 20 in Weishaupt 2-3 group. T value, entropy, and contrast increased significantly as the exacerbation of facet joint degeneration (all <0.05), while the inverse difference moment, energy, and correlation decreased (all <0.05). Entropy among different groups was significantly different (all <0.05), and the differences of T value, contrast, inverse difference moment, and energy between Weishaupt 0 and Weishaupt 1 groups, or Weishaupt 0 and Weishaupt 2-3 groups were statistically significant (all <0.05). Multivariate logistic regression analysis suggested that T value and inverse difference moment were the independent predictors for evaluating early degeneration of facet joints. The combination of T value with inverse difference moment achieved the best performance in distinguishing Weishaupt 0 from Weishaupt 1 (AUC=0.85), with sensitivity and specificity at 92.7% and 76.5%, respectively. In the symptom group, the cartilage T value combined inverse difference moment was positively correlated with JOA score (=0.475, <0.05) and VAS score (=0.452, <0.05).@*CONCLUSIONS@#3.0T magnetic resonance imaging T mapping combined with texture analysis is helpful to quantitatively evaluate the early degeneration of lumbar facet joints, in which the T value and inverse difference moment show an indicative significance．.

[Lumbar facet joint degeneration contributes to degenerative lumbar scoliosis induced by asymmetric stress in rabbits].

OBJECTIVE: To investigate the role of lumbar facet joint degeneration in the development of degenerative lumbar scoliosis caused by asymmetric stress. METHODS: Thirty-six New Zealand white rabbits were randomly divided into 3 groups (n=12): Group A with aspiration of the nucleus pulposus to induce disc degeneration; Group B with removal of the left capsule from the facet joints at L3/4 to L5/6 to induce degeneration; and Group C with both treatments. Springs were deployed on the left adjacent facets at L3/4, L5/6 and L5/6 to stress the facet joints. Serial radiographs were taken at 3 and 6 months, and the facet joint tissues were sampled at 6 months for Safranin O-fast green staining to assess the severity of cartilage degeneration based on the Mankin score. RESULTS: The Cobb angle differed significantly among the 3 groups (F=24.865, P=0.000). In all the groups, the Cobb angles at 6 months increased significantly as compared with that at 3 months (P <0.05). The Cobb angles were significantly greater in group C than in the other 2 groups at both 3 and 6 months (P <0.05) but showed no significant difference between Groups A and B (P>0.05). The severity of facet joint degeneration also differed significantly among the 3 groups (F= 22.009, P=0.000), and was the most severe in group C (P <0.05); facet joint degeneration was more severe in group B than in group A (P <0.05). CONCLUSIONS: Facet joint degeneration is an important factor that contributes to the development of degenerative lumbar scoliosis. Disc degeneration and facet joints degeneration can lead to lumbar scoliosis, which in turn aggravates disc degeneration, facet joints degeneration and asymmetric stress, thus forming a vicious circle to further exacerbate lumbar scoliosis.

Lumbar facet joint degeneration contributes to degenerative lumbar scoliosis induced by asymmetric stress in rabbits / 南方医科大学学报

OBJECTIVE@#To investigate the role of lumbar facet joint degeneration in the development of degenerative lumbar scoliosis caused by asymmetric stress.@*METHODS@#Thirty-six New Zealand white rabbits were randomly divided into 3 groups (n=12): Group A with aspiration of the nucleus pulposus to induce disc degeneration; Group B with removal of the left capsule from the facet joints at L3/4 to L5/6 to induce degeneration; and Group C with both treatments. Springs were deployed on the left adjacent facets at L3/4, L5/6 and L5/6 to stress the facet joints. Serial radiographs were taken at 3 and 6 months, and the facet joint tissues were sampled at 6 months for Safranin O-fast green staining to assess the severity of cartilage degeneration based on the Mankin score.@*RESULTS@#The Cobb angle differed significantly among the 3 groups (=24.865, =0.000). In all the groups, the Cobb angles at 6 months increased significantly as compared with that at 3 months ( <0.05). The Cobb angles were significantly greater in group C than in the other 2 groups at both 3 and 6 months ( <0.05) but showed no significant difference between Groups A and B (>0.05). The severity of facet joint degeneration also differed significantly among the 3 groups (= 22.009, =0.000), and was the most severe in group C ( <0.05); facet joint degeneration was more severe in group B than in group A ( <0.05).@*CONCLUSIONS@#Facet joint degeneration is an important factor that contributes to the development of degenerative lumbar scoliosis. Disc degeneration and facet joints degeneration can lead to lumbar scoliosis, which in turn aggravates disc degeneration, facet joints degeneration and asymmetric stress, thus forming a vicious circle to further exacerbate lumbar scoliosis.