The role of the intra-articular synovial fold as a source of facet joint pain is unclear, because the nature of nociceptive innervation in lumbar synovial folds is controversial, and there have been no such studies in cervical synovial folds. The present study aimed to demonstrate the presence of nerve fibers including nociceptive fibers in synovial folds of human cervical facet joints using immunohistochemistry. Synovial folds of cervical facet joints removed from patients undergoing cervical spine laminoplasty were analyzed immunohistochernically using antibodies to protein gene product 9.5, p 111-tubulin, substance P and calcitonin gene-related peptide. Many nerve fibers immunoreactive for protein gene product 9.5 and 111-tubulin were demonstrated both around blood vessels and as free fibers in the stroma of the synovial fold. Also, immunostaining showed the presence of free nerve fibers immunoreactive for substance P and calcitonin gene-related peptide in the stroma. The presence of putative nociceptive fibers in cervical synovial folds supports a possible role for these structures as a source of cervical facet joint pain. 0 3001 Orthopaedic Research Society. Published by

We performed CT myelography in 38 patients with cervical myelopathy before and after laminoplasty to enlarge the canal. The sagittal and transverse diameters, the cross-sectional area, and the central point of the spinal cord were measured. After cervical laminoplasty, the mean sagittal diameter of the spinal cord at C5 increased by 0.8 mm, but the mean transverse diameter decreased by 0.9 mm. The mean cross-sectional area of the cord increased by 7.4% and that of the dural sac and its contents by 33.8% at C5. The centre of the spinal cord moved a mean 2.8 mm posteriorly at this level. Enlargement of the spinal canal is sufficient to decompress the spinal cord, but posterior movement may be the limiting factor in determining the decompressive effect of laminoplasty.

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