A Morphological Study of the Fibrous Capsule of the Human Lumbar Facet Joint

Yamashita, Toshihiko; Minaki, Yasuhiko; Özaktay, A. Cüneyt; Cavanaugh, John M.; King, Albert I.

doi:10.1097/00007632-199603010-00002

Cited by 94 publications

(67 citation statements)

References 8 publications

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“…Several studies have reported that the greatest loads experienced by the facet joints occur during extension. [1][2][3][4]10,12,13,17 Current treatment options for facet-induced lower back pain include arthrodesis and therapeutic injection. Both treatment options have had limited success with long-term LBP relief.…”

Section: Discussionmentioning

confidence: 99%

“…8,11 The capsule surrounding the facet joint has been shown to be well innervated by afferent nociceptive fibers, which are activated by mechanical stresses. 1,2,4,6,7,11 Several in vitro studies and analytical models have confirmed that facet loading is increased during extension. [5][6][7][8][12][13][14][15] Shirazi-Adl and Drouin showed that the facets carry as much as 30% of the load in the presence of 2°to 5.6°of extension rotation.…”

mentioning

confidence: 96%

“…[1][2][3][4][5][6][7] The lifetime incidence of LBP is estimated to be between 60% and 90% with 15% to 40% of chronic LBP caused by the lumbar facet joints. 8 -10 Although clinically difficult to diagnose, facet specific back pain is exacerbated by hyperextension and lessened in a recumbent position or flexion.…”

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confidence: 99%

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The Effect of an Interspinous Process Implant on Facet Loading During Extension

Wiseman¹,

Lindsey²,

Fredrick³

et al. 2005

Spine

156

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Study Design. Facet loading parameters of lumbar cadaver spines were measured during extension before and after placement of an interspinous process implant.Objective. The study was undertaken to quantify the influence of an interspinous implant on facet loading at the implanted and adjacent levels during extension.Summary of Background Data. Facet loading is increased during extension and decreased during flexion. Previous studies have demonstrated that interspinous process decompression relieves disc pressure at the implanted level and does not alter disc pressure at the adjacent levels. Facet joints are believed to play a key role in back pain, especially in patients with collapsed discs and increased motion segment mobility resulting in increased facet loading.Methods. Seven cadaver spines (L2-L5) were loaded to 15 Nm of extension and 700 N compression with and without an interspinous process implant (X STOP) placed between the L3-L4 spinous processes. Pressure-sensitive film was placed in the facet joints of the implanted and adjacent levels. After loading, the film was digitally analyzed for peak pressure, average pressure, contact area, and force. These values were compared between the intact and implanted specimens at the adjacent and implanted levels using a paired t test (P Ͻ 0.05).Results. The implant significantly reduced the mean peak pressure, average pressure, contact area, and force at the implanted level. The mean peak pressure, average pressure, contact area, and force at the adjacent levels were not significantly different between the intact and implanted specimens with the exception of contact area at the L2-L3 level.Conclusions. Interspinous process decompression will unlikely cause adjacent level facet pain or accelerated facet joint degeneration. Furthermore, pain induced from pressure originating in the facets and/or posterior anulus of the lumbar spine may be relieved by interspinous process decompression. Clinical results from patients with a component of lower back pain suggest that this is a valid conclusion.Key words: facet joint, neurogenic intermittent claudication, lumbar, back pain, interspinous process decompression. Spine 2005;30:903-907Although the precise etiology of lower back pain (LBP) lacks a general consensus, there is general agreement that the facet joints must be considered when studying its pathology. 1-7 The lifetime incidence of LBP is estimated to be between 60% and 90% with 15% to 40% of chronic LBP caused by the lumbar facet joints. 8 -10 Although clinically difficult to diagnose, facet specific back pain is exacerbated by hyperextension and lessened in a recumbent position or flexion. 1,6,8 During extension, loading of the facet joints is increased, resulting in compression of the nerve root and central canals and deformation of the joint capsule. 6,9 It is believed that the deformation of the joint capsule is the source of pain as it stimulates nociceptors of the capsule. 8,11 The capsule surrounding the facet joint has been shown to be well innervated by aff...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 96%

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The Effect of an Interspinous Process Implant on Facet Loading During Extension

Wiseman¹,

Lindsey²,

Fredrick³

et al. 2005

Spine

156

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“…Anatomical studies of the facet capsule evaluating the macroscopic and microscopic matrix composition and orientation of those components have shown that the facet capsule is composed of an outer layer of primarily collagen fibers orientated across the facet joint, while in its inner layer there are more randomly orientated elastic fibers. 111,112 The thickness of the outer layer of the capsule, and the length of the collagen fibers within it, vary with the anatomic location of the capsule, as does the proportion of elastic fibers within the collagen matrix. 111,112 Because the microstructure of the capsular ligament dictates the biomechanical function and potential for injury, any variation in capsular microstructure likely corresponds to the functional ability of the capsule to guide and limit motions of the facet joint.…”

Section: Kinematics and Facet Tissue Injury During Whiplashmentioning

confidence: 99%

“…111,112 The thickness of the outer layer of the capsule, and the length of the collagen fibers within it, vary with the anatomic location of the capsule, as does the proportion of elastic fibers within the collagen matrix. 111,112 Because the microstructure of the capsular ligament dictates the biomechanical function and potential for injury, any variation in capsular microstructure likely corresponds to the functional ability of the capsule to guide and limit motions of the facet joint. The greater proportion of elastic fibers in the posteroinferior aspect corresponds to the large strains that are sustained in that region during extension and the potential for recovery to the neutral position with minimal risk of impingement.…”

Section: Kinematics and Facet Tissue Injury During Whiplashmentioning

confidence: 99%

The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges

Ita¹,

Zhang²,

Holsgrove³

et al. 2017

Journal of Orthopaedic & Sports Physical Therapy

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FIGURE 1. Schematic illustrating the anatomy in the periphery of the facet joint and the relevant neuronal connections to the central nervous system. Afferents that innervate the facet joint and its capsular ligament have cell bodies in the DRG and synapse with neurons in the spinal dorsal horn. Nociceptive information is encoded by many types of afferents, including IB4-positive nonpeptidergic neurons and peptidergic fibers that produce neuropeptides, such as CGRP and substance P. Noxious stimuli are translated into electrical (eg, action potentials) and biochemical (eg, neurotransmitter) signals. In persistent pain, central sensitization occurs, with neuronal hyperexcitability and altered neurotransmitter production and release in the spinal dorsal horn. Abbreviations: CGRP, calcitonin gene-related peptide; DRG, dorsal root ganglion; IB4, isolectin B4.

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