Intra-Articular Meniscoid Folds in Thoracic Zygapophysial Joints

Schulte, Tobias L.; Filler, Timm J.; Struwe, Patrick; Liem, Dennis; Bullmann, Viola

doi:10.1097/brs.0b013e3181c9b053

Cited by 16 publications

(12 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These tissues are crescent-shaped and have a triangular cross-section in the sagittal plane (Fig. 2), with the base being attached to the capsule and the point extending as much as 9 mm inward toward the interior of the joint [72,75,78]. The connective rims of the synovial tissue are ring-shaped, wraparound the edge of the bony pillar, and are tapered inward towards the center of the joint [72,74,75,77,78].…”

Section: Synovium Menisci and Capsular Ligamentmentioning

confidence: 99%

“…2), with the base being attached to the capsule and the point extending as much as 9 mm inward toward the interior of the joint [72,75,78]. The connective rims of the synovial tissue are ring-shaped, wraparound the edge of the bony pillar, and are tapered inward towards the center of the joint [72,74,75,77,78]. The meniscoids are composed of fat, fibrous connective tissue and/or a mix of fat and fibers covered by a cellular synovial lining [72][73][74][75]77,79].…”

Section: Synovium Menisci and Capsular Ligamentmentioning

confidence: 99%

See 1 more Smart Citation

Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions

Jaumard¹,

Welch²,

Winkelstein³

2011

J. Biomech. Eng.

276

225

View full text Add to dashboard Cite

The facet joint is a crucial anatomic region of the spine owing to its biomechanical role in facilitating articulation of the vertebrae of the spinal column. It is a diarthrodial joint with opposing articular cartilage surfaces that provide a low friction environment and a ligamentous capsule that encloses the joint space. Together with the disc, the bilateral facet joints transfer loads and guide and constrain motions in the spine due to their geometry and mechanical function. Although a great deal of research has focused on defining the biomechanics of the spine and the form and function of the disc, the facet joint has only recently become the focus of experimental, computational and clinical studies. This mechanical behavior ensures the normal health and function of the spine during physiologic loading but can also lead to its dysfunction when the tissues of the facet joint are altered either by injury, degeneration or as a result of surgical modification of the spine. The anatomical, biomechanical and physiological characteristics of the facet joints in the cervical and lumbar spines have become the focus of increased attention recently with the advent of surgical procedures of the spine, such as disc repair and replacement, which may impact facet responses. Accordingly, this review summarizes the relevant anatomy and biomechanics of the facet joint and the individual tissues that comprise it. In order to better understand the physiological implications of tissue loading in all conditions, a review of mechanotransduction pathways in the cartilage, ligament and bone is also presented ranging from the tissue-level scale to cellular modifications. With this context, experimental studies are summarized as they relate to the most common modifications that alter the biomechanics and health of the spine-injury and degeneration. In addition, many computational and finite element models have been developed that enable more-detailed and specific investigations of the facet joint and its tissues than are provided by experimental approaches and also that expand their utility for the field of biomechanics. These are also reviewed to provide a more complete summary of the current knowledge of facet joint mechanics. Overall, the goal of this review is to present a comprehensive review of the breadth and depth of knowledge regarding the mechanical and adaptive responses of the facet joint and its tissues across a variety of relevant size scales.

show abstract

Section: Synovium Menisci and Capsular Ligamentmentioning

confidence: 99%

Section: Synovium Menisci and Capsular Ligamentmentioning

confidence: 99%

Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions

Jaumard¹,

Welch²,

Winkelstein³

2011

J. Biomech. Eng.

276

225

View full text Add to dashboard Cite

show abstract

“…Based on the postulates of Bogduk ( 1472), thoracic facet joints have been shown to have an abundant nerve supply (15,16,1471,1960,1961,1987,1988,(1991)(1992)(1993); been shown to be capable of causing pain similar to that seen clinically, in normal volunteers with persistent mid back and upper back pain and referred pain into the chest wall (1987,1988); shown to be affected by osteoarthritis, rheumatoid arthritis, spondylitis, degeneration, inflammation, and injury leading to pain upon joint motion and restriction of motion (1961,1962,1994); and been shown to be a source of pain in patients, using diagnostic techniques of known reliability and validity (1346,1347,1989).…”

Section: Thoracic Facet Joint Painmentioning

confidence: 96%

An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations

Asipp¹

2013

Pain Phys

129

View full text Add to dashboard Cite

Objective: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain. Methodology: Systematic assessment of the literature. Evidence: I. Lumbar Spine • The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation discography, it is fair. • The evidence for diagnostic lumbar facet joint nerve blocks and diagnostic sacroiliac intraarticular injections is good with 75% to 100% pain relief as criterion standard with controlled local anesthetic or placebo blocks. • The evidence is good in managing disc herniation or radiculitis for caudal, interlaminar, and transforaminal epidural injections; fair for axial or discogenic pain without disc herniation, radiculitis or facet joint pain with caudal, and interlaminar epidural injections, and limited for transforaminal epidural injections; fair for spinal stenosis with caudal, interlaminar, and transforaminal epidural injections; and fair for post surgery syndrome with caudal epidural injections and limited with transforaminal epidural injections. • The evidence for therapeutic facet joint interventions is good for conventional radiofrequency, limited for pulsed radiofrequency, fair to good for lumbar facet joint nerve blocks, and limited for intraarticular injections. • For sacroiliac joint interventions, the evidence for cooled radiofrequency neurotomy is fair; limited for intraarticular injections and periarticular injections; and limited for both pulsed radiofrequency and conventional radiofrequency neurotomy. • For lumbar percutaneous adhesiolysis, the evidence is fair in managing chronic low back and lower extremity pain secondary to post surgery syndrome and spinal stenosis. • For intradiscal procedures, the evidence for intradiscal electrothermal therapy (IDET) and biaculoplasty is limited to fair and is limited for discTRODE. • For percutaneous disc decompression, the evidence is limited for automated percutaneous lumbar discectomy (APLD), percutaneous lumbar laser disc decompression, and Dekompressor; and limited to fair for nucleoplasty for which the Centers for Medicare and Medicaid Services (CMS) has issued a noncoverage decision. II. Cervical Spine • The evidence for cervical provocation discography is limited; whereas the evidence for diagnostic cervical facet joint nerve blocks is good with a criterion standard of 75% or greater relief with controlled diagnostic blocks. • The evidence is good for cervical interlaminar epidural injections for cervical disc herniation or radiculitis; fair for axial or discogenic pain, spinal stenosis, and post cervical surgery syndrome. • The evidence for therapeutic cervical facet joint interventions is fair for conventional cervical radiofrequency neurotomy and cervical medial branch blocks, and limited for cervical intraarticular injections. III. Thoracic Spine • The evidence is limited for thoracic provocation discography and is good for diagnostic accuracy of thoracic facet joint nerve blocks with a criterion standard of at least 75% pain relief with controlled diagnostic blocks. • The evidence is fair for thoracic epidural injections in managing thoracic pain. • The evidence for therapeutic thoracic facet joint nerve blocks is fair, limited for radiofrequency neurotomy, and not available for thoracic intraarticular injections. IV. Implantables • The evidence is fair for spinal cord stimulation (SCS) in managing patients with failed back surgery syndrome (FBSS) and limited for implantable intrathecal drug administration systems. V. Anticoagulation • There is good evidence for risk of thromboembolic phenomenon in patients with antithrombotic therapy if discontinued, spontaneous epidural hematomas with or without traumatic injury in patients with or without anticoagulant therapy to discontinue or normalize INR with warfarin therapy, and the lack of necessity of discontinuation of nonsteroidal anti-inflammatory drugs (NSAIDs), including low dose aspirin prior to performing interventional techniques. • There is fair evidence with excessive bleeding, including epidural hematoma formation with interventional techniques when antithrombotic therapy is continued, the risk of higher thromboembolic phenomenon than epidural hematomas with discontinuation of antiplatelet therapy prior to interventional techniques and to continue phosphodiesterase inhibitors (dipyridamole, cilostazol, and Aggrenox). • There is limited evidence to discontinue antiplatelet therapy with platelet aggregation inhibitors to avoid bleeding and epidural hematomas and/or to continue antiplatelet therapy (clopidogrel, ticlopidine, prasugrel) during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic fatalities. • There islimited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa) and rivaroxan (Xarelto) to discontinue to avoid bleeding and epidural hematomas and are continued during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic events. Conclusion: Evidence is fair to good for 62% of diagnostic and 52% of therapeutic interventions assessed. Disclaimer: The authors are solely responsible for the content of this article. No statement on this article should be construed as an official position of ASIPP. The guidelines do not represent “standard of care.” Key words: Interventional techniques , chronic spinal pain, diagnostic blocks, therapeutic interventions, facet joint interventions, epidural injections, epidural adhesiolysis, discography, radiofrequency, disc decompression, spinal cord stimulation, intrathecal implantable systems

show abstract

“…6), im Bereich der gesamten Wirbelsäule darüber hinaus zu Einengungen durch Facettgelenksarthrosen und Bandscheibendegenerationen. Auch die in allen Wirbelsäulenabschnitten vorkommenden Synovialfalten in den Zygapophysealgelenken können bei Fehlbelastungen und degenerativen Prozessen der Gelenke eine Kompression erfahren und aufgrund ihrer reichhaltigen Innervation zu Schmerzgeneratoren werden [24].…”

Section: Nerveneinengungenunclassified

Neuroanatomische Grundlagen des Gelenkschmerzes

Peuker

2017

Phys Med Rehab Kuror

View full text Add to dashboard Cite

Zusammenfassung Gelenkschmerzen sind die h?ufigsten Behandlungsanl?sse in der orthop?dischen, haus?rztlichen und schmerztherapeutischen Praxis. Die gelenkinnervierenden Strukturen spielen eine wichtige Rolle in der Pathogenese unterschiedlicher Arten von schmerzhaften St?rungen der Gelenkfunktion. Insbesondere Mechanismen der peripheren Sensibilisierung sind verantwortlich f?r die Schmerzchronifizierung und fortschreitende Gelenkzerst?rung. Diese ?bersichtsarbeit gibt einen ?berblick hinsichtlich der zu Grunde liegenden Gelenkanatomie und pathologischen Ver?nderungen der an der Innervation beteiligten Strukturen sowie deren Auswirkungen auf die Gelenkfunktion.

show abstract

Intra-Articular Meniscoid Folds in Thoracic Zygapophysial Joints

Abstract: This study for the first time systematically classifies intra-articular meniscoid folds in human thoracic ZAJs. These folds may represent an anatomic correlate for thoracic back pain. The chronic hemorrhage observed may be an important factor leading to arthritis.

Cited by 16 publications

References 21 publications

Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions

Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions

An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations

Neuroanatomische Grundlagen des Gelenkschmerzes

Contact Info

Product

Resources

About