Lumbar facet pain: Biomechanics, neuroanatomy and neurophysiology

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

doi:10.1016/0021-9290(96)00023-1

Cited by 203 publications

(101 citation statements)

References 39 publications

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“…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.…”

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confidence: 96%

“…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.…”

mentioning

confidence: 99%

“…[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%

“…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 afferent nociceptive fibers, which are activated by mechanical stresses.…”

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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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confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

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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“…However, due to the increased muscle effort required to stabilize abnormal postural displacements, the actual increase in load on the spine is much higher [19]. The presence of mechano-sensitive and nociceptive afferent fibers in spinal tissues (intervertebral disc, facet, ligaments, and muscles) [30,42,43,46,50]-and the subsequent neurophysiological research demonstrating the role of such afferent stimulation in pain production [9,10,11] and coordinated neuromuscular stabilization of the spine [28,29,52,53,54,55]-provide a substantial theoretical framework supporting the rationale for goals of treatment regimens to include a reduction of stresses on spinal joints in spinal rehabilitation programs.…”

Section: Variablementioning

confidence: 99%

A non-randomized clinical control trial of Harrison mirror image methods for correcting trunk list (lateral translations of the thoracic cage) in patients with chronic low back pain

et al. 2004

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Spinal trunk list is a common occurrence in clinical practice, but few conservative methods of spinal rehabilitation have been reported. This study is a non-randomized clinical control trial of 63 consecutive retrospective subjects undergoing spinal rehabilitation and 23 prospective volunteer controls. All subjects presented with lateral thoracic-cage-translation posture (trunk list) and chronic low back pain. Initial and follow-up numerical pain rating scales (NRS) and AP lumbar radiographs were obtained after a mean of 11.5 weeks of care (average of 36 visits) for the treatment group and after a mean of 37.5 weeks for the control group. The radiographs were digitized and analyzed for a horizontal displacement of T12 from the second sacral tubercle, verticality of the lumbar spine at the sacral base, and any dextro/levo angle at mid-lumbar spine. Treatment subjects received the Harrison mirror image postural correction methods, which included an opposite trunk-list exercise and a new method of opposite trunk-list traction. Control subjects did not receive spinal rehabilitation therapy, but rather self-managed their back pain. For the treatment group, there were statistically significant improvements (approximately 50%) in all radiographic measurements and a decrease in pain intensity (NRS: 3.0 to 0.8). For the control group, no significant radiographic and NRS differences were found, except in trunk-list displacement of T12 to S1, worsened by 2.4 mm. Mirror image (opposite posture) postural corrective exercises and a new method of trunk-list traction resulted in 50% reduction in trunk list and were associated with nearly resolved pain intensity in this patient population. The findings warrant further study in the conservative treatment of chronic low back pain and spinal disorders.

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