Prevalence and Clinical Impact of Cervical Facet Joint Degeneration on Degenerative Cervical Myelopathy: A Novel Computed Tomography Classification Study

Okamoto, Ai; Takeshima, Yukio; Yokoyama, Shohei; Nishimura, Fusanori; Nakagawa, Ichiro; Park, Young Soo; Nakase, Hiroyuki

doi:10.14245/ns.2143258.629

Cited by 15 publications

(27 citation statements)

References 23 publications

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“…He stated that all facet degenerations are secondary to vertical spinal instability that originates from the weakness of back extensor muscles [ 3 ]. Our study showed that facet degeneration is not related to cervical spondylolisthesis in patients with rapid progression of myelopathy [ 2 ], which supports the arguments he mentioned, but there are a few disagreements and misunderstandings, which we discuss below.…”

supporting

confidence: 82%

“…To the editor, We thank Dr. Goel for his insightful comments 1 on our recent article. 2 The comments are very helpful to readers when considering the value of diagnosing facet joint degeneration. He stated that all facet degenerations are secondary to vertical spinal instability that originates from the weakness of back extensor muscles.…”

mentioning

confidence: 99%

“…4 Indeed, the oldest patient in our case series was aged 93 years. 2 Spinal fusion could remove dynamic pathological factors, and the short-term clinical outcomes are great. But very long-term effects cannot be predicted.…”

mentioning

confidence: 99%

“…We thank Dr. Goel for his insightful comments [ 1 ] on our recent article [ 2 ]. The comments are very helpful to readers when considering the value of diagnosing facet joint degeneration.…”

mentioning

confidence: 99%

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Reply Letter to “Cervical Facet Joint Degeneration”

Takeshima

Okamoto²,

Yokoyama³

et al. 2022

Neurospine

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confidence: 82%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Reply Letter to “Cervical Facet Joint Degeneration”

Takeshima

Okamoto²,

Yokoyama³

et al. 2022

Neurospine

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“…

To the editor, I read with interest the article by Okamoto et al, 1 as it directly relates to our clinical interests. The article is focused on observations of facet joint degeneration and its relationship with degenerative cervical myelopathy.

…”

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confidence: 99%

Cervical Facet Joint Degeneration

Goel

2022

Neurospine

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To the editor, I read with interest the article by Okamoto et al., 1 as it directly relates to our clinical interests. The article is focused on observations of facet joint degeneration and its relationship with degenerative cervical myelopathy. Unfortunately, the authors did not include our several publications on the subject in their reference list. 2-8 I wish to update this subject, particularly as regards the clinical implications of facet joint degeneration. The observations of the authors regarding facet joint degeneration reinforce our hypotheses on the subject. [2][3][4][5][6][7][8] Although we agree with the authors that the evaluation of facets is less debated and that are only a few relevant reports, we contest their statement that the relationship between facet joint degeneration and degenerative spinal disease is unknown. [2][3][4][5][6][7][8][9][10][11] Mobility and stability are essential elements of life. Human beings are additionally burdened by their unique natural gift of a posture standing on 2 legs. The major bulk of human muscles is located on the extensor compartment of the body, or on its "back, " and cater to movements that facilitate sitting, standing, and running. However, relatively few strands of muscles are located in the flexor or anterior compartment of the body, flexion movement being essentially of a passive nature. The activity of all major extensor muscles is focused on the facetal articulation, which forms the point of fulcrum of all movements. In essence, the activity of no major muscle group is focused on the disc or the odontoid process, or in other words, the disc or the odontoid process does not form a fulcrum point of movement. Our articles have discussed the role of the disc and the odontoid process in human movements. We philosophized that both the disc and odontoid process are like opera conductors who regulate all music without holding any instrument in their hands. 12 While muscles are the brawn, the disc (and odontoid process) is the brain of all movements.We hypothesized that the weakness of muscles related to their disuse, abuse, or injury forms the basis of all spinal instability and deformities. [2][3][4][5][6][7][8][9][10][11] As the facets are the focal point of activity of spinal muscles and their movements, muscle incompetence has its initial impact on the facets and their articulation. We identified for the first time in the literature that such muscle weakness leads to telescoping or listhesis of the facets of spinal segments and labeled it as "vertical" spinal instability. 9 We hypothesized that vertical facetal instability is the primary issue in spinal degeneration and reduction in the disc space, bulging of the disc into spinal canal, buckling of intervertebral ligaments (including the posterior longitudinal ligament and ligamentum flavum), osteophyte formation, facetal and vertebral body fusion, and all the other known so-called "pathological" entities that lead to reduction in the spinal and neural canal dimensions are secondary natural responses. 7...

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