Radiological and radionuclide imaging of degenerative disease of the facet joints

Shur, Natalie F.; Corrigan, Alexis; Agrawal, Kanhaiyalal; Desai, Amidevi; Gnanasegaran, Gopinath

doi:10.4103/0972-3919.158526

Cited by 9 publications

(8 citation statements)

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“…In addition, fluid production in the facet joints seen on MRI is presently interpreted as a sign of instability [ 41 – 43 ] rather than a sign of inflammation. Perhaps the activation of the degenerative stage could be visualised by imaging of metabolic processes, using, for example, SPECT-CT or positron emission tomography-CT [ 44 ]. It is still a matter of discussion whether the response to infiltration and the prognostic value of facet joint degeneration in these imaging modalities is increased compared with those for MRI.…”

Section: Discussionmentioning

confidence: 99%

Predictability of the effects of facet joint infiltration in the degenerate lumbar spine when assessing MRI scans

2017

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BackgroundImaging results are frequently considered as hallmarks of disease by spine surgeons to plan their future treatment strategy. Numerous classification systems have been proposed to quantify or grade lumbar magnetic resonance imaging (MRI) scans and thus objectify imaging findings. The clinical impact of the measured parameters remains, however, unclear. To evaluate the pathological significance of imaging findings in patients with multisegmental degenerative findings, clinicians can perform image-guided local infiltrations to target defined areas such as the facet joints.The aim of the present retrospective study was to evaluate the correlation of MRI facet joint degeneration and spinal stenosis measurements with improvement obtained by image-guided intraarticular facet joint infiltration.MethodsFifty MRI scans of patients with chronic lumbar back pain were graded radiologically using a wide range of classification and measurement systems. The reported effect of facet joint injections at the site was recorded, and a comparative analysis performed.ResultsWhen we allocated patients according to their reported pain relief, 27 showed no improvement (0–30%), 16 reported good improvement (31–75%) and 7 reported excellent improvement (> 75%). MRI features assessed in this study did, however, not show any relevant correlation with reported pain after facet joint infiltration: Values for Kendall’s tau ranged from τ = − 0.190 for neuroforaminal stenosis grading as suggested by Lee, to τ = 0.133 for posterior disc height as proposed by Hasegawa.ConclusionDespite the trend in evidence-based medicine to provide medical algorithms, our findings underline the continuing need for individualised spine care that, along with imaging techniques or targeted infiltrations, includes diagnostic dimensions such as good patient history and clinical examination to formulate a diagnosis.Trial registration ClinicalTrials.gov, NCT03308149, retrospectively registered October 2017Electronic supplementary materialThe online version of this article (10.1186/s13018-017-0685-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Predictability of the effects of facet joint infiltration in the degenerate lumbar spine when assessing MRI scans

2017

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“…Intervertebral disc height loss or facet degeneration is highly prevalent among patients without low back pain and therefore lack specificity 38 . The correlation between abnormal morphology on radiologic findings and pain originating from the facet joints (diagnostic value) and the prognostic value of abnormal radiologic findings and the effect of denervation is low 5,39–42 . Plain radiography, CT, MRI, scintigraphy imaging cannot accurately identify painful lumbar facet joint levels and are not routinely recommended before performing a diagnostic facet joint block 5 …”

Section: Diagnosismentioning

confidence: 99%

“…Standard views include an antero‐posterior (AP) and lateral view for detecting spinal misalignments or tumors but are of limited value to visualize facet joints. In the oblique view, joint space narrowing, sclerosis and bone hypertrophy of the facet joints can be seen, especially in severe disease 29,40 CT‐imaging—is the most sensitive imaging technique for detecting degenerative changes in facet joints due to high contrast visibility between bony structures and soft tissue, and its capability to image the joint in multiple plains 39,40 …”

Section: Diagnosismentioning

confidence: 99%

“…In the oblique view, joint space narrowing, sclerosis and bone hypertrophy of the facet joints can be seen, especially in severe disease 29,40 CT‐imaging—is the most sensitive imaging technique for detecting degenerative changes in facet joints due to high contrast visibility between bony structures and soft tissue, and its capability to image the joint in multiple plains 39,40 MRI is less sensitive than CT in detecting facet pathology but provides a superior delineation of soft tissues compared to other imaging modalities and has the advantage of detecting the consequences of facet degeneration on adjacent neural structures, for example, hypertrophy causing foraminal stenosis and radiculopathy 41,42 …”

Section: Diagnosismentioning

confidence: 99%

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3. Pain originating from the lumbar facet joints

Van den Heuvel,

Cohen,

de Andrès Ares

et al. 2023

Pain Practice

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IntroductionPain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well‐designed studies, the prevalence is generally between 10% and 20%, increasing with age.MethodsThe literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.ResultsThere are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni‐ or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non‐dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After “red flags” are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation.ConclusionsWell‐selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.

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“…MRI has a superior delineation of soft tissues compared to other imaging modality. However, both modalities were not significant predictor of clinical outcome in the treatment of facet joint block while bone SPECT was able to detect appropriate patients to be treated [ 28 ]. Fig.…”

Section: Main Bodymentioning

confidence: 99%

Bone scintigraphy in patients with pain

Shin

Kim

2017

Korean J Pain

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Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

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Radiological and radionuclide imaging of degenerative disease of the facet joints

Cited by 9 publications

References 42 publications

Predictability of the effects of facet joint infiltration in the degenerate lumbar spine when assessing MRI scans

Predictability of the effects of facet joint infiltration in the degenerate lumbar spine when assessing MRI scans

3. Pain originating from the lumbar facet joints

Bone scintigraphy in patients with pain

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