Unilateral Degenerative Facet Joint Pathology Eliciting Rapidly Progressive Cervical Spondylotic Myelopathy

Takeshima, Yukio; Okamoto, Ai; Yokoyama, Shohei; Nakagawa, Ichiro; Nakase, Hiroyuki

doi:10.7759/cureus.14238

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…Therefore, these 2 factors, facet joint degeneration and spondylolisthesis, seem to be interrelated and can together lead to the onset of DCM. However, we reported a case of rapidly progressive DCM induced by severe unilateral facet joint degeneration without any trauma or cervical spondylolisthesis [ 6 ]. This case showed that the 2 factors are not necessarily interrelated concerning the onset of DCM, as indicated in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…We recently reported a case of DCM with unilateral severe facet joint degeneration at the responsible spinal segmental level and rapid neurological deterioration without any trauma or cervical spondylolisthesis [ 6 ]. Because the relationship between facet joint degeneration and DCM remains unknown, we conducted a retrospective study to identify the prevalence of facet joint degeneration using a newly developed CT classification reflecting articular irregularities in patients with DCM and discuss its impact on the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Objective: To evaluate cervical facet joint degeneration using a newly developed classification, investigate its prevalence and relationship with cervical degenerative spondylolisthesis, and clarify its clinical significance in patients with degenerative cervical myelopathy (DCM).Methods: This study included 145 consecutive patients with DCM who underwent surgical treatment. Clinical variables and radiological findings were analyzed. A new 6-grade computed tomography (CT) classification for cervical facet joint degeneration was adapted, and its prevalence was evaluated by categorizing the joints into those at responsible and those at nonresponsible spinal segmental levels. We evaluated the association between rapidly progressive myelopathy and the presence of significant facet joint degeneration or spondylolisthesis at the responsible segmental level.Results: Finally, 140 patients with a mean age of 64.1 ± 12.8 years were analyzed. The prevalence of grade 1, 2, 3, 4, 5A, and 5B classification in all facet joints was 72.0%, 9.5%, 10.9%, 4.3%, 2.9%, and 0.4%, respectively. There was a statistically significant difference in the distribution of CT grades between the joints at the responsible and nonresponsible segmental levels (p < 0.001), with a high prevalence of grade 4 or 5B degeneration at the responsible segmental level, reflecting articular irregularity. There was also a statistically significant relationship between rapidly progressive myelopathy and grade 4 or 5B degeneration at the responsible segmental level (p < 0.001), but not between rapidly progressive myelopathy and spondylolisthesis (p = 0.255).Conclusion: This novel CT classification for facet joints deserves additional evaluation in patients with DCM. Abnormal findings on the articular surfaces might be related to the progression of myelopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…This highlights the importance of degenerative changes, dynamic and static adaptative factors, which result in massive hypertrophy with synovial cysts of the facet joint. Only one case in the literature reported a unilateral facet joint hypertrophy resulting in rapidly progressing CSM [3]. In this case, the rapid progression and the demonstration of the "facet joint gap" sign on the cervical radiogram was acute.…”

Section: Discussionmentioning

confidence: 73%

“…During ten years from 1993 to 2002, the incidence of CSM and a subsequent number of cervical spinal surgery demonstrated a 7-fold increase in the United States [1]. Even though it is one of the most common causes ofcervical spinal cord dysfunction, there has been only one other case report addressing this issue in the literature: unilateral facet joint pathology causing rapidly progressive CSM [3].…”

Section: Introductionmentioning

confidence: 99%

Massive Obstruction of the Spinal Canal and Progressive Cervical Myelopathy due to Osseous Hypertrophy of a Facet Joint: A Case Report

et al. 2022

AustinNeurosurgOpenAccess

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Introduction: Cervical spondylotic myelopathy is one of the most common causes of cervical spinal cord dysfunction. Case Report: A 65-year-old patient was admitted with slowly-progressing myelopathic symptoms. Imaging studies indicated a massive lesion, which was thought to be a primary bone tumor. Resection at Segment C4 was performed, and histopathology showed hypertrophic facet joint. Discussion: Age-related degenerative changes and adaptation mechanisms result in hypertrophy of the joint and synovial cyst formation. In our case, it was enormous, and could be easily mistaken for a tumorous process. Conclusion: Such extensive hypertrophic changes are rarely addressed in the literature and should be considered as differential diagnosis.

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“…8,9 We recently reported, for the first time, that the degenerative pathology of the facet joint is potentially important, and that facet articular irregularity is a specific finding in cases of rapidly progressive DCM. 11,12 However, the impact of facet joint pathology in DCM is still controversial. 13,14 Thus, the importance of specific findings regarding facet degeneration remain unclear when compared to known factors involved in the progression of myelopathy.…”

Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

Facet Articular Irregularity Is the Most Relevant Risk Factor for Rapidly Progressive Degenerative Cervical Myelopathy

et al. 2023

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Objective: Facet articular irregularity is associated with rapidly progressive degenerative cervical myelopathy (DCM). However, its significance compared with other known risk factors remains unknown. Therefore, this retrospective study aimed to clarify the potential impact of facet articular irregularity as a risk factor for rapid DCM progression.Methods: This study included 141 consecutive patients with DCM who underwent surgical treatment at our institution. Clinical variables and radiological findings related to DCM progression were collected. Imaging findings were analyzed at the segmental level of myelopathy in each case. The patients were divided into 2 groups based on the presence or absence of rapid DCM progression, and independent risk factors were determined using logistic regression analyses.Results: Overall, 131 patients with a mean age of 63.9 ± 12.6 years were analyzed; 27 patients (20.6%) were classified into the rapid DCM progression group. The mean age was significantly higher in the rapid progression group than in the slow progression group (72.4 ± 9.6 vs. 61.7 ± 12.4, p < 0.001). According to univariate analysis, facet articular irregularity, dynamic segmental translation (≥ 1.6 mm), upper cervical spine involvement above C4–5, history of cerebrovascular events, preceding minor trauma, local lordotic angle (≥ 4.5°), diabetes, hypertension, ligamentum flavum hypertrophy, and age were independent risk factors. Additionally, multivariate analysis showed that facet articular irregularity was the highest risk factor for rapid DCM progression (p = 0.001).Conclusion: Facet articular irregularity is the most clinically significant finding among the known risk factors in patients with rapid DCM progression.

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Unilateral Degenerative Facet Joint Pathology Eliciting Rapidly Progressive Cervical Spondylotic Myelopathy

Cited by 4 publications

References 9 publications

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

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

Massive Obstruction of the Spinal Canal and Progressive Cervical Myelopathy due to Osseous Hypertrophy of a Facet Joint: A Case Report

Facet Articular Irregularity Is the Most Relevant Risk Factor for Rapidly Progressive Degenerative Cervical Myelopathy

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