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Acosta JI, Ermann J, Isaac Z, DeFilipp M, Gottreich JR, Andrew MN, Chang Y, Zampini JM, Katz JN, Mandell JC. Comprehensive Grading System of Inflammatory Features of the Lumbar Facet Joints on Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2024; 49:332-340. [PMID: 37798843 PMCID: PMC10922347 DOI: 10.1097/brs.0000000000004846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE We aimed to describe a magnetic resonance imaging (MRI)-based grading system of inflammatory features of the lumbar facet joints using an atlas and assess its reliability. SUMMARY OF BACKGROUND DATA Chronic low back pain is often caused by facet joint arthropathy. Inflammatory features are often evident on MRI. While several grading systems of facet arthropathy have been described, there is scant data on the reliability of these systems, and none focus exclusively on inflammatory features. MATERIALS AND METHODS We describe a grading system that assesses facet joint effusion, bone marrow edema, and soft tissue edema. Each feature was graded from 0 to 3 (facet edema) or 0 to 2 (bone marrow edema intensity and extent, soft tissue edema intensity and extent). Four spine experts graded MRIs of 50 subjects at the bilateral L3/4, L4/5, and L5/S1 levels. All subjects had symptomatic facet arthropathy and received therapeutic facet joint injections. We assessed the intra-reader and inter-reader reliability of each feature at each joint and summarized across all six joints. RESULTS The mean age of subjects was 56 years (SD = 17), and 48% were female. The injections occurred at the L3/4 level in 12% of cases, at L4/5 in 88%, and at L5/S1 in 80% of cases. The intra-reader reliability kappa's for each feature ranged from 0.42 to 0.81. In contrast, the inter-reader reliability kappa values for each feature ranged from 0.37 to 0.54. CONCLUSION MRI inflammatory features of the lumbar facet joints are often noted in patients with low back pain. The proposed grading system is reliable and could serve as a research tool for studies assessing the clinical relevance and prognostic value of these features.
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Affiliation(s)
- José I. Acosta
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael N. Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Acosta JI, Mandell JC, Ermann J, Isaac Z, Zampini JM, DeFilipp M, Gottreich JR, Andrew M, Katz JN. Grading Systems of Lumbar Facet Joint Inflammatory Changes on Magnetic Resonance Imaging: A Scoping Review. Spine (Phila Pa 1976) 2023; 48:636-644. [PMID: 36856452 PMCID: PMC10101880 DOI: 10.1097/brs.0000000000004609] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN A scoping review. OBJECTIVE We aimed to identify and characterize grading systems of the inflammatory features of the lumbar facet joints (FJs) noted on magnetic resonance imaging and summarize their reliability. SUMMARY OF BACKGROUND DATA Chronic low back pain is one of the most common causes of disability worldwide and is frequently accompanied by FJ osteoarthritis. Inflammatory changes in the lumbar FJs are commonly noted in imaging studies of patients with FJ osteoarthritis and low back pain. Several grading systems for these inflammatory changes have been developed. However, these grading system's features and reliability have yet to be reviewed. MATERIALS AND METHODS We performed a literature search of studies reporting grading systems for FJ inflammatory changes published in English or Spanish between 1985 and 2022. We collected data on reported interreader reliability measures of each grading system. Finally, we compared the features of inflammation described by each system. RESULTS Six studies met the inclusion criteria and were used in our analysis. Features commonly graded in these systems are the hyperintensity signal noted within the FJ, bone marrow edema, and the extent of the soft-tissue edema surrounding the FJs. We found that the interreader reliability measures ranged from 0.56 to 0.96. CONCLUSIONS Only 6 studies have reported methods for documenting inflammation in the FJs. Studies varied in the precise tissues and phenomena included in the grading systems. However, the systems were generally reliable. Future studies should document the reliability of these methods when independent investigators are not involved in developing the classification schemes. Further work might combine one or more of these measures to establish a standard and reliable grading system for inflammatory changes in the FJs, including signal intensity within the joint, bone marrow edema, and soft-tissue inflammation.
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Affiliation(s)
- José I. Acosta
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Rodrigues LMR, Cesar AEM, Asano LYJ, Carvalho CD, Bisson G, Andrade VAD, Campos ZMDS. INTER-OBSERVER REPRODUCIBILITY OF THE “LUMBAR FACET HYPERSIGNAL CLASSIFICATION” AND THE CLASSIFICATION OF PFIRRMANN. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191802196875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the inter-observer relationship of the “lumbar facet hypersignal classification” and the correlation with disc degeneration. Methods: Retrospective study of magnetic resonance images obtained from 24 (N=24) patients (9 males and 15 females), aged 35 to 79 years, mean age 48 years and 1 month. The images were reviewed by two spine surgeons, by five orthopedists in training in the specialty of spine surgery and one radiologist to evaluate and quantify the presence of hypersignal lumbar facet and the Pfirrmann Classification for disc degeneration. Results: One hundred and twenty lumbar discs and their joint facets were evaluated by the eight examiners, with data analyzed by the Cronbach test and the Spearman Correlation Analysis with statistically high results, confirming good inter-observer relation for the “Lumbar Facet Hypersignal Classification” and for the classification of Pfirrmann. There was no statistically significant relationship between facet arthrosis and disc degeneration. Conclusions: The results confirm that there is good inter-observer relationship for the classification of Facet Hypersignal and for the Classification of Pfirrmann. However, in spite of a positive relationship, a correlation between facet arthrosis and disc degeneration was not statistically significant. Level of Evidence III; Retrospective Comparative Study.
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Cox JM. Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report. J Chiropr Med 2012; 11:7-15. [PMID: 22942836 DOI: 10.1016/j.jcm.2011.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/15/2011] [Accepted: 08/18/2011] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. CASE REPORT A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst-induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. INTERVENTION AND OUTCOMES Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. CONCLUSION Lumbar synovial cyst and stenosis-generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation.
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Affiliation(s)
- James M Cox
- Clinician and Chief of Radiology, Chiropractic Medicine, Inc, Fort Wayne, IN 46845
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César AEM, Yonezaki AM, Ueno FH, Valesin Filho ES, Rodrigues LMR. Reprodutibilidade intra e interobservadores da classificação de hipersinal facetário lombar e correlação com a degeneração discal para ressonância magnética. COLUNA/COLUMNA 2011. [DOI: 10.1590/s1808-18512011000300002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a reprodutibilidade intra e interobservadores da "classificação de hipersinal facetário lombar" e avaliar a correlação com a degeneração discal. MÉTODOS: Estudo retrospectivo de imagens de ressonância magnética obtidas de 41 (N=41) pacientes (18 homens e 23 mulheres), com idade variando de 26 a 84 anos, com média de 48 anos e três meses. As imagens foram revisadas por três ortopedistas especialistas em cirurgia de coluna e um radiologista, para avaliar e quantificar a presença do hipersinal facetário lombar. Posteriormente, foi verificada a relação entre a artrose facetária e degeneração discal. RESULTADOS: Foram avaliados e classificados 205 discos lombares e suas facetas articulares pelos quatro examinadores, com os dados analisados pelo Teste de Cronbach e da Análise de Correlação de Spearman com resultados estatisticamente elevados, confirmando boa relação intra e interobservadores para a "classificação de hipersinal facetário". Não foi observada relação estatisticamente significante entre artrose facetária e degeneração discal. CONCLUSÃO: Foram obtidos resultados suficientes para afirmar que existe boa relação intra e interobservadores para a "classificação de hipersinal facetário lombar". Não se verificou relação estatisticamente significante entre artrose facetária e degeneração discal.
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