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Wang A, Wang T, Zang L, Yuan S, Fan N, Du P, Wu Q. Quantitative Radiological Characteristics of the Facet Joints in Patients with Lumbar Foraminal Stenosis. J Pain Res 2022; 15:2363-2371. [PMID: 36003291 PMCID: PMC9393112 DOI: 10.2147/jpr.s374720] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the degeneration patterns of the facet joints (FJs) in patients with lumbar foraminal stenosis (LFS) and investigate the correlation between quantitative parameters and FJ osteoarthritis (FJ OA). Patients and Methods A total of 171 patients with LFS at the L4/5 level and 146 control patients were enrolled in this study. The severity of FJ OA was graded according to the Weishaupt classification. The FJ orientation, FJ tropism, superior articular process cross-sectional area (SAPA), and FJ area were measured at the L3/4, L4/5, and L5/S1 spinal levels. Associations among the parameters were assessed using Pearson's correlation coefficients. Independent sample t-tests and Pearson's chi-square tests were used for univariate analyses. The association between LFS and the quantitative parameters was also analyzed using multivariate logistic regression models adjusted for age, gender, and body mass index. Results Patients with LFS had more sagittal FJ orientation (37.9 vs 45.0, p < 0.001), more FJ tropism (5.6 vs 3.8, p < 0.001), larger SAPA (129.0 vs 97.8, p < 0.001), and less FJ area (21.7 vs 23.3, p = 0.016). Logistic regression analysis showed that LFS was significantly associated with FJ tropism (odds ratio [OR]: 1.153; p = 0.003) and SAPA (OR: 1.113; p < 0.001). The SAPA showed the largest area under the curve (0.908, 95% confidence interval: 0.875-0.942) for the diagnosis of LFS. The optimal cutoff value was 114.75 mm2 with 85.4% sensitivity and 87.0% specificity. Additionally, a significant correlation was observed between FJ OA and SAPA and FJ area at each studied spinal level. Conclusion This study confirmed that LFS is significantly associated with FJ hypertrophy and tropism. FJ hypertrophy and joint space narrowing correlated with the severity of FJ OA. These results are helpful in understanding the morphology and pathology of FJs.
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Affiliation(s)
- Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Oldweiler AB, Martin JT. In vivo relationships between lumbar facet joint and intervertebral disc composition and diurnal deformation. Clin Biomech (Bristol, Avon) 2021; 88:105425. [PMID: 34289433 PMCID: PMC8490326 DOI: 10.1016/j.clinbiomech.2021.105425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spinal motion is facilitated by a "three joint complex", two facet joints and one intervertebral disc at each spinal level. Both the intervertebral discs and facet joints are subject to natural age-related degeneration, and while these processes may be linked it is not clear how. As instability in the disc could underlie facet arthritis, we evaluated the hypothesis that the discs and facet joints are mechanically coupled. METHODS We recruited young, asymptomatic volunteers (n = 10; age: mean 25, range 21-30 years; BMI: mean 23.1, range 19.1-29.0 kg/m2) and applied magnetic resonance imaging (MRI) and three-dimensional (3D) modeling to measure facet and disc composition (MRI T1rho relaxation time) and facet and disc function (diurnal changes in facet space width, disc height) in the lumbar spine. FINDINGS We found that facet space width was positively associated with facet T1rho relaxation time (fluid content) and negatively associated with disc T1rho, and that facets adjacent to degenerated discs were significantly thicker and had significantly higher T1rho. Furthermore, the diurnal change in wedge angle was positively associated the diurnal change in facet space width, while disc degeneration, the diurnal change in disc height, and facet T1rho were not. INTERPRETATION These data demonstrate an interdependence between disc and facet health, but not between disc and facet mechanical function. Furthermore, the weak relationship between facet cartilage composition and in vivo function suggests that other factors, like spinal curvature, determine in vivo spine mechanics. Future work in symptomatic or aged populations are warranted to confirm these findings.
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Xue J, Chen H, Zhu B, Li X, Ouyang Z, Li S, Xu Z, Xie Y, Yan Y. Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment. BMC Musculoskelet Disord 2021; 22:236. [PMID: 33648479 PMCID: PMC7923329 DOI: 10.1186/s12891-021-04100-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Recently, a percutaneous spinal endoscopy unilateral posterior interlaminar approach to perform bilateral decompression has been proposed for use in treatment of lumbar spinal stenosis, As a development and supplement to traditional surgery, its advantages regarding therapeutic effects and prognosis, such as minor soft tissue damage, little intraoperative blood loss, and a quick return to daily life. However, there are few analyses of this surgery with a follow-up of more than 1 year,we conducted this study in order to quantitatively investigate radiographic and clinical efficacies of this surgery for central lumbar spinal stenosis. Materials and methods Forty-six patients with central lumbar spinal stenosis were enrolled from January 2017 to July 2018. The visual analog scale (VAS) for back pain and leg pain, Oswestry disability index (ODI), modified MacNab criteria were used to evaluate clinical efficiency at preoperative and postoperative time points. The intervertebral height index (IHI), cross-sectional area of the spinal canal (CSAC), calibrated disc signal (CDS) and spinal stability were examined to assess radiographic decompression efficiency via magnetic resonance imaging and X-ray at preoperative and postoperative time points. Results The VAS score for lower back pain and leg pain improved from 7.50 ± 0.78 to 1.70 ± 0.66 and from 7.30 ± 0.79 to 1.74 ± 0.68, respectively, and the ODI improved from 72.35 ± 8.15 to 16.15 ± 4.51. In terms of modified MacNab criteria, 91.3% of the patients achieved good or excellent outcomes. Furthermore, significant changes after surgery were observed for the percentage of CSAC, increasing from 125.3 ± 53.9 to 201.4 ± 78 mm2; however, no significant differences were observed for the remaining measurement indicators. Conclusions The clinical and radiographic efficacies of this surgery for central lumbar spinal stenosis were good in short-term follow-up, and this surgery did not cause meaningful changes in IHI, CDS, and spine stability in short-term follow-up. The effect of long-term follow-up needs further investigation.
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Affiliation(s)
- Jingbo Xue
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Haoxiang Chen
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Bin Zhu
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Xuelin Li
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Zhihua Ouyang
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Shan Li
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Zhun Xu
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Yong Xie
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China
| | - Yiguo Yan
- Department of Spine Surgery, The First Affiliated Hospital of University of South China, Hengyang, People's Republic of China.
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Lee K, Jeong HS, Park C, Kim M, Ryu H, Roh J, Yeom JA, Kim JH, Kim TU, Jeon CH. The Relationship between Neural Foraminal Stenosis and Imaging Features of Lumbar Spine MRI in Patients Older Than 60 Years with Lumbar Radiculopathy. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:862-875. [PMID: 36238060 PMCID: PMC9514398 DOI: 10.3348/jksr.2020.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/01/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Kyeyoung Lee
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Seok Jeong
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chankue Park
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Maeran Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jieun Roh
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Ho Jeon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
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Khalsa SS, Kim HS, Singh R, Kashlan ON. Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis. Neurosurg Focus 2019; 46:E10. [DOI: 10.3171/2019.2.focus18617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.
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Affiliation(s)
- Siri Sahib Khalsa
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
| | - Hyeun Sung Kim
- 2Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Ravindra Singh
- 2Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Osama Nezar Kashlan
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
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