Prediction of the human thoracic and lumbar articular facet joint morphometry from radiographic images

Morphometric analysis of thoracolumbar junction (T11-L2) in central Indian population: A computerized tomography based study of 800 vertebrae

OBJECTIVE

To determine various morphometric parameters like transverse and sagittal pedicle width; interpedicular distance; antero-posterior and transverse canal diameter and canal surface area at thoracolumbar junction (T11, T12, L1, L2) in central Indian population and compare results with similar studies available in literature.

MATERIAL AND METHODS

A prospective, computerized tomography scan based morphometric analysis of thoracolumbar junction was conducted at medical college and tertiary care centre in central India. All asymptomatic cases more than 18 years age with normal lateral radiograph and CT scan of thoracolumbar junction and free from any spinal pathology or trauma were included in the study. Parameters measured were transverse and sagittal pedicle width; interpedicular distance; antero-posterior and transverse canal diameter and canal surface area at thoracolumbar junction (T11, T12, L1, L2).

RESULTS

Mean transverse pedicle width was maximum at T11 and minimum at L1 in both males and females, whereas sagittal width was maximum at T11 and minimum at L2 in both the groups. Interpedicular distance was largest at L1 in both the groups. All the measurements were significantly different (P < 0.05) in males and females. Mean antero-posterior and transverse diameter was maximum at T12 and L2 respectively in both male and female study population. Canal surface area was maximum at L1 among males (230.10 mm²) as well as females (209.02 mm²).

CONCLUSION

There is significant variation in morphometric parameters of thoracolumbar junction in different races and population. Thorough knowledge of morphometry of a particular population is essential for dealing with pathology or trauma of thoracolumbar junction.

A Rare Case of Thoracic Pyogenic Facet Joint Infection

Pyogenic facet joint infection is a rare but severe infection. The most common complaint on presentation is pain followed by fever, then neurologic impairment. While the lumbar spine is involved in the vast majority of cases presented in the literature, the case presented here occurred in the thoracic spine. The patient was a 48-year-old immune-competent female who presented with left back pain. Magnetic resonance imaging (MRI) indicated a facet effusion, paraspinal abscess, and epidural abscess in the level of 9th-11th thoracic vertebra. On the 6th day of treatment, she presented a neurological disorder and underwent decompressive laminectomy and surgical debridement. We observed immediate improvement as a result of the surgery.

Sonoanatomic indices of lumbar facet joints in patients with facetogenic back pain in comparison to healthy subjects

BACKGROUND

Nowadays, ultrasound is increasingly used with a great accuracy in performing nerve blocks for facet joint disease.

OBJECTIVES

To measure sonoanatomic characteristics for the facet joints of lumbar vertebras in patients with facetogenic pain and healthy volunteers.

STUDY DESIGN

Cross-sectional, observational study.

SETTING

University-affiliated Specialty Clinic for Pain Management.

PATIENTS

Twenty patients with facet joint disease (FJD) and 40 healthy volunteers (HVGs) were matched for age and sex, height, and weight. Patients with FJD were referred with complaints of pain in the left lumbar facet joints that twice responded favorably to ultrasound guided medial branch blocks.

INTERVENTION

Medial branch blocks.

MEASUREMENT

The interfacet joint distance (IFJD) between the third, the fourth, and the fifth lumbar vertebras and their depth from the level of skin (DFS) were measured bilaterally, using a high-resolution ultrasound in both groups.

RESULTS

Thirty-one men and 29 women with average age of 41.5±9.5 years were enrolled. The IFJD for L3-L4 was 31.5±4.0 mm on the left side and 31.8±4.0 mm on the right side. The IFJD for L4-L5 was 31.3±4.4 mm on the left side and 31.5±4.0 mm on the right side. The IFJD was uniformly 2.2 mm shorter in the FJD group than those in the HVG group (P=.021). The measurements of DFS increased in lower vertebras (L3<L4<L5), bilaterally. With an exception of the left facet joints of L4 (P=.016), DFS measurements were similar in FJD and HVG groups.

LIMITATIONS

The diagnosis of facet joint disease was merely clinical and the total number of the patients was relatively small.

CONCLUSION

Interfacet distances of the lumbar vertebras are smaller in patients suffering from degenerative FJD compared with HVGs. Degenerative changes of intervertebral discs and partial reduction of space between 2 adjacent vertebras may contribute to this observation.

Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

Objective:

The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ‘Goel facet spacer’ in the treatment of degenerative spinal canal stenosis.

Materials and Methods:

Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint.

Results:

The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented.

Conclusions:

Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.

Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients

Object

Cervical arthroplasty with an artificial disc (AD) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis. This study aims to provide 3D motion analysis data comparing patients after ACDF and AD replacement.

Methods

Ten patients who underwent C5–6 ACDF and 7 who underwent C5–6 AD replacement were enrolled. Using biplanar fluoroscopy and a model-based track technique (accurate up to 0.6 mm and 0.6°), motion analysis of axial rotation and flexion-extension of the neck was performed. Three nonoperative segments (C3–4, C4–5, and C6–7) were assessed for both intervertebral rotation (coronal, sagittal, and axial planes) and facet shear (anteroposterior and mediolateral).

Results

There was no difference in total neck motion comparing ACDF and AD replacement for neck extension (43.3° ± 10.2° vs 44.3° ± 12.6°, p = 0.866) and rotation (36.0° ± 6.5° vs 38.2° ± 9.3°, p = 0.576). For extension, when measured as a percentage of total neck motion, there was a greater amount of rotation at the nonoperated segments in the ACDF group than in the AD group (p = 0.003). When comparing specific motion segments, greater normalized rotation was seen in the ACDF group at C3–4 (33.2% ± 4.9% vs 26.8% ± 6.6%, p = 0.036) and C6–7 (28.5% ± 6.7% vs 20.5% ± 5.5%, p = 0.009) but not at C4–5 (33.5% ± 6.4% vs 31.8% ± 4.0%, p = 0.562). For neck rotation, greater rotation was observed at the nonoperative segments in the ACDF group than in the AD group (p = 0.024), but the differences between individual segments did not reach significance (p ≥ 0.146). Increased mediolateral facet shear was seen on neck extension with ACDF versus AD replacement (p = 0.008). Comparing each segment, C3–4 (0.9 ± 0.5 mm vs 0.4 ± 0.1 mm, p = 0.039) and C4–5 (1.0 ± 0.4 mm vs 0.5 ± 0.2 mm, p = 0.022) showed increased shear while C6–7 (1.0 ± 0.4 mm vs 1.0 ± 0.5 mm, p = 0.767) did not.

Conclusions

This study illustrates increased motion at nonoperative segments in patients who have undergone ACDF compared with those who have undergone AD replacement. Further studies will be required to examine whether these changes contribute to adjacent-segment disease.

In vivo topographic analysis of lumbar facet joint space width distribution in healthy and symptomatic subjects

STUDY DESIGN

In vivo 3-dimensional facet joint space width measurement.

OBJECTIVE

To determine lumbar facet joint space width within clinically relevant topographical zones in vivo and its correlations with age, level, and presence of lower back pain symptoms.

SUMMARY OF BACKGROUND DATA

Facet joint gap narrowing, articular cartilage thinning, and subarticular cortical bone hypertrophy are frequently observed age-related changes. Facet joint space width is a well-defined parameter to evaluate osteoarthritis. To the best of our knowledge, there is no other study that quantifies 3-dimensional facet joint space width distribution in vivo.

METHODS

Three-dimensional measurement to quantify facet joint space width distribution based on 5 clinically relevant topographic zones in a cohort of healthy and symptomatic volunteers with low back pain, using subject-based 3-dimensional computed tomographic models with respect to spinal level, subject age, sex, and presence/absence of lower back pain.

RESULTS

Facet joint space width (mean ± SD) was 1.93 ± 0.51 mm for the central zone, 1.75 ± 0.48 mm for the superior zone, 1.63 ± 0.49 mm for the inferior zone, 1.48 ± 0.44 mm for the medial zone, and 1.65 ± 0.48 mm for the lateral zone, respectively. There were no significant differences between right and left facet joints. Male patients showed larger space width than female patients. Overall, space width of symptomatic subjects was significantly narrower than that of the asymptomatic group. Facet joints in the peripheral zones were narrower than in the central zone. Age-group comparisons showed that local narrowing occurring as early as in the third decade at the inferior zone of L5-S1, with all the remaining zones implicated after the fourth decade.

CONCLUSION

This in vivo study shows variations in facet joint space width narrowing with spinal level and region within the facet joint and in vivo evidence of localized, age-influenced facet cartilage thinning. Techniques developed in this study may be applied in the detection of early osteoarthritis-related changes in the facet joints.

Morphometric analysis of the relationships between intervertebral disc and vertebral body heights: an anatomical and radiographic study of the human thoracic spine

The main aim of this study was to provide anatomical data on the heights of the human intervertebral discs for all levels of the thoracic spine by direct and radiographic measurements. Additionally, the heights of the neighboring vertebral bodies were measured, and the prediction of the disc heights based only on the size of the vertebral bodies was investigated. The anterior (ADH), middle (MDH) and posterior heights (PDH) of the discs were measured directly and on radiographs of 72 spine segments from 30 donors (age 57.43 ± 11.27 years). The radiographic measurement error and the reliability of the measurements were calculated. Linear and non-linear regression analyses were employed for investigation of statistical correlations between the heights of the thoracic disc and vertebrae. Radiographic measurements displayed lower repeatability and were shorter than the anatomical ones (approximately 9% for ADH and 37% for PDH). The thickness of the discs varied from 4.5 to 7.2 mm, with the MDH approximately 22.7% greater. The disc heights showed good correlations with the vertebral body heights (R(2), 0.659-0.835, P-values < 0.005; anova), allowing the generation of 10 prediction equations. New data on thoracic disc morphometry were provided in this study. The generated set of regression equations could be used to predict thoracic disc heights from radiographic measurement of the vertebral body height posterior. For the creation of parameterized models of the human thoracic discs, the use of the prediction equations could eliminate the need for direct measurement on intervertebral discs. Moreover, the error produced by radiographic measurements could be reduced at least for the PDH.