Better Health Through Research image
 Better Health Through Research image
      

Search Center...



SEARCH PARAMETERS
Search:
Journal: Author:
Years: through Show:  Display: 
 

  Page 1 of 59  
Search Results for : Facet Arthropathy
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
An unusual occurrence of chondromyxoid fibroma with secondary aneurysmal bone cyst in the cervical spine.
Author(s): Subach, BR; Copay, AG; Martin, MM; Schuler, TC; Romero-Gutierrez, M
Journal: Spine J 2010 May 4; Vol. 10, Issue 2; Page(s) e5-9
[Medline ID - 20036621]

BACKGROUND CONTEXT: Chondromyxoid fibroma (CMF) and aneurysmal bone cysts (ABCs) are rare bone tumors and even rarer in the spine. To date, no report has been made of CMF with secondary ABC in the cervical spine. PURPOSE: The purpose of this study was to describe the diagnosis and surgical treatment of a case of CMF with secondary ABC of C6, a rare occurrence in an uncommon location. STUDY DESIGN: The study design is a case report. METHODS: A 27-year-old woman presented with numbness with paresthesias of the right upper extremity. Diagnostic imaging revealed diffuse enlargement of the right C6 lamina extending into the pedicle and medial facet joint. Surgical treatment consisted of complete C6 laminectomy, total resection of the extradural cervical mass, posterior lateral fusion at C5-C7, and posterior segmental instrumentation from C5 to C7. Histopathology was consistent with CMF with secondary ABC. RESULTS: Laminectomy and instrumented segmental fusion provided an excellent clinical outcome. The instrumented fusion maintained the sagittal balance of the spine and stabilized across a complete facetectomy. The excision will likely avoid recurrence of the lesion. CONCLUSIONS: Treatment of CMF and ABC is challenging in the spine because of the proximity to neural structures. Aggressive surgical treatment makes recurrence less likely but creates the risk of spinal instability. Adequate surgical treatment needs to provide spinal stability.

Association between disc degeneration and degenerative spondylolisthesis? Pilot study.
Author(s): Kalichman, L; Hunter, DJ; Kim, DH; Guermazi, A
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 1; Page(s) 21-5
[Medline ID - 20023360]

OBJECTIVES: The aim of this pilot study was to test the generally believed hypothesis that intervertebral disc degeneration is a prerequisite for degenerative spondylolisthesis (DS). METHODS: This cross-sectional study was an ancillary project to the Framingham Study. A sample of 3529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 188 individuals were randomly enrolled in this study. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA) and DS were evaluated. We used the multiple logistic regressions to evaluate the association between DS as a dependent variable and FJOA, disc narrowing, age, sex and BMI as independent variables. RESULTS: There were 23 individuals (24 spinal segments) affected by DS (15 female, 8 male), mean age 62.0 +/- 6.8 years. In segments with DS, FJOA was observed and rated "severe" at 20 (83.3%) segments, "moderate" at 3 (12.5%) levels, and "mild" at 1 (4.2%) level. Intervertebral disc height was normal in 6 (25.0%), slightly decreased in 6 (25.0%), moderately decreased in 5 (20.8%) and severely decreased in 7 (29.2%) of the segments. Three (12.5%) segments with DS had severe FJOA but no apparent disc degeneration. In 9 (37.5%) segments with DS we found no or m ild disc degeneration and severe FJOA. In a multiple regression analysis age, sex and FJOA, but not disc narrowing, showed significant associations with DS. CONCLUSIONS: The results of our study did not support the theory that disc degeneration necessarily precedes vertebral subluxation in DS.

Association between age, sex, BMI and CT-evaluated spinal degeneration features.
Author(s): Kalichman, L; Guermazi, A; Li, L; Hunter, DJ
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 4; Page(s) 189-95
[Medline ID - 20023349]

OBJECTIVE: The aim of our study was to evaluate the association between age, sex and body mass index (BMI) and lumbar spine degeneration features evaluated on computed tomography (CT) in a community-based sample. METHODS: This cross-sectional study was an ancillary project to the Framingham Study. A sample of 3529 participants of the Framingham study aged 40-80 had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this ancillary study. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (OA), spondylolysis, spondylolisthesis and spinal stenosis were evaluated. To evaluate the association between spinal degeneration features and age, sex and BMI we used chi2 test and logistic regression analyses. RESULTS: 104 men and 83 women, mean age 52.6 +/- 10.8 participated in the study. Statistically significant sexual dimorphism was found in prevalence of spondylolysis (p = 0.015) the male-to-female ratio was 3.3:1; and degenerative spondylolisthesis (p=0.008), the male-to-female ratio was 1:2.8. Prevalence of disc narrowing, facet joint OA, and degenerative spondylolisthesis showed a significant linear trend (p < 0.0001) of association with increasing age. Significantly higher prevalence of facet joint OA was found in the obese group OR (95%CI): 2.8 (1.1-7.2). CONCLUSIONS: Marked differences in the prevalence of spinal degeneration features occur in association with age, sex and obesity. Given the high prevalence of many of these degeneration features these simple demographic factors should be considered when interpreting imaging results reporting these features.

Computed tomography-evaluated features of spinal degeneration: prevalence, intercorrelation, and association with self-reported low back pain.
Author(s): Kalichman, L; Kim, DH; Li, L; Guermazi, A; Hunter, DJ
Journal: Spine J 2010 Jun 4; Vol. 10, Issue 3; Page(s) 200-8
[Medline ID - 20006557]

BACKGROUND CONTEXT: Although the role of radiographic abnormalities in the etiology of nonspecific low back pain (LBP) is unclear, the frequent identification of these features on radiologic studies continues to influence medical decision making. PURPOSE: The primary purposes of the study were to evaluate the prevalence of lumbar spine degeneration features, evaluated on computed tomography (CT), in a community-based sample and to evaluate the association between lumbar spine degeneration features. The secondary purpose was to evaluate the association between spinal degeneration features and LBP. STUDY DESIGN: This is a cross-sectional community-based study that was an ancillary project to the Framingham Heart Study. SAMPLE: A subset of 187 participants were chosen from the 3,529 participants enrolled in the Framingham Heart Study who underwent multidetector CT scan to assess aortic calcification. OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a Nordic self-report questionnaire. Physiologic measures: Dichotomous variables indicating the presence of intervertebral disc narrowing, facet joint osteoarthritis (OA), spondylolysis, spondylolisthesis, and spinal stenosis and the density (in Hounsfield units) of multifidus and erector spinae muscles were evaluated on CT. METHODS: We calculated the prevalence of spinal degeneration features and mean density of multifidus and erector spinae muscles in groups of individuals with and without LBP. Using the chi(2) test for dichotomous and t test for continuous variables, we estimated the differences in spinal degeneration parameters between the aforementioned groups. To evaluate the association of spinal degeneration features with age, the prevalence of degeneration features was calculated in four age groups (less than 40, 40-50, 50-60, and 60+ years). We used multiple logistic regression models to examine the association between spinal degeneration features (before and after adjustment for age, sex, and body mass index [BMI]) and LBP, and between all degeneration features and LBP. RESULTS: In total, 104 men and 83 women, with a mean age (+/-standard deviation) of 52.6+/-10.8 years, participated in the study. There was a high prevalence of intervertebral disc narrowing (63.9%), facet joint OA (64.5%), and spondylolysis (11.5%) in the studied sample. When all spinal degeneration features as well as age, sex, and BMI were factored in stepwise fashion into a multiple logistic regression model, only spinal stenosis showed statistically significant association with LBP, odds ratio (OR) (95% confidence interval [CI]): 3.45 [1.12-10.68]. Significant association was found between facet joint OA and low density of multifidus (OR [95% CI]: 3.68 [1.36-9.97]) and erector spinae (OR [95% CI]: 2.80 [1.10-7.16]) muscles. CONCLUSIONS: Degenerative features of the lumbar spine w ere extremely prevalent in this community-based sample. The only degenerative feature associated with self-reported LBP was spinal stenosis. Other degenerative features appear to be unassociated with LBP.

Randomized study assessing the accuracy of cervical facet joint nerve (medial branch) blocks using different injectate volumes.
Author(s): Cohen, SP; Strassels, SA; Kurihara, C; Forsythe, A; Buckenmaier, CC; McLean, B; Riedy, G; Seltzer, S
Journal: Anesthesiology 2010 Jan 13; Vol. 112, Issue 1; Page(s) 144-52
[Medline ID - 20657206]

BACKGROUND: Neck pain is a frequent cause of disability, with facet joint arthropathy accounting for a large percentage of cases. The diagnosis of cervical facet joint pain is usually made with diagnostic blocks of the nerves that innervate them. Yet, medial branch blocks are associated with a high false-positive rate. One hypothesized cause of inaccurate diagnostic blocks is inadvertent extravasation of injectate into adjacent pain-generating structures. The objective of this study was to evaluate the accuracy of medial branch blocks by using different injectate volumes. METHODS: Twenty-four patients received cervical medial branch blocks, using either 0.5 or 0.25 ml of bupivacaine mixed with contrast. One half of the patients in each group were suballocated to receive the blocks in the prone position and the other half through a lateral approach. Participants then underwent computed tomography of the cervical spine to evaluate accuracy and patterns of aberrant contrast spread. RESULTS: Sixteen instances of aberrant spread were observed in nine patients receiving blocks using 0.5 ml versus seven occurrences in six patients in the 0.25 ml group (P = 0.07). Aberrant spread was most commonly observed (57%) when an injection at C3 engulfed the third occipital nerve. Among the 86 nerve blocks, foraminal spread occurred in five instances using 0.5 ml and in two cases with 0.25 ml. The six "missed" nerves were equally divided between treatment groups. No significant difference in any outcome measure was observed between the prone and lateral positions. CONCLUSIONS: Reducing the volume during cervical medial branch blocks may improve precision and accuracy.

A critical evaluation of subtalar joint arthrosis associated with middle facet talocalcaneal coalition in 21 surgically managed patients: a retrospective computed tomography review. Investigations involving middle facet coalitions-part III.
Author(s): Kernbach, KJ; Barkan, H; Blitz, NM
Journal: Clin Podiatr Med Surg 2010 Mar 2; Vol. 27, Issue 1; Page(s) 135-43
[Medline ID - 19963175]

Symptomatic middle facet talocalcaneal coalition is frequently associated with rearfoot arthrosis that is often managed surgically with rearfoot fusion. However, no objective method for classifying the extent of subtalar joint arthrosis exists. No study has clearly identified the extent of posterior facet arthrosis present in a large cohort treated surgically for talocalcaneal coalition through preoperative computerized axial tomography. The authors conducted a retrospective review of 21 patients (35 feet) with coalition who were surgically treated over a 12-year period for coalition on at least 1 foot. Using a predefined original staging system, the extent of the arthrosis was categorized into normal or mild (Stage I), moderate (Stage II), and severe (Stage III) arthrosis. The association of stage and age is statistically significant. All of the feet with Stage III arthrosis had fibrous coalitions. No foot with osseous coalition had Stage III arthrosis. The distribution of arthrosis staging differs between fibrous and osseous coalitions. Only fibrous coalitions had the most advanced arthrosis (Stage III), whereas osseous coalitions did not. This suggests that osseous coalitions may have a protective effect in the prevention of severe degeneration of the subtalar joint. Concomitant subtalar joint arthrosis severity progresses with age; surgeons may want to consider earlier surgical intervention to prevent arthrosis progression in patients with symptomatic middle facet talocalcaneal coalition.

Pigmented villonodular synovitis of thoracic facet joint presenting as rapidly progressive paraplegia.
Author(s): del Carmen Baena-Ocampo, L; Rosales Olivares, LM; Arriaga, NM; Izaguirre, A; Pineda, C
Journal: J Clin Rheumatol 2010 Mar 20; Vol. 15, Issue 8; Page(s) 393-5
[Medline ID - 19955996]

Pigmented villonodular synovitis (PVNS) is a proliferative disorder of the synovial membrane of uncertain etiology. It commonly affects synovial joints of the appendicular skeleton and rarely affects the spine. We present the case of a young man presenting with a rapidly progressive myelopathy due to spinal cord compression by PVNS arising from a thoracic facet joint, which finally resulted in paraplegia.The spinal location of PVNS has been seldom emphasized in the rheumatologic literature. PVNS should be considered as a possible cause of soft tissue masses arising from the facet joints, with variable degrees of nerve root or spinal cord compression.

How does spinal canal decompression and dorsal stabilization affect segmental mobility? A biomechanical study.
Author(s): Delank, KS; Gercek, E; Kuhn, S; Hartmann, F; Hely, H; R; öllinghoff, M; Rothschild, MA; St; ützer, H; Sobottke, R; Eysel, P
Journal: Arch Orthop Trauma Surg 2010 Mar 24; Vol. 130, Issue 2; Page(s) 285-92
[Medline ID - 19936771]

INTRODUCTION: When decompression of the lumbar spinal canal is performed, segmental stability might be affected. Exactly which anatomical structures can thereby be resected without interfering with stability, and when, respectively how, additional stabilization is essential, has not been adequately investigated so far. The present investigation describes kinetic changes in a surgically treated motion segment as well as in its adjacent segments. MATERIAL AND METHODS: Segmental biomechanical examination of nine human lumbar cadaver spines (L1 to L5) was performed without preload in a spine-testing apparatus by means of a precise, ultrasound-guided measuring system. Thus, samples consisting of four free motion segments were made available. Besides measurements in the native (untreated) spine specimen further measurements were done after progressive resection of dorsal elements like lig. flavum, hemilaminectomy, laminectomy and facetectomy. The segment was then stabilised by means of a rigid system (ART((R))) and by means of a dynamic, transpedicularly fixed system (Dynesys((R))). RESULTS: For the analysis, range of motion (ROM) values and separately viewed data of the respective direction of motion were considered in equal measure. A very high reproducibility of the individual measurements could be verified. In the sagittal and frontal plane, flavectomy and hemilaminectomy did not achieve any relevant change in the ROM in both directions. This applies to the segment operated on as well as to the adjacent segments examined. Resection of the facet likewise does not lead to any distinct increase of mobility in the operated segment as far as flexion and right/left bending is concerned. In extension a striking increase in mobility of more than 1degree compared to the native value can be perceived in the operated segment. Stabilization with the rigid and dynamic system effect an almost equal reduction of flexion/extension and right/left bending. In the adjacent segments, a slightly higher mobility is to be noted for rigid sta bilization than for dynamic stabilisation. A linear regression analysis shows that in flexion/extension monosegmental rigid stabilisation is compensated predominantly in the first cranial adjacent segment. In case of a dynamic stabilisation the compensation is distributed among the first and second cranial, and by 20% in the caudal adjacent segment. SUMMARY: Monosegmental decompression of the lumbar spinal canal does not essentially destabilise the motion segment during in vitro conditions. Regarding rigid or dynamic stabilisation, the ROM does not differ within the operated segment, but the distribution of the compensatory movement is different.

Role of imaging in spine, hand, and wrist osteoarthritis.
Author(s): Feydy, A; Pluot, E; Guerini, H; Drap; é, JL
Journal: Rheum Dis Clin North Am 2010 Feb 18; Vol. 35, Issue 3; Page(s) 605-49
[Medline ID - 19931806]

Osteoarthritis (OA) of the wrist is mainly secondary to traumatic ligamentous or bone injuries. Involvement of the radiocarpal joint occurs early on in the disease, whereas the mediocarpal joint is involved at a later stage. Metabolic diseases may also involve the wrist and affect specific joints such as the scapho-trapezio-trapezoid joint. Although OA of the wrist is routinely diagnosed on plain films, a thorough assessment of cartilage injuries on computed tomographic arthrography, magnetic resonance imaging (MRI), or MR arthrography remains necessary before any surgical procedure. OA of the fingers is frequently encountered in postmenopausal women. Distal interphalangeal joints and trapezio-metacarpal joint are the most frequently involved joints. Whereas the clinical diagnosis of OA of the wrist and hand is straightforward, the therapeutic management of symptomatic forms remains unclear, with no clear guidelines. OA of the spine is related to degenerative changes of the spine involving the disc space, vertebral endplates, the facet joints, or the supportive and surrounding soft tissues. The sequelae of disc degeneration are among the leading causes of functional incapacity in both sexes, and are a common source of chronic disability in the working years. Disc degeneration involves structural disruption and cell-mediated changes in composition. Radiography remains usually the first-line imaging method. MRI is ideally suited for delineating the presence, extent, and complications of degenerative spinal disease. Other imaging modalities such as computed tomography, dynamic radiography, myelography, and discography may provide complementary information in selected cases, especially before an imaging-guided percutaneous treatment or spinal surgery. The presence of degenerative changes on imaging examinations is by no means an indicator of symptoms, and there is a high prevalence of lesions in asymptomatic individuals. This article focuses on imaging of OA of the wrist and hand, as well as lumbar spine OA, with an emphasis on current MRI grading systems available for the assessment of discovertebral lesions.

Imaging correlation of the degree of degenerative L4-5 spondylolisthesis with the corresponding amount of facet fluid.
Author(s): Cho, BY; Murovic, JA; Park, J
Journal: J Neurosurg Spine 2009 Dec 31; Vol. 11, Issue 5; Page(s) 614-9
[Medline ID - 19929367]

OBJECT: The aim of this study was to correlate the degree of L4-5 spondylolisthesis on plain flexion-extension radiographs with the corresponding amount of L4-5 facet fluid visible on MR images. METHODS: Patients underwent evaluation at the Neurosurgical Spine Clinics of Stanford University Medical Center and National Health Insurance Medical Center (Goyang, South Korea) between January 2006 and December 2007. Only patients who were diagnosed with L4-5 degenerative spondylolisthesis (DS) and who had both lumbosacral flexion-extension radiographs and MR images available for review were eligible for this study. Each patient's dynamic motion index (DMI) was measured using the lateral lumbosacral plain radiograph and was the percentage of the degree of anterior slippage seen on flexion versus that seen on extension. Axial T2-weighted MR images of the L4-5 facet joints obtained in each patient was analyzed for the amount of facet fluid, using the image showing the widest portion of the facets. The facet fluid index was calculated from the ratio of the sum of the amounts of facet fluid found in the right plus left facets over the sum of the average widths of the right plus left facet joints. RESULTS: Fifty-four patients with L4-5 DS were included in this study. Of these 54 patients, facet fluid was noted on MR images in 29 patients (53.7%), and their mean DMI was 6.349 +/- 2.726. Patients who did not have facet fluid on MR imaging had a mean DMI of 1.542 +/- 0.820; this difference was statistically significant (p < 0.001). There was a positive linear association between the facet fluid index and the DMI in the group of patients who exhibited facet fluid on MR images (Pearson correlation coefficient 0.560, p < 0.01). In the subgroup of 29 patients with L4-5 DS who showed facet fluid on MR images, flexion-extension plain radiographs in 10 (34.5%) showed marked anterolisthesis, while the corresponding MR images did not. CONCLUSIONS: There is a linear correlation between the degree of segmental motion seen on flexion-extension plain radiography in patients with DS at L4-5 and the amount of L4-5 facet fluid on MR images. If L4-5 facet fluid in patients with DS is seen on MR images, a corresponding anterolisthesis on weight-bearing flexion-extension lateral radiographs should be anticipated. Obtaining plain radiographs will aid in the diagnosis of anterolisthesis caused by an L4-5 hypermobile segment, which may not always be evident on MR images obtained in supine patients.
  Page 1 of 59  




 



Resource Center

 - Merck Manual

 - Lab Test On-Line

 - MeSH Search



Clinical Conditions

 - A/C Degeneration

 - Adolescent Low Back

 - Ankle Sprain

 - Ankylosing Spondylitis

 - Arthritides

 - Brachial Plexus Neuritis

 - Carpal Tunnel Syndrome

 - Headache/Cephalgia

 - Cervical Disc Degen

 - Cervical Sprain

 - Cervical Strain

 - Cervical Osteoarthritis

 - Cervical Radiculopathy

 - Cervical Spine Instability

 - Cervical Spondylosis

 - Cervical Torticollis

 - Chronic Low Back Pain

 - Chronic Pain

 - Disc Displacement

 - Facet Arthropathy

 - Facet Capsulitis

 - Failed Back

 - Fibromyalgia

 - Frozen Shoulder

 - Knee Sprain

 - Lateral Epicondylitis

 - Low Back Pain

 - Lumbar Disc Degen

 - Lumbar Stenosis

 - Metatarsalgia

 - Psoriatic Arthritis

 - Reactive Arthritis

 - Rheumatoid Arthritis

 - Rotator Cuff Syndrome

 - SI Dysfunction

 - Sciatica

 - Scoliosis

 - Shoulder Bursitis

 - Spondylolisthesis

 - Stroke

 - Tarsal Tunnel Syndrome

 - TMD

 - Tendinopathy

 - Thoracic Outlet Syn

 - Ulnar Nerve Entrapment

 - Whiplash Injuries

 - Wrist Sprain



Resources

 - Chiropractic Organizations

 - State Associations

 - Schools & Institutions

 - NIH Grants Feed

 - HRSA Grants Feed

 - Evidence-Based Resource

 - Journal Links


Bookmark and Share

|  Home  |


 Copyright © 2007 - | DCConsult.com | All Rights Reserved.


the primary url for this site ( "DCConsult" ) is http://DCConsult.com




Category : Topics




Support for DCConsult provided by :