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Abstract Purpose Facet joint degeneration (FJD) is a major cause of low back pain. Parathyroid hormone (PTH) (1–34) is commonly used to treat osteoporosis. However, little is known about its effects on FJD induced by estrogen deficiency. This study aims to investigate the effects of PTH (1–34) on FJD induced by estrogen deficiency and the underlying pathogenesis of the disease. Methods Forty 3-month-old female Sprague-Dawley rats were randomly divided into four groups: 30 received bilateral ovariectomy (OVX) followed by 12 weeks of treatment with normal saline, PTH (1–34) or 17β-estradiol (E2), and 10 received sham surgery followed by administration of normal saline. Status and Wnt/β-catenin signaling activity in the cartilage and subchondral bone of the L4–L5 FJs and serum biomarkers were analyzed. Results Administration of PTH (1–34) and E2 ameliorated cartilage lesions, and significantly decreased MMP-13 and caspase-3 levels and chondrocyte apoptosis. PTH (1–34) but not E2 significantly increased cartilage thickness, number of chondrocytes, and the expression of aggrecan. PTH (1–34) significantly improved microarchitecture parameters of subchondral bone, increased the expression of collagen I and osteocalcin, and decreased RANKL/OPG ratio. E2 treatment significantly increased the OPG level and decreased the RANKL/OPG ratio in the subchondral bone of ovariectomized rats, but it did not significantly improve the microarchitecture parameters of subchondral bone. Wnt3a and β-catenin expression was significantly reduced in the articular cartilage and subchondral bone in OVX rats, but PTH (1–34) could increase the expression of these proteins. E2 significantly increased the activity of Wnt/β-catenin pathway only in cartilage, but not in subchondral bone. The restoration of Wnt/β-catenin signaling had an obvious correlation with the improvement of some parameters associated with the FJs status. Conclusion Wnt/β-catenin signaling may be a potential therapeutic target for FJD induced by estrogen deficiency. PTH (1–34) is effective in treating this disease with better efficacy than 17β-estradiol, and the efficacy may be attributed to its restoration of Wnt/β-catenin signaling.

Purpose: Facet joint degeneration (FJD) is a major cause of low back pain. Parathyroid hormone (PTH) (1–34) is commonly used to treat osteoporosis. However, little is known about its effects on FJD induced by estrogen deficiency. This study aims to investigate the effects of PTH (1–34) on FJD induced by estrogen deficiency and the underlying pathogenesis of the disease. Methods: Forty 3-month-old female Sprague-Dawley rats were randomly divided into four groups: 30 received bilateral ovariectomy (OVX) followed by 12 weeks of treatment with normal saline, PTH (1–34) or 17β-estradiol (E2), and 10 received sham surgery followed by administration of normal saline. Status and Wnt/β-catenin signaling activity in the cartilage and subchondral bone of the L4–L5 FJs and serum biomarkers were analyzed. Results: Administration of PTH (1–34) and E2 ameliorated cartilage lesions, and significantly decreased MMP-13 and caspase-3 levels and chondrocyte apoptosis. PTH (1–34) but not E2 significantly increased cartilage thickness, number of chondrocytes, and the expression of aggrecan. PTH (1–34) significantly improved microarchitecture parameters of subchondral bone, increased the expression of collagen I and osteocalcin, and decreased RANKL/OPG ratio. E2 treatment significantly increased the OPG level and decreased the RANKL/OPG ratio in the subchondral bone of ovariectomized rats, but it did not significantly improve the microarchitecture parameters of subchondral bone. Wnt3a and β-catenin expression was significantly reduced in the articular cartilage and subchondral bone in OVX rats, but PTH (1–34) could increase the expression of these proteins. E2 significantly increased the activity of Wnt/β-catenin pathway only in cartilage, but not in subchondral bone. The restoration of Wnt/β-catenin signaling had an obvious correlation with the improvement of some parameters associated with the FJs status. Conclusion: Wnt/β-catenin signaling may be a potential therapeutic target for FJD induced by estrogen deficiency. PTH (1–34) is effective in treating this disease with better efficacy than 17β-estradiol, and the efficacy may be attributed to its restoration of Wnt/β-catenin signaling. [ABSTRACT FROM AUTHOR]

Few epidemiological studies have evaluated associations between lumbar facet joint (LFJ) osteoarthritis (OA) and comorbidities. This study aimed to investigate the prevalence of LFJ OA in a Japanese community population and associations between LFJ OA and underlying diseases, including lower extremity OA. This epidemiological cross-sectional study evaluated LFJ OA in 225 Japanese community residents (81 males, 144 females; median age, 66 years) using magnetic resonance imaging (MRI). LFJ OA from L1–L2 to L5–S1 was evaluated using a 4-grade classification. Associations between LFJ OA and comorbidities were examined using multiple logistic regression analyses adjusting for age, sex, and body mass index. Prevalences of LFJ OA were 28.6% at L1–L2, 36.4% at L2–L3, 48.0% at L3–L4, 57.3% at L4–L5, and 44.2% at L5–S1. Males were significantly more likely to have LFJ OA at several spinal levels (L1–L2 45.7% vs 18.9%, p < 0.001; L2–L3 46.9% vs 30.6%, p < 0.05; L4–L5 67.9% vs 51.4%, p < 0.05). LFJ OA was present in 50.0% of residents <50 years old, 68.4% at 50–59 years old, 86.3% at 60–69 years old, and 85.1% at ≥70 years old. Multiple logistic regression analysis showed no associations between LFJ OA and comorbidities. The prevalence of LFJ OA as evaluated by MRI was >85% at ≥60 years old and highest at the L4–L5 spinal level. Males were significantly more likely to have LFJ OA at several spinal levels. Comorbidities were not associated with LFJ OA. [ABSTRACT FROM AUTHOR]

Abstract Background To investigate the biochemical changes in lumbar facet joint (LFJ) and intervertebral disc (IVD) with different degenerative grade by T2* mapping. Methods Sixty-eight patients with low back pain (study group) and 20 volunteers (control group) underwent standard MRI protocols and axial T2* mapping. Morphological evaluation of LFJ and IVD were performed on T2-weighted imaging according to Weishaupt and Pfirrmann grading system, respectively. T2* values of LFJ and of AF (anterior annulus fibrosus), NP (nucleus pulposus), and PF (posterior annulus fibrosus) in IVD were measured. Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare T2* values of subjects with different degenerative grade. Results The mean T2* value of grade 0 LFJ (21.68[17.77,26.13]) was higher than those of grade I (18.42[15.68,21.8], p

BackgroundChronic back pain (CBP) is a condition that places a considerable burden on society, with several million people affected in the United States alone. Treatment options to address this problem and relieve CBP are constantly evolving, and one of the most promising treatment modalities for CBP that is refractory to conservative treatment options is endoscopic rhizotomy (ER).MethodsA thorough search of the PubMed (MEDLINE) database was conducted to assess the full progression of ER from its earliest uses to present day in a historical narrative review of ER, with treatment of facetogenic pain as a model pathology.ResultsER allows for direct visualization and ablation of sensory branches of the dorsal ramus to provide pain relief in up to 80% of patients faced with refractory CBP. This technique has been built upon since the early 20th century, and the novel endoscopic approach continues to gain popularity among physicians. Benefits of ER include superior postoperative median pain-free duration compared with traditional percutaneous radiofrequency ablation, as well as direct visualization of regional anatomy. Patient selection criteria for the procedure and a modest list of contraindications allow the use of ER as a viable treatment option for a significant population of patients suffering from CBP. Potential barriers to ER include high cost of the procedure, longer intraoperative time, and expensive proprietary equipment.ConclusionsER is an effective treatment for refractory CBP with notable advantages. As the technology and popularity of this procedure progress, improvements in the cost, training, and intraoperative time may make it a favorable alternative to the current standard of care.

Background: To investigate the biochemical changes in lumbar facet joint (LFJ) and intervertebral disc (IVD) with different degenerative grade by T2* mapping. Methods: Sixty-eight patients with low back pain (study group) and 20 volunteers (control group) underwent standard MRI protocols and axial T2* mapping. Morphological evaluation of LFJ and IVD were performed on T2-weighted imaging according to Weishaupt and Pfirrmann grading system, respectively. T2* values of LFJ and of AF (anterior annulus fibrosus), NP (nucleus pulposus), and PF (posterior annulus fibrosus) in IVD were measured. Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare T2* values of subjects with different degenerative grade. Results: The mean T2* value of grade 0 LFJ (21.68[17.77,26.13]) was higher than those of grade I (18.42[15.68,21.8], p < 0.001), grade II (18.98[15.56,22.76], p = 0.011) and grade III (18.38[16.05,25.07], p = 0.575) LFJ in study group, and a moderate correlation was observed between T2* value and LFJ grade (rho=-0.304, p < 0.001) in control group. In the analysis of IVD, a moderate correlation was observed between AF T2* value and IVD grade (rho=-0.323, p < 0.001), and between NP T2* value and IVD grade (rho=-0.328, p < 0.001), while no significant difference was observed between the T2* values of PF in IVD of different grade in study group. Conclusions: Downward trend of T2* values can be found in LFJ, AF and NP as the degenerative grade rised. But in elderly patients with low back pain, no change trend was found in LFJ due to increased fluid accumulation in the joint space. [ABSTRACT FROM AUTHOR]

The facet joint contributes to lumbar spine stability as it supports the weight of body along with the intervertebral discs. However, most studies on the causes of degenerative lumbar diseases focus on the intervertebral discs and often overlook the facet joints. This study aimed to investigate the impact of facet joint degeneration on the degenerative changes and diseases of the lumbar spine. A finite element model of the lumbar spine (L1–S1) was fabricated and validated to study the biomechanical characteristics of the facet joints. To simulate degeneration of the facet joint, the model was divided into four grades based on the number of degenerative segments (L4–L5 or L4–S1) and the contact condition between the facet joint surfaces. Finite element analysis was performed on four spine motions: flexion, extension, lateral bending, and axial torsion, by applying a pure moment to the upper surface of L1. Important parameters that could be used to confirm the effect of facet joint degeneration on the lumbar spine were calculated, including the range of motion (ROM) of the lumbar segments, maximum von Mises stress on the intervertebral discs, and reaction force at the facet joint. Facet joint degeneration affected the biomechanical characteristics of the lumbar spine depending on the movements of the spine. When analyzed by dividing it into degenerative onset and onset-adjacent segments, lumbar ROM and the maximum von Mises stress of the intervertebral discs decreased as the degree of degeneration increased in the degenerative onset segments. The reaction force at the facet joint decreased with flexion and increased with lateral bending and axial torsion. In contrast, lumbar ROM of the onset-adjacent segments remained almost unchanged despite severe degeneration of the facet joint, and the maximum von Mises stress of the intervertebral discs increased with flexion and extension but decreased with lateral bending and axial torsion. Additionally, the facet joint reaction force increased with extension, lateral bending, and axial rotation. This analysis, which combined the ROM of the lumbar segment, maximum von Mises stress on the intervertebral disc, and facet joint reaction force, confirmed the biomechanical changes in the lumbar spine due to the degeneration of isolated facet joints under the load of spinal motion. In the degenerative onset segment, spinal instability decreased, whereas in the onset-adjacent segment, a greater load was applied than in the intact state. When conducting biomechanical studies on the lumbar spine, considering facet joint degeneration is important since it can lead to degenerative spinal diseases, including adjacent segment diseases.

BACKGROUND: Oblique-pulling manipulation has a reliable curative effect on lumbar synovial incarceration, and it has been widely used in the clinic. However, the related research on the treatment of lumbar synovial incarceration by oblique-pulling manipulation is still relatively lacking. OBJECTIVE: To analyze the biomechanical mechanism and effect of oblique-pulling manipulation in the treatment of lumbar synovial incarceration by threedimensional finite element method, and provide theoretical basis for the treatment of lumbar synovial incarceration by oblique-pulling manipulation. METHODS: The CT data of patients with lumbar synovial incarceration were collected, and the three-dimensional finite element model of L4-5 motor unit of spine was established by using Mimics and Ansys software. The operation process of the oblique-pulling manipulation in the left lateral position was simulated, and the influence of the oblique-pulling manipulation on the biomechanics, morphological changes and facet joint contact area of each tissue structure of L4-5 segment of lumbar spine was analyzed. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of lumbar L4-5 segment was established, and the validity of the model was verified. (2) Before and after the oblique-pulling manipulation was applied, the stress of left facet joint cartilage increased from 2.959 MPa to 14.35 MPa; the strain increased from 0.078 34 to 0.345 1, and the contact area of articular cartilage increased from 20.806 2 mm² to 94.872 7 mm². On the other hand, the stress of the right facet joint cartilage decreased from 3.127 MPa to 0 MPa; the strain decreased from 0.081 96 to 0, and the articular cartilage contact surface decreased from 16.705 3 mm2 to 0 mm² on the right. (3) It is concluded that oblique-pulling manipulation has a good effect on patients with lumbar synovial incarceration. It can change the stress and strain of the articular process and the contact area of the upper and lower articular processes, fully release and open the articular process, and achieve the therapeutic purpose of reducing the articular process and relieving the synovial incarceration. [ABSTRACT FROM AUTHOR]

Abstract Introduction A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. Methods An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). Results Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3–5], number of diagnostic blocks (37%, median 4, IQR 2–4), bilateral denervation (59%, median 4, IQR 2–4), technique and number of lesions (66%, median 4, IQR 3–5), and strategy after denervation failure (68%, median 4, IQR 3–4). Conclusion Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence.

Background: Computed tomography (CT) is the reference standard for assessment of the bone. Magnetic resonance imaging (MRI) developments enable a CT-like visualization of the osseous structures. Purpose: To assess the diagnostic performance of 3D zero-echo time (3D-ZTE) and 3D T1-weighted gradient-echo (3D-T1GRE) MRI sequences for the evaluation of lumbar facet joints (LFJs) and the detection of lumbosacral transitional vertebrae (LSTV) using CT as the reference standard. Material and Methods: In total, 87 adult patients were included in this prospective study. Evaluation of degenerative changes of the facet joints at the L3/L4, L4/L5, and L5/S1 levels on both sides was performed by two readers using a 4-point Likert scale. LSTV were classified according to Castelvi et al. Image quality was quantitatively measured using the signal-to-noise (SNR) and contrast-to-noise (CNR) ratios. Intra-reader, inter-reader, and inter-modality reliability were calculated using Cohen's kappa statistic. Results: Intra-reader agreement for 3D-ZTE, 3D-T1GRE, and CT was 0.607, 0.751, and 0.856 and inter-reader agreement was 0.535, 0.563, and 0.599, respectively. The inter-modality agreement between 3D-ZTE and CT was 0.631 and between 3D-T1GRE and CT 0.665. A total of LSTV were identified in both MR sequences with overall comparable accuracy compared to CT. Mean SNR for bone, muscle, and fat was highest for 3D-T1GRE and mean CNR was highest for CT. Conclusion: 3D-ZTE and 3D-T1GRE MRI sequences can assess the LFJs and LSTV and may serve as potential alternatives to CT. [ABSTRACT FROM AUTHOR]

Introduction: A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. Methods: An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). Results: Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3–5], number of diagnostic blocks (37%, median 4, IQR 2–4), bilateral denervation (59%, median 4, IQR 2–4), technique and number of lesions (66%, median 4, IQR 3–5), and strategy after denervation failure (68%, median 4, IQR 3–4). Conclusion: Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence. [ABSTRACT FROM AUTHOR]

Background: Lumbar zygapophyseal joint dysfunction represents one of the major sources of chronic low back pain. Radiofrequency ablation (RFA) using a V-shaped active tip needle may offer a larger lesion of the medial branch nerves, improving clinical outcome. The aim of our study is to evaluate the efficacy and the feasibility of RFA using V-shaped active tip needles. Methods: This is a single-center observational retrospective study. Clinical records were screened and analyzed if they met the following inclusion criteria: adult patients (> 18 years), diagnosis of chronic lumbar zygapophyseal joint pain, failure of conservative treatments, ability to provide informed consent for data analysis and publication. Exclusion criteria: lumbar pain not related to zygapophyseal joints, previous spinal/lumbar surgery, incomplete data, absence or withdrawal of informed consent. The primary outcome of the study was a change in pain intensity at follow-up. The secondary outcomes were the evaluation of quality-of-life improvement, the occurrence of adverse events and the impact on post-procedural analgesic consumption. For these purposes, pre- and post-treatment numeric rating scale (NRS), neuropathic pain 4 questions (DN4), EuroQoL - EQ-5D-3L, EQ-VAS, EQ-index and North American Spine Society (NASS) index were retrieved and analysed. Results: Sixty-four patients were included. 7.8% of patients at 1-month (CI95% 0.026, 0.173), 37.5% at 3-month (CI95% 0.257, 0.505), 40.6% at 6-month (CI95% 0.285, 0.536) and 35.9% at 9-month (CI95% 0.243, 0.489) follow-up reported a reduction of more than 80% in NRS Statistical analysis indicated a significant change in NRS, DN4, EQ-index and EQ-5D-VAS (p-value < 0.001) at the different time-points. Conclusion: RFA using a V-shaped active tip needle might be a feasible and effective treatment for chronic lumbar zygapophyseal joint pain. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy between platelet-rich plasma (PRP) and corticosteroids (CS) in improving magnetic resonance imaging (MRI)-detected synovitis in correlation with clinical complaints among patients with lumbar facet joint (FJ) disease. Methods: This study was carried out at Eldemerdash Hospital, Cairo, Egypt between September 2019 and January 2021. A prospective, randomized, comparative, single blinded study included 30 patients with lumbar FJ disease, divided into 2 equal groups, received PRP and CS injections. Patients were comparatively assessed before and after the intervention according to number of tender lumbar FJs, maximum active lumbar extension range of motion, LBP visual analogue score, LBP functional disability questionnaires and MRI lumbar FJ detected synovitis and their grading. Results: Both groups showed a significant improvement in all mentioned parameters at follow-up after 3 months. However, PRP injections promoted better performance in terms of MRI synovitis grade in all lumbar FJ levels compared to CS injections. Conclusion: Both PRP and CS injections were effective in improving MRI-detected FJ synovitis while concurrently improving all examined parameters at follow-up after 3 months. However, PRP promoted better improvement in MRI-detected synovitis grade, suggesting that it may be a better treatment option for longer duration efficacy. [ABSTRACT FROM AUTHOR]

Purpose of Review: Regenerative medicine through interventional pain procedures is evolving with data demonstrating efficacy for a number of pain states in recent years. Platelet-rich plasma (PRP), defined as a sample of plasma with a platelet concentration 3 to 5 times greater than the physiologic platelet concentration found in healthy whole blood, releases bioactive proteins which can restore anatomical function in degenerative states. PRP is dense in growth factors, such as platelet-derived growth factor, transforming growth factor-beta1, basic fibroblastic growth factor, vascular endothelial growth factor, and epidermal growth factors. Recent Findings: To date, well-designed case–control or cohort studies for the use of PRP have demonstrated efficacy in lumbar facet joint, lumbar epidural, and sacroiliac joint injections. At present, there is only level IV evidence indicating the need for larger and more carefully controlled prospective studies. PRP is utilized autogenously in order to facilitate healing and injection and has been studied in the long-term management of discogenic low back pain. In this regard, numerous studies have evaluated PRP to steroid injections in chronic pain states with favorable results. Summary: PRP represents an opportunity for a new strategy in the therapeutic treatment of degenerative states of spines, joints, and other locations throughout the body with evolving data demonstrating both safety and long-term efficacy. [ABSTRACT FROM AUTHOR]

Bcl2-associated athanogene3 (BAG3) protein, mainly induced by stressful stimuli, has been confirmed to participate in apoptosis and autophagy. In recent studies, BAG3 has gradually become a key molecule in tumors. However, the role of BAG3 in the progression of lumbar facet joint osteoarthritis (FJOA) and whether it can regulate chondrocyte apoptosis and autophagy are still unknown. In both human and FJOA rat models, we observed an upregulation of BAG3 and apoptosis and autophagy-related proteins compared with healthy tissues. Then, we established the chondrocytes injury model in vitro by using IL-1β to stimulate human SW1353 cells. Western blot analysis data showed significant expression of BAG3, apoptosis, and autophagy-related proteins in SW1353 cells. Finally, by knocking down and overexpressing BAG3, we discovered possible anti-apoptotic and autophagy-promoted effects of BAG3 in FJOA through various experimental methods. This study demonstrated that BAG3 actively participates in regulating chondrocyte apoptosis and autophagy in FJOA and may be a highly interesting target for pharmacological interventions. [ABSTRACT FROM AUTHOR]

Abstract Background Facet orientation (FO) and facet tropism (FT) are two important structural parameters of lumbar facet joint. The purpose of this study was to evaluate the association between facet joint parameters and chronic low back pain (LBP). Methods From June 2017 to January 2019, a total of 542 cases were enrolled in this study. There were 237 males and 305 females with a mean age of 35.8 years (range 18~59 years). All the cases were divided into a LBP group (LBP group) and a non-LBP group (N-LBP group) in this study. We compared their clinical parameters and facet joint parameters between two groups. Results The LBP group was composed of 190 male and 252 female, whose ages ranged from 17 to 59 years (35.6 ±7.9 y). The N- LBP group was composed of 47 male and 53 female, whose ages ranged from 18 to 59 years (35.9 ± 7.5 y). Of these parameters, BMI (P = 0.008) and FT (P = 0.003) at all three levels were found to be significantly associated with incidence of chronic LBP (P < 0.05), but FO were only found to be significant at L3-L4 level and L5-S1 level (P < 0.05). Logistic regression analysis showed that high BMI and large FT were significant risk factors for chronic LBP (P < 0.05), and FT were found to might be independent risk factors for chronic LBP. Conclusion FT may play a more important role in the pathogenesis of chronic LBP.

Chondromyxoid fibroma (CMF) is a rarely documented benign osseous neoplasm, particularly with respect to its incidence in the lumbar spinal region. CMF predominantly manifests in vertebral bodies, exhibiting atypical emergence in ancillary anatomical sites. The present report describes, to the best of our knowledge, the second documented instance of CMF originating from the lumbar facet joint. The present case provides an example of CMF in the lumbar facet joint precipitating spinal canal stenosis, thereby engendering neurological manifestations in the lower extremities due to neoplastic proliferation through the intervertebral foramen. The present therapeutic intervention entailed surgical excision of the neoplasm concomitant with facet joint arthrodesis, with the objective of achieving comprehensive neoplasm eradication, ameliorating the symptomatology and safeguarding the spinal structural integrity of the patient. The present study aimed to illustrate the clinical implications of this rare neoplasm, thereby elucidating the diagnostic quandaries and therapeutic complexities associated with CMF in the lumbar facet joint. In addition, the present study aimed to augment the existing knowledge for the diagnosis and clinical management of CMF. [ABSTRACT FROM AUTHOR]

Tumor necrosis factor receptor-associated factor 6 (TRAF6), a regulator of NF-κB signaling, has been discovered recently to be probably related to osteoarthritis, while the function of TRAF6 in lumbar facet joint osteoarthritis(FJOA)still remains unknown. The aim of this study was to probe the specific function of TRAF6 in chondrocytes and its connection with the pathophysiology of FJOA. We found upregulation of TRAF6 in FJOA cartilage by western blot analysis. In vitro, we stimulated immortalized human chondrocytes by LPS to establish the cells apoptosis model. Western blot analysis demonstrated that levels of TRAF6 and cleaved caspase-3/8 in the chondrocyte injury model increased significantly. Knockdown of TRAF6 suppressed the expression of matrix metallopeptidase-13 (MMP-13) and interleukin-6 (IL-6) induced by LPS, and alleviated cell apoptosis. Meanwhile, western blot and immunofluorescent staining demonstrated that IκBα degradation and p65 nuclear transportation were also inhibited, revealing that knockdown of TRAF6 suppressed activation of the NF-κB pathway in LPS-induced chondrocytes apoptosis model. Collectively, our findings suggest that TRAF6 plays a crucial role in FJOA development by regulating NF-κB signaling pathway. Knockdown of TRAF6 may supply a potential therapeutic strategy for FJOA. [ABSTRACT FROM AUTHOR]

The facet joint contributes to lumbar spine stability as it supports the weight of body along with the intervertebral discs. However, most studies on the causes of degenerative lumbar diseases focus on the intervertebral discs and often overlook the facet joints. This study aimed to investigate the impact of facet joint degeneration on the degenerative changes and diseases of the lumbar spine. A finite element model of the lumbar spine (L1-S1) was fabricated and validated to study the biomechanical characteristics of the facet joints. To simulate degeneration of the facet joint, the model was divided into four grades based on the number of degenerative segments (L4-L5 or L4-S1) and the contact condition between the facet joint surfaces. Finite element analysis was performed on four spine motions: flexion, extension, lateral bending, and axial torsion, by applying a pure moment to the upper surface of L1. Important parameters that could be used to confirm the effect of facet joint degeneration on the lumbar spine were calculated, including the range of motion (ROM) of the lumbar segments, maximum von Mises stress on the intervertebral discs, and reaction force at the facet joint. Facet joint degeneration affected the biomechanical characteristics of the lumbar spine depending on the movements of the spine. When analyzed by dividing it into degenerative onset and onset-adjacent segments, lumbar ROM and the maximum von Mises stress of the intervertebral discs decreased as the degree of degeneration increased in the degenerative onset segments. The reaction force at the facet joint decreased with flexion and increased with lateral bending and axial torsion. In contrast, lumbar ROM of the onset-adjacent segments remained almost unchanged despite severe degeneration of the facet joint, and the maximum von Mises stress of the intervertebral discs increased with flexion and extension but decreased with lateral bending and axial torsion. Additionally, the facet joint reaction force increased with extension, lateral bending, and axial rotation. This analysis, which combined the ROM of the lumbar segment, maximum von Mises stress on the intervertebral disc, and facet joint reaction force, confirmed the biomechanical changes in the lumbar spine due to the degeneration of isolated facet joints under the load of spinal motion. In the degenerative onset segment, spinal instability decreased, whereas in the onset-adjacent segment, a greater load was applied than in the intact state. When conducting biomechanical studies on the lumbar spine, considering facet joint degeneration is important since it can lead to degenerative spinal diseases, including adjacent segment diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Park, Goh, Lee and Lee.)

The aim of the present study was to develop a novel animal model of lumbar facet joint osteoarthritis induced by persistent compressive injury. An intraspinal compression spring was randomly implanted into either the L4/5 or the L5/6 spinal segments of 40 Sprague Dawley (SD) rats to induce compression. Sham-operations were used in the other segment of the same rats as the control levels. The animals were sacrificed at 7, 14, 28, 42 and 56 days after surgery, prior to the radiological confirmation of the spring location. Degeneration of the lumbar facet joints was evaluated by macroscopic observation in addition to histological and immunohistological analyses. The results of this present study revealed the absence of spring dislocation during the entire observation period. Macroscopic and Osteoarthritis Research Society International scores of the compression levels were found to be higher in the compression levels compared with those noted in the control levels (P<0.05). In addition, interleukin-1β and tumor necrosis factor-α expression in the compression levels were increased over time compared with those recorded in the control levels. In conclusion, persistent compressive injury may induce degeneration of the lumbar facet joint. This novel animal model could serve as a useful tool for further studies into the mechanisms of action and potential treatment of lumbar facet joint osteoarthritis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lumbar facet joint degeneration has become the focus of scholars’ research in recent years. Understanding the risk factors of lumbar facet joint degeneration plays a key role in preventing and reducing the damage to spine health. Moreover, comprehending its anatomy has important guiding significance for the treatment of spine-related diseases and related operations. OBJECTIVE: To briefly describe the anatomy and histological characteristics of the lumbar facet joints, and summarize therisk factors of lumbar facet joints degeneration. METHODS: A computer-based search of CNKI, Wanfang database, VIP database, PubMed, Elsevier and Web of Science was performed with the search terms “lumbar facet joint, joint capsule, articular direction, eneurosis, osteoarthritis, biomechanics, low back pain, intervertebral disc degeneration, lumbar spondylolisthesis, lumbar degenerative scoliosis” for articlespublished from March 2018 to September 2019. Review, basic research and clinical research were screened by reading title and abstract. The studies with low relevance to the subject were excluded, and 60 studies were included in the final analysis. RESULTS AND CONCLUSION: (1) The main risk factors for lumbar facet joint degeneration include age, gender, abnormal stress, articular surface orientation, joint asymmetry, lumbar segment and disc degeneration. (2) When the joints degenerate, it can cause low back pain, disc degeneration, lumbar spondylolisthesis, degenerative scoliosis and other clinical diseases, which seriously affect people’s daily life and work, and reduce people’s living quality. Therefore, lumbar facet joints should not be ignored in the treatment of spine-related diseases. [ABSTRACT FROM AUTHOR]

• Facet orientation (FO) and facet tropism (FT) are two important structural parameters of lumbar facet joint. • Facet joint parameters significantly influence the biomechanics of the corresponding segment. • With the decrease of FO, the risk of recurrent lumbar disc herniation (rLDH) increases continuously. • The incidence of rLDH increases gradually with the increase of FT. • Facet joint parameters may play a more important role in the pathogenesis of rLDH. Recurrent lumbar disc herniation (rLDH) is one of the major problems when surgically treating patients with LDH. Data on previous studies investigated the associations between facet joint parameters and rLDH appear only rarely in the literature. This study's objective was to evaluate the association between facet joint parameters [facet orientation (FO) and facet tropism (FT)] and rLDH. From June 2005 to January 2014, 346 patients having single-level lumbar disc herniation (LDH), who underwent surgery, were included in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group). According to 25%, 50% and 75% quantiles of FO, all the cases were divided into 4 subgroups (＜42°, 42～45°, 46～49°, and ＞49°). Cases were divided into 3 groups according to different range of FT (＜3°, 3～4° and ＞4°). The relationships between the facet joint parameters and rLDH were evaluated. All cases in the study were followed up for more than 5 years postoperatively. The recurrence rates of different FO groups were statistically significant (P < 0.001). With the decrease of FO, the risk of rLDH increases continuously. Also, there were statistically significant recurrence rates in different FT groups (P < 0.001), which showed the incidence of rLDH increases gradually with the increase of FT. Facet joint parameters significantly influence the biomechanics of the corresponding segment. Facet joint parameters may play a more important role in the pathogenesis of rLDH. [ABSTRACT FROM AUTHOR]

Background: Facet orientation (FO) and facet tropism (FT) are two important structural parameters of lumbar facet joint. The purpose of this study was to evaluate the association between facet joint parameters and chronic low back pain (LBP). Methods: From June 2017 to January 2019, a total of 542 cases were enrolled in this study. There were 237 males and 305 females with a mean age of 35.8 years (range 18~59 years). All the cases were divided into a LBP group (LBP group) and a non-LBP group (N-LBP group) in this study. We compared their clinical parameters and facet joint parameters between two groups. Results: The LBP group was composed of 190 male and 252 female, whose ages ranged from 17 to 59 years (35.6 ±7.9 y). The N- LBP group was composed of 47 male and 53 female, whose ages ranged from 18 to 59 years (35.9 ± 7.5 y). Of these parameters, BMI (P = 0.008) and FT (P = 0.003) at all three levels were found to be significantly associated with incidence of chronic LBP (P < 0.05), but FO were only found to be significant at L3-L4 level and L5-S1 level (P < 0.05). Logistic regression analysis showed that high BMI and large FT were significant risk factors for chronic LBP (P < 0.05), and FT were found to might be independent risk factors for chronic LBP. Conclusion: FT may play a more important role in the pathogenesis of chronic LBP. [ABSTRACT FROM AUTHOR]

Objective: To report in vivo measurements of lumbar facet joint subchondral bone mineral density used in the description of facet joint loading patterns and to interrogate if low back pain is associated with changes in subchondral bone mineral density.Materials and Methods: In vivo measurements of lumbar facet joint subchondral bone mineral density (L1/2 to L5/S1) in Hounsfield units were performed on 89 volunteers (56 controls and 33 with low back pain) by computed tomography osteoabsorptiometry at subchondral regions between 1.5 mm and 2.5 mm below the joint surface. The facet surface was divided into five topographic zones: cranial, lateral, caudal, medial, and central.Results: We analyzed 1780 facet joint surfaces. Facets were denser (p < 0.0001) both in superior facets and in low back pain subjects (p < 0.0001). For the entire cohort, the facet center zone subchondral bone mineral density was higher (p < 0.0001) than that of the peripheral zones. The analyses indicate that subchondral bone mineral density is highest in patients with low back pain, the superior facets, and the center zone of the facets.Conclusions: Subchondral bone mineral density is thought to reflect cumulative, long-term distribution of stress acting on a joint. This work shows that higher subchondral bone mineral density values in the center zone indicate predominant stress transmission through the center of the facet joints. Finally, the greater subchondral bone mineral density in patients with low back pain may reflect both increased load bearing by the facets secondary to disc degeneration and misdistribution of loading within the joint. [ABSTRACT FROM AUTHOR]

Lumbar facet joint osteoarthritis (LFJ OA) is regarded as one of the common causes of low back pain (LBP). The pathogenesis and underlying mechanism of this disease are largely unknown, there is still no effective disease‐modifying therapy. This study aims to investigate the efficacy of exosomes derived from bone marrow mesenchymal stem cells (BMSCs) on the pathogenesis and behavioral signs of LBP in the LFJ OA mouse model. The pathogenetic change in cartilage and aberrant nerve invasion in the subchondral bone of LFJ in a mouse model after treatment with BMSC‐exosomes was evaluated. BMSC‐exosomes could relieve pain via abrogation of aberrant CGRP‐positive nerve and abnormal H‐type vessel formation in the subchondral bone of LFJ. Moreover, BMSC‐exosomes attenuated cartilage degeneration and inhibited tartrate‐resistant acid phosphatase expression and RANKL‐RANK‐TRAF6 signaling activation to facilitate subchondral bone remodeling. These results indicated that BMSC‐exosomes could relive behavioral signs of LBP and pathological processes in LFJ OA. BMSC‐exosomes have a prominent protective effect and might be a potential therapeutic option for the treatment of LFJ OA causing LBP. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:670–679, 2020 [ABSTRACT FROM AUTHOR]

Purpose: To report and discuss a rare case of septic arthritis of a lumbar facet joint presenting as septic bacterial peritonitis and requiring surgical debridement. Methods: A 55-year-old man, with a history of intravenous drug usage and hepatitis C, presented to the emergency department with fever, abdominal and lumbar pain. Examination showed ascites. Erythrocyte sedimentation rate and C-reactive protein were elevated. A paracentesis was performed, and a diagnosis of spontaneous bacterial peritonitis was assumed as acute on chronic liver failure. The patient was admitted for antibiotic treatment with cefotaxime. Staphylococcus aureus was isolated in blood cultures. Despite directed treatment, there were persistent fever, back pain and continuous elevation of serum inflammatory markers. An MRI of the lumbar spine was performed 14 days after presentation and identified septic arthritis of the left L4–L5 facet joint. In the absence of a response to the medical treatment, surgical debridement of the facet joint was performed. After surgery, back pain resolved and inflammatory markers started to decline. One year after surgery, the patient is asymptomatic and has normalization of the inflammatory markers of infection. Follow-up MRI shows complete resolution of the infection. Conclusions: Septic arthritis of the lumbar facet joints is a rare condition with no more than 50 cases reported in the literature. This infection, which can cause significant morbidity, can result from local or systemic inoculation. MRI is the diagnostic method of choice. While antibiotic therapy is the first line of treatment, when it fails, surgical debridement may be necessary. [ABSTRACT FROM AUTHOR]

Lumbar facet joint osteoarthritis (FJOA) caused by degenerative change(s) is considered to be the main cause of facet joint-origin low back pain (LBP). Intra-articular lumbar facet joint (IA LFJ) corticosteroid injection is widely used for controlling pain induced by FJOA. In the current study, the outcomes of IA LFJ corticosteroid injection were evaluated according to the severity of FJOA. A total of 50 patients who received IA LFJ corticosteroid injections for the treatment of LFJ pain were recruited. Patients were classified into three groups according to the severity of FJOA, which was indicated during a lumbar axial MRI. A total of 10 patients were assigned to group A (patients with mild FJOA), 27 to group B (patients with moderate FJOA) and 13 to group C (patients with severe FJOA). Pain intensity was evaluated using a numerical rating scale (NRS) prior to treatment and at 1, 2 and 3 months after treatment. A total of 26 (52%) patients experienced successful treatment outcomes (defined as >50% reduction in NRS score at 3 months). Patients in all groups demonstrated a significant decrease in NRS scores at 1, 2 and 3 months after IA LFJ corticosteroid injection compared with the pre-treatment score (P<0.001). However, the effect of IA LFJ corticosteroid injection was not significantly different among the three groups (P=0.889). The results demonstrated that facet joint-origin LBP was significantly reduced after IA LFJ corticosteroid injection, regardless of the severity of FJOA. The results of the current study indicated that IA LFJ corticosteroid injection is a beneficial clinical option for managing LBP caused by FJOA. [ABSTRACT FROM AUTHOR]

To evaluate and compare the effects of salmon calcitonin (sCT) and celecoxib (CLX) on cartilage, subchondral bone and tactile allodynia in a rat model of lumbar facet joint (FJ) osteoarthritis (OA). Forty 3-month-old male Sprague-Dawley rats were randomly divided into four groups: 30 received surgical collagenase (type II) injections in the right L3–L6 facet joints followed by 8 weeks of treatment with normal saline, CLX or sCT, and the other 10 received sham surgery. Tactile allodynia, changes of cartilage and subchondral bone of the L4–L5 FJs, and serum biomarkers were analyzed for all rats. Both sCT and CLX ameliorated cartilage lesions, significantly increased aggrecan expression and decreased caspase-3 expression. sCT also decreased the expression of a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4). According to the micro-computed tomography (micro-CT) analysis, sCT significantly improved microarchitecture parameters of subchondral bone and micro-CT score; and inhibited articular process hypertrophy. CLX showed better antihyperalgesic effects than sCT on days 3 and 7 postoperatively despite no statistical differences, whereas sCT possessed better analgesic effects than CLX on days 42 and 56. Besides, the sCT treatment reduced the elevated cartilage oligomeric matrix protein (COMP) concentration in rats injected with collagenase (type II). Both sCT and CLX exerted preventive effects on FJ OA caused by collagenase (type II), but sCT showed more protective effects, particularly on maintaining cartilage metabolism, restraining the deterioration of the subchondral bone microarchitecture and tactile allodynia, and reducing serum COMP concentrations. • sCT displays significant benefits in maintaining cartilage metabolism and restraining subchondral bone degeneration in rats with FJ OA. • sCT has significantly better antihyperalgesic effects for the long-term than for the short-term in rats with FJ OA. • The serum COMP level may be a diagnostic biomarker of FJ OA. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the relationship between vacuum facet phenomena and lumbar instability in patients with degenerative spondylolisthesis (DS) in L4-L5. Patients with L4-L5 DS who had both lumbosacral flexion–extension radiographs and computed tomography (CT) scans available for review from January 2016 to December 2017 were eligible for the present study. The dynamic motion index (DMI) of each patient was used to represent the percentage of slippage of L-L4 on the L5 vertebral disks on the flexion radiographs minus the percentage on the extension radiographs. The facet vacuum index refers to the average width of the facet vacuum on the left and right sides. A total of 67 patients with L4-L5 DS were included in the present study. Of the 67 patients, 35 had a vacuum facet phenomenon on their CT scan and 32 patients did not. The incidence of lumbar instability in the patients with a vacuum facet phenomenon was significantly greater than that in the patients without a vacuum facet phenomenon (P = 0.015). The mean DMI for the patients with a vacuum facet phenomenon was significantly greater than that for the patients without a vacuum facet phenomenon (P < 0.001). A positive linear correlation was found between the facet vacuum index and DMI for patients with a vacuum facet phenomenon (Pearson correlation coefficient, 0.597; P < 0.001). A linear correlation was found between the degree of segmental motion and the width of the vacuum facet phenomenon in patients with DS at L4-L5. Our study has shown that vacuum facet phenomena detected on the CT images of patients with DS are highly predictive of segmental instability. [ABSTRACT FROM AUTHOR]

Study Design: The lumbar facet joint (LFJ) osteoarthritis (OA) model that highly mimics the clinical conditions was established and evaluated.Objective: Here, we innovatively constructed and evaluated the aberrant mechanical loading-related LFJ OA model.Summary Of Background Data: LFJ is the only true synovial joint in a functional spinal unit in mammals. The LFJ osteoarthritis is considered to contribute 15% to 45% of low back pain. The establish of animal models highly mimicking the clinical conditions is a useful tool for the investigation of LFJ OA. However, the previously established animal models damaged the LFJ structure directly, which did not demonstrate the effect of aberrant mechanical loading on the development of LFJ osteoarthritis.Methods: In the present study, an animal model for LFJ degeneration was established by the unilateral osteotomy of LFJ (OLFJ) in L4/5 unit to induce the spine instability. Then, the change of contralateral LFJ was evaluated by morphological and molecular biological techniques.Results: We showed that the OLFJ induced instability accelerated the cartilage degeneration of the contralateral LFJ. Importantly, the SRμCT elucidated that the three-dimensional structure of the subchondral bone changed in contralateral LFJ, indicated as the abnormity of bone volume/total volume ratio (BV/TV), trabecular pattern factor (Tb. Pf), and the trabecular thickness (Tb. Th). Immunostaining further demonstrated the uncoupled osteoclastic bone resorption, and bone formation in the subchondral bone of contralateral LFJ, indicated as increased activity of osteoclast, osteoblast, and Type H vessels.Conclusion: We develop a novel LFJ OA model demonstrating the effect of abnormal mechanical instability on the degeneration of LFJ. This LFJ degeneration model that highly mimics the clinical conditions is a valuable tool to investigate the LFJ osteoarthritis.Level Of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar facet joint pain accounts for 5-15% of the cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low level trauma, leading to inflammation and stretching of the joint capsule. Patients and Methods: In this descriptive study 76 patients who were diagnosed, after a diagnostic block, as having lumbar facet joint pain were evaluated by their age, sex, and body mass index (BMI). Data were collected according to a checklist and entered to SPSS version 16. Results: The mean age of the participants was 48.53 years; the participants included 44 women and 32 men. Lumbar facet joint pain was more frequent in the age range of 40-55 years. With respect to BMI, lumbar facet joint pain was most frequently seen in patients with BMI of 24.5-29.5 kg/m 2 (40.8%). Conclusion: Based on our findings, the chances of developing lumbar facet joint pain is more in women who are between 40 years and 55 years of age and whose BMI is 24.5-29.5 kg/m 2 .

Tumor necrosis factor receptor-associated factor 2 (TRAF2) has been demonstrated that it plays a significant role in cell death receptor signal transduction. The purpose of this study was to investigate the expression of TRAF2 and its possible role in FJOA. We observed an up-regulation of TRAF2 in FJOA by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR) compared to normal tissues. In vitro, we used TNF-α to stimulate Human SW1353 chondrosarcoma cells to establish the chondrocytes injury model. Western blot analysis revealed significant expression of TRAF2 and cleaved caspase-3/8 in SW1353 cells. Co-localization of TRAF2/cleaved caspase-3/8 was detected in the cells injury model by double-labeling immunofluorescent staining. We demonstrated a possible anti-apoptotic effect of TRAF2 in chondrocyte apoptosis in FJOA by knockdown of its expression with siRNA. Moreover, TRAF2 knockdown was demonstrated to enhance TNF-α-induced apoptosis by flow cytometry assay. In conclusion, our results show that the up-regulation of TRAF2 may play an important role in the inhibition of chondrocyte apoptosis of FJOA. [ABSTRACT FROM AUTHOR]

Background Context: Low back pain (LBP) is more prevalent among postmenopausal women than men. Ovariectomy (OVX) is an established animal model that mimics the estrogen deficiency of postmenopausal women. Little is known about the three-dimensional (3D) morphologic properties of cartilage and subchondral bone changes in the lumbar facet joint (LFJ) of an OVX mouse model.Purpose: The purpose of this study was to characterize the 3D morphologic change of cartilage and subchondral bone in the LFJ of an OVX mouse model.Study Design: Three-dimensional visualization and a histologic study on degenerative changes in cartilage and subchondral bone in the LFJ of an OVX mouse model were conducted.Materials and Methods: Ovariectomy is performed to mimic postmenopausal changes in adult female mice. We present an imaging tool for 3D visualization of the pathologic characteristics of cartilage and subchondral bone changes LFJ degradation using propagation-based phase-contrast computed tomography (PPCT). The samples were further dissected, fixed, and stained for histologic examination.Results: Propagation-based phase-contrast computed tomography imaging provides a 3D visualization of altered cartilage with a simultaneous high detail of the subchondral bone abnormalities in an OVX LFJ model. A quantitative analysis demonstrated that the cartilage volume, the surface area, and thickness were decreased in the OVX group compared with the control group (p<.05). Meanwhile, these decreases were accompanied by an obvious destruction of the subchondral bone surface and a loss of trabecular bone in the OVX group (p<.05). The delineation of the 3D pathologic changes in the PPCT imaging was confirmed by a histopathologic method with Safranin-O staining. Tartrate-resistant acid phosphatase staining revealed an increased number of osteoclasts in the subchondral bone of the OVX mice compared with that of the control group.Conclusions: These results demonstrated that a mouse model of OVX-induced LFJ osteoarthritis (OA)-like changes was successfully established and showed a good resemblance to the human OA pathology. Propagation-based phase-contrast computed tomography has great potential to becomea powerful 3D imaging method to comprehensively characterize LFJ OA and to effectively monitor therapeutics. Moreover, degenerative LFJ possesses a severe morphologic change in the subchondral bone, may be the source of postmenopausal LBP, and has the potential to be a novel therapeutic target for LBP treatment. [ABSTRACT FROM AUTHOR]

The lumbar facet joint (FJ) is often associated with pathogenesis in the spine, but quantification of normal FJ motion remains limited to in vitro studies or static imaging of non-functional poses. The purpose of this study was to quantify lumbar FJ kinematics in healthy individuals during functional activity with dynamic stereo radiography (DSX) imaging. Ten asymptomatic participants lifted three known weights starting from a trunk-flexed (∼75°) position to an upright position while being imaged within the DSX system. High resolution computed tomography (CT) scan-derived 3D models of their lumbar vertebrae (L2-S1) were registered to the biplane 2D radiographs using a markerless model-based tracking technique providing instantaneous 3D vertebral kinematics throughout the lifting tasks. Effects of segment level and weight lifted were assessed using mixed-effect repeated measures ANOVA. Superior-inferior (SI) translation dominated FJ translation, with L5S1 showing significantly less translation magnitudes ( Median (Md) = 3.5 mm, p < 0.0001 ) than L2L3, L3L4, and L4L5 segments (Md = 5.9 mm, 6.3 mm and 6.6 mm respectively ). Linear regression-based slopes of continuous facet translations revealed strong linearity for SI translation ( r 2  > 0.94), reasonably high linearity for sideways sliding ( Z -) ( r 2  > 0.8), but much less linearity for facet gap change ( X -) ( r 2  ∼ 0.5). Caudal segments (L4-S1), particularly L5S1, displayed greater coupling compared to cranial (L2-L4) segments, revealing distinct differences overall in FJ translation trends at L5S1. No significant effect of weight lifted on FJ translations was detected. The study presents a hitherto unavailable and highly precise baseline dataset of facet translations measured during a functional, dynamic lifting task. [ABSTRACT FROM AUTHOR]

Purpose: To assess the feasibility of axial T2 , T2*, and T1 ρ mapping of lumbar facet joint (LFJ) cartilage for evaluation of early degeneration.Materials and Methods: We examined a total of 176 LFJs from 21 volunteers using axial T2 , T2*, and T1 ρ mapping with a 3.0T magnetic resonance imaging (MRI) scanner. All LFJs were measured and grouped according to the presence of low back pain (LBP), the Weishaupt grading system, and the Pfirrmann grade of the adjacent intervertebral disk (IVD). T2 , T2*, and T1 ρ values were analyzed and compared among the different groups.Results: Low interobserver agreement was found in the Weishaupt grading of LFJs (κ = 0.161). The T1 ρ values of LFJs were significantly different between adjacent two Pfirrmann grade of disks (grade I 50.15 ± 3.63 msec / grade II 53.27 ± 3.80 msec, P = 0.002; grade II 53.27 ± 3.80 msec / grade III 58.40 ± 4.17 msec, P < 0.01), and in different Weishaupt grades of LFJs (P = 0.000). T2* values were only found significantly different between Pfirrmann grade I and III of disks (P = 0.048). There was no significant difference in T2 values of LFJs whatever in Pfirrmann (P = 0.556) or Weishaupt grades (P = 0.694). No significant difference was found in T2 , T2*, and T1 ρ values between volunteers with LBP and without LBP (PT2  = 0.783, PT2*=0.311, PT1 ρ = 0.259).Conclusion: Axial T1 ρ could be an effective and sensitive method to assess for early degenerative changes in LFJ cartilage.Level Of Evidence: 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:468-475. [ABSTRACT FROM AUTHOR]

Abstract Objectives To determine whether data obtained from patients returning postal questionnaires accurately reflect how patients receiving imaging-guided lumbar facet injections respond. Methods Seventy-eight patients receiving lumbar facet joint injections who returned an outcomes questionnaire (responders) were age and gender matched with 78 patients who did not return the postal questionnaire (non-responders) after facet joint injections. Baseline numerical rating scale (NRS) pain data were collected. NRS and Patients’ Global Impression of Change (PGIC) data were collected 1 month after injection by postal questionnaire or telephone interview. Differences in NRS scores were calculated using the unpaired t-test. One level injection patients were compared to patients having ≥2 levels injected using the paired and unpaired t-test. The proportion of patients reporting significant improvement in each group was calculated. Results NRS scores were significantly improved compared to baseline (p = 0.0001). Thirty-eight percent of responders were significantly improved compared to 50 % of non-responders. Patients having ≥2 levels injected reported significantly higher baseline NRS scores, but by 1 month there was no difference in NRS scores between groups. Conclusions Patients returning postal questionnaires report a less favourable outcome. Telephone interview patients having injections at more than one level have better outcomes. Main messages • Patients returning postal questionnaires report worse outcomes after facet injection. • Method of data collection should be considered when reporting treatment outcomes. • Patients receiving facet injections at more than one level report greater levels of pain reduction.