Facet Fluid Sign and Segmental Instability of the Spine
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Published:
Jun 17, 2023
Keywords:
Chronic lumbar disease, angular instability, translational instability, facet fluid, low back pain
Main Article Content
Abstract
Introduction: Degenerative lumbar spine disease is prevalent, however, the criteria for instability are still debated.
Objectives: To analyze the presence of the lumbar facet fluid sign as a criterion for segmental instability of the spine.
Materials and Methods: Patients with chronic lumbar disease, who present facet hydrarthrosis on MRI and dynamic lumbar spine radiographs. The prevalence of sex, age, main symptomatology, and pain on unilateral or bilateral extension was investigated.
Results: A total of 139 patients (62% women) were evaluated, with an average age of 50.8 years; the main reason for consultation was low back pain (76%). Sixtyfive percent reported pain in extension, with 35% reporting unilateral pain and 30% reporting bilateral pain. Fourteen percent had low-grade spondylolisthesis at L4-L5 and 7% at L5-S1. Hydrarthrosis was unilateral in 20% and bilateral in 80%; the most frequent level of hydrarthrosis was L4-L5 (58%). Six percent had only translational instability and 2% had mixed instability. 8% and 5%, respectively, had Modic I and Modic II changes.
Conclusions: The presence of facet fluid is not a criterion for segmental instability of the spine, regardless of the level and localized segment, or the unilateral or bilateral lumbar facet presentation.
Objectives: To analyze the presence of the lumbar facet fluid sign as a criterion for segmental instability of the spine.
Materials and Methods: Patients with chronic lumbar disease, who present facet hydrarthrosis on MRI and dynamic lumbar spine radiographs. The prevalence of sex, age, main symptomatology, and pain on unilateral or bilateral extension was investigated.
Results: A total of 139 patients (62% women) were evaluated, with an average age of 50.8 years; the main reason for consultation was low back pain (76%). Sixtyfive percent reported pain in extension, with 35% reporting unilateral pain and 30% reporting bilateral pain. Fourteen percent had low-grade spondylolisthesis at L4-L5 and 7% at L5-S1. Hydrarthrosis was unilateral in 20% and bilateral in 80%; the most frequent level of hydrarthrosis was L4-L5 (58%). Six percent had only translational instability and 2% had mixed instability. 8% and 5%, respectively, had Modic I and Modic II changes.
Conclusions: The presence of facet fluid is not a criterion for segmental instability of the spine, regardless of the level and localized segment, or the unilateral or bilateral lumbar facet presentation.
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How to Cite
Bazán, P. L., Rosas Mendieta, M. A., Padini, E., Carrizo Becerra, J. F., Borri, Álvaro E., & Medina, M. (2023). Facet Fluid Sign and Segmental Instability of the Spine. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(3), 269-274. https://doi.org/10.15417/issn.1852-7434.2023.88.3.1511
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Clinical Research
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References
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2. Sethi R. Relationship betwen disc degeneration and facet joint arthrosis a MRI study. J Anat Soc India 2016;65:123-7. https://doi.org/10.1016/j.jasi.2017.02.010
3. Fujiwara A, Tamai K, An HS, Lim TH, Yoshida H, Kurihashi A, et al. Orientation and osteoarthritis of the lumbar facet joint. Clin Orthop Relat Res 2001;(385):88-94. https://doi.org/10.1097/00003086-200104000-00015
4. Chaput C, Padon D, Rush J, Lenehan E, Rahm M. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine (Phila Pa 1976) 2007;32(17):1883-7. https://doi.org/10.1097/BRS.0b013e318113271a
5. Hasegawa K, Kitahara K, Shimoda H, Ishii K, Ono M, Homma T, et al. Lumbar degenerative spondylolisthesis is not always unstable: clinicobiomechanical evidence. Spine (Phila Pa 1976) 2014;39(26):2127-35. https://doi.org/10.1097/BRS.0000000000000621
6. Hasegawa K, Shimoda H, Kitahara K, Sasaki K, Homma T. What are the reliable radiological indicators of lumbar segmental instability? J Bone Joint Surg Br 2011;93(5):650-7. https://doi.org/10.1302/0301-620X.93B5.25520
7. Rihn JA, Lee JY, Khan M, Ulibarri JA, Tannoury C, Donaldson WF 3rd, et al. Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease? Spine (Phila Pa 1976) 2007;32(14):1555-60. https://doi.org/10.1097/BRS.0b013e318067dc55
8. Lattig F, Fekete TF, Grob D, Kleinstück FS, Jeszenszky D, Mannion AF. Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis? Eur Spine J 2012;21(2):276-81.
https://doi.rog/10.1007/s00586-011-1993-1
9. Helbig T, Lee CK. The lumbar facet syndrome. Spine (Phila Pa 1976) 1988;13(1):61-4.
https://doi.org/10.1097/00007632-198801000-00015
10. Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 1999;8(5):396-401. https://doi.org/10.1007/s005860050193
11. Phan KH, Daubs MD, Kupperman AI, Scott TP, Wang JC. Kinematic analysis of diseased and adjacent segments in degenerative lumbar spondylolisthesis. Spine J 2015;15(2):230-7. https://doi.org/10.1016/j.spinee.2014.08.453
12. Dupuis PR, Yong-Hing K, Cassidy JD, Kirkaldy-Willis WH. Radiologic diagnosis of degenerative lumbar spinal instability. Spine (Phila Pa 1976) 1985;10(3):262-76. https://doi.org/10.1097/00007632-198504000-00015
13. Boden SD, Wiesel SW. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine (Phila Pa 1976) 1990;15(6):571-6. https://doi.org/10.1097/00007632-199006000-00026
14. Bazán PL, Borri AE, Medina M. Correlación entre signo de Modic I e inestabilidad radiográfica dinámica. Coluna/Columna 2021;20(4):259-62. https://doi.org/10.1590/S1808-185120212004250503
15. Ciccioli NM, Medina M, Bazán PL, Borri AE. Artritis séptica facetaria en columna. Orthotips 2021;17(1):6-10. https://doi.org/10.35366/99161
2. Sethi R. Relationship betwen disc degeneration and facet joint arthrosis a MRI study. J Anat Soc India 2016;65:123-7. https://doi.org/10.1016/j.jasi.2017.02.010
3. Fujiwara A, Tamai K, An HS, Lim TH, Yoshida H, Kurihashi A, et al. Orientation and osteoarthritis of the lumbar facet joint. Clin Orthop Relat Res 2001;(385):88-94. https://doi.org/10.1097/00003086-200104000-00015
4. Chaput C, Padon D, Rush J, Lenehan E, Rahm M. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine (Phila Pa 1976) 2007;32(17):1883-7. https://doi.org/10.1097/BRS.0b013e318113271a
5. Hasegawa K, Kitahara K, Shimoda H, Ishii K, Ono M, Homma T, et al. Lumbar degenerative spondylolisthesis is not always unstable: clinicobiomechanical evidence. Spine (Phila Pa 1976) 2014;39(26):2127-35. https://doi.org/10.1097/BRS.0000000000000621
6. Hasegawa K, Shimoda H, Kitahara K, Sasaki K, Homma T. What are the reliable radiological indicators of lumbar segmental instability? J Bone Joint Surg Br 2011;93(5):650-7. https://doi.org/10.1302/0301-620X.93B5.25520
7. Rihn JA, Lee JY, Khan M, Ulibarri JA, Tannoury C, Donaldson WF 3rd, et al. Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease? Spine (Phila Pa 1976) 2007;32(14):1555-60. https://doi.org/10.1097/BRS.0b013e318067dc55
8. Lattig F, Fekete TF, Grob D, Kleinstück FS, Jeszenszky D, Mannion AF. Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis? Eur Spine J 2012;21(2):276-81.
https://doi.rog/10.1007/s00586-011-1993-1
9. Helbig T, Lee CK. The lumbar facet syndrome. Spine (Phila Pa 1976) 1988;13(1):61-4.
https://doi.org/10.1097/00007632-198801000-00015
10. Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 1999;8(5):396-401. https://doi.org/10.1007/s005860050193
11. Phan KH, Daubs MD, Kupperman AI, Scott TP, Wang JC. Kinematic analysis of diseased and adjacent segments in degenerative lumbar spondylolisthesis. Spine J 2015;15(2):230-7. https://doi.org/10.1016/j.spinee.2014.08.453
12. Dupuis PR, Yong-Hing K, Cassidy JD, Kirkaldy-Willis WH. Radiologic diagnosis of degenerative lumbar spinal instability. Spine (Phila Pa 1976) 1985;10(3):262-76. https://doi.org/10.1097/00007632-198504000-00015
13. Boden SD, Wiesel SW. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine (Phila Pa 1976) 1990;15(6):571-6. https://doi.org/10.1097/00007632-199006000-00026
14. Bazán PL, Borri AE, Medina M. Correlación entre signo de Modic I e inestabilidad radiográfica dinámica. Coluna/Columna 2021;20(4):259-62. https://doi.org/10.1590/S1808-185120212004250503
15. Ciccioli NM, Medina M, Bazán PL, Borri AE. Artritis séptica facetaria en columna. Orthotips 2021;17(1):6-10. https://doi.org/10.35366/99161