CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2020; 30(04): 427-435
DOI: 10.4103/ijri.IJRI_390_20
Musculoskeletal Imaging

Is thoracic facet joint arthritis over-reported? It’s time to review CT grading parameters - An analytical cross-sectional study

Punit Tiwari
Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh
,
Harmeet Kaur
Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India
,
Vivek Jha
Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

Background: In the absence of any exclusive classification for dorsal FJA, there is a lot of confusion while labelling grade 1 FJA in thoracic spine based on decreased FJ space. Purpose: The purpose of this study was to know the facet joint space measurements in thoracic spine of asymptomatic and symptomatic participants and to comment whether the lower cut-off of 2 mm used in lumbar FJA classification can be safely applied in thoracic spine too. Materials and Methods: This cross-sectional study was done from December 1, 2018 to November 30, 2019. Patients above 18 years of age in this study who underwent CT thorax for causes unrelated to dorsal spinal pain were included. IBM SPSS Statistics v 26 was used for statistical analysis. Results: We measured and analysed 1512 thoracic facet joints in 63 patients (30 females and 33 males) in both axial and sagittal plane on CT scan. Mean age of the entire sample was 59.19 ± 15.19 years, ranging from 33 to 97 years and a standard error of mean 1.365 years. Overall mean thoracic facet joint space was measured to be 1.270 mm ± 0.3416 mm, ranging from 0 to 3.1 mm and a standard error of mean 0.0088 mm and a variance of 0.117 mm. The median was 1.300 mm while mode was 1.1 mm. Conclusion: The popular lumbar FJA classification by Weishupt et al. cannot be applied in its present form in thoracic spine, without the modification in parameters of grade 1 FJA. The lower cut-off of normal thoracic facet joint space probably lies around 1 mm. MeSH Terms: Zygapophyseal joints, dorsal, thoracic, facet joint, arthritis, classification



Publication History

Received: 19 May 2020

Accepted: 01 September 2020

Article published online:
14 July 2021

© 2020. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331: 69-73
  • 2 Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine (Phila Pa 1976) 2003; 28: 616-20
  • 3 Weiner DK, Kim YS, Bonino P, Wang T. Low back pain in older adults: Are we utilizing healthcare resources wisely?. Pain Med 2006; 7: 143-50
  • 4 Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28: 215-9
  • 5 Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: Accuracy of oblique radiographic assessment. Radiology 1987; 164: 227-30
  • 6 SnellRS. The Back. Clinical Anatomy by Regions. 8th ed. New Delhi: Wolters Kluwer Health Publishers; 2008: 855
  • 7 Niemeläinen R, Videman T, Battiè MC. Prevalence and characteristics of upper or mid-back pain in Finnish men. Spine (Phila Pa 1976) 2006; 31: 1846-9
  • 8 Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC MusculoskeletDisord 2009; 10: 77
  • 9 Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord 2004; 5: 15
  • 10 Chopra P. Chapter 26 - Thoracic pain. In: Smith HS. editor Current Therapy in Pain. W.B. Saunders; 2009: 194-201 DOI: 10.1016/B978-1-4160-4836-7.00026-2 Available from: ISBN: 9781416048367 http://www.sciencedirect.com/science/article/pii/B9781416048367000262
  • 11 Boswell MV, Manchikanti L, Kaye AD, Bakshi S, Gharibo CG, Gupta S. et al. A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (Zygapophysial) joint injections in chronic spinal pain. Pain Physician 2015; 18: E497-533
  • 12 Piraccini E, Byrne H, Calli M, Maitan S. High abdominal wall pain: An unusual radiation in thoracic facet joint syndrome. Pain Med 2017; 18: 1603-4
  • 13 Dreyfuss P, Tibiletti C, Dreyer SJ. Thoracic zygapophyseal joint pain patterns. A study in normal volunteers.Spine (Phila Pa 1976) 1994; 19: 807-11
  • 14 Laslett M, McDonald B, Aprill CN, Tropp H, Oberg B. Clinical predictors of screening lumbar zygapophyseal joint blocks: Development of clinical prediction rules. Spine J 2006; 6: 370-9
  • 15 Schwarzer AC, Wang SC, O’Driscoll D, Harrington T, Bogduk N, Laurent R. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine (Phila Pa 1976) 1995; 20: 907-12
  • 16 Zhou X, Liu Y, Zhou S, Fu XX, Yu XL, Fu CL. et al. The correlation between radiographic and pathologic grading of lumbar facet joint degeneration. BMC Med Imaging 2016; 16: 27
  • 17 Kim JH, Sharan A, Cho W, Emam M, Hagen M, Kim SY. The prevalence of asymptomatic cervical and lumbar facet arthropathy: A computed tomography study. Asian Spine J 2019; 13: 417-22
  • 18 Tiwari P, Kaur H, Kaur H, Jha V, Singh N, Ashraf A. Prevalence of facet joint arthritis and its association with spinal pain in mountain population - A cross-sectional study. J Craniovertebr Junction Spine 2020; 11: 36-45
  • 19 Manchikanti L, Pampati V, Fellows B, Bakhit CE. The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents. Curr Rev Pain 2000; 4: 337-44
  • 20 Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 1994; 58: 195-200
  • 21 Hinkle DE, Wiersma W, Jurs SG. Applied Statistics for the Behavioural Sciences. 5th ed. Boston: Houghton Mifflin; 2003
  • 22 Whyte MB, Kelly P. The normal range: It is not normal and it is not a range. Postgrad Med J 2018; 94: 613-6
  • 23 Vialle EN, Vialle LRG, Simões CE, de Souza Menegaz P. Clinical-radiographic correlation of degenerative changes of the spine – Systematic review. Columna 2016; 15: 325-9
  • 24 Haughton V. Imaging techniques in intraspinal diseases. In: Resnick D. editor Diagnosis of Bone and Joint Disorders. Philadelphia: Saunders; 1995: 237-76
  • 25 Shepherd DET, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. AnnRheum Dis 1999; 58: 27-34
  • 26 Yoganandan N, Knowles SA, Maiman DJ, Pintar FA. Anatomic study of the morphology of human cervical facet joint. Spine (Phila Pa 1976) 2003; 28: 2317-23
  • 27 Chua WH, Bogduk N. The surgical anatomy ofthoracic facet denervation. ActaNeurochir 1995; 136: 140-4
  • 28 Masharawi Y, Rothschild B, Dar G, Peleg S, Robinson D, Been E. et al. Facet orientation in the thoracolumbar spine: Three dimensional anatomic and biomechanical analysis. Spine (Phila Pa 1976) 2004; 29: 1755-63
  • 29 Thorpe Lowis CG, Xu Z, Zhang M. Visualisation of facet joint recesses of the cadaveric spine: Amicro-CT and sheet plastination study. BMJ Open Sport Exerc Med 2018; 4: e000338
  • 30 World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision. 2nd ed. World Health Organization; 2004
  • 31 Goel A, Shah A, Jadhav M, Nama S. Distraction of facets with intraarticular spacers as treatment for lumbar canal stenosis: Report on a preliminary experience with 21 cases. J Neurosurg Spine 2013; 19: 672-7
  • 32 O’Leary SA, Paschos NK, Link JM, Klineberg EO, Hu JC, Athanasiou KA. Facet joints of the spine: Structure-function relationships, problems and treatments, and the potential for regeneration. Ann Rev Biomed Eng 2018; 20: 145-70