Tuesday, July 13, 2010

Lumbar facet pain & facet pain in Osteoarthritis of lumbar spine



Lumbar facet pain (1):

Lumbar facet joints are a well recognized source of low back pain and referred pain in the lower extremity in patients with chronic low back pain. Conventional clinical features and other non-invasive diagnostic modalities are unreliable in diagnosing lumbar zygapophysial joint pain.
However with invasive diagnostic technique the chance of false positive result may be up to 47% but these controlled diagnostic studies have shown the prevalence of lumbar facet joint pain in 27% to 40% of the patients with chronic low back pain without disc displacement or radiculitis.

Facet joint surface area in LBA (2):

Facet joint surface area is an important parameter for understanding facet joint function and pathology. Otsuka et al investigated lumbar facet joint surface area in relation to age and the presence of chronic low back pain.
In this invivo study the following things are found:
1. The lumbar facet area was significantly greater at the inferior lumbar levels and also increased with age.
2. There is age-related increase in the facet joint surface was observed more in the low back pain subjects compared with asymptomatic subjects.
3. The increase in the area of the facet joint surface is probably secondary to increased load-bearing in the lower lumbar segments and facet joint osteoarthritis.

Facet joint dimension in OA of lumbar spine (3):

The FJ play an important role in load transmission; they provide a posterior load-bearing helper, stabilizing the motion segment in flexion and extension and also restricting axial rotation.
The capsule of the FJ, subchondral bone, and synovium are richly innervated and can be a potential source of the low back pain.
Degenerative changes: Degenerative changes in the FJ comprise cartilage degradation that leads to the formation of focal and then diffuse erosions with joint space narrowing, and sclerosis of the subchondral bone.
Risk factors for lumbar FJ osteoarthritis include advanced age, relatively more sagittal orientation of the FJ, and a background of intervertebral disk degeneration.

Facet joint tropism (dissimilar facing and/or size of a vertebra's zygapophyseal joints) in facet joint OA (4):

One cross sectional study tried to find out association between lumbar facet joint osteoarthritis (OA), degenerative spondylolisthesis (DS) and facet orientation and tropism which remains unclear. This study found:
1. Facets with OA were more sagittally oriented than those without OA, which is significant observed at L4-L5 spinal level.
2. Facet tropism did not show an association with facet joint OA at any spinal level.
3. Facet orientation was significantly associated with DS, however, facet tropism showed no association with DS.
This study confirms a significant association between sagittal orientation and OA of the lumbar facet joints at L4-L5 and DS. Facet tropism was not associated with occurrence of facet joint OA or DS.

Does osteoarthritis of the lumbar spine cause chronic low back pain of facet origin? (5)

According to may authorities OA it self is a painless condition which is readily exemplified in hip joint. However, according to Borenstein Osteoarthritis of the lumbar spine does cause low back pain.
The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages.
Despite these similarities, in our discussion’s context, questions remain regarding the lumbar spine facet joints as a source of chronic back pain.
The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis.
Low back pain is responsive to therapies that are effective for osteoarthritis in other locations.

References:

1. Dutta S et al; Pain Physician. 2009 Mar-Apr;12(2):437-60. (Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions.)

2. Otsuka Y et al; Spine (Phila Pa 1976). 2010 Apr 15;35(8):924-8. (In vivo measurement of lumbar facet joint area in asymptomatic and chronic low back pain subjects.)

3. Kalichman L et al; Semin Arthritis Rheum. 2007 Oct;37(2):69-80. Epub 2007 Mar 26.
4. Kalichman L et al; Spine (Phila Pa 1976). 2009 Jul 15;34(16):E579-85. Facet orientation and tropism: associations with facet joint osteoarthritis and degeneratives.

5. Borenstein D; Curr Pain Headache Rep. 2004 Dec;8(6):512-7. (Does osteoarthritis of the lumbar spine cause chronic low back pain?)



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