Lumbar facet joint osteoarthritis: a review.

OBJECTIVES The facet joints (FJ) can be a potentially important source of symptoms because of the high level of mobility and load forces, especially in the lumbar area. We reviewed the anatomy, biomechanics, and possible sources of pain of the FJ, natural history, and risk factors of lumbar FJ osteoarthritis and briefly reviewed the relevant imaging methods. METHODS PubMed and MEDLINE databases (1950-2006) were searched for the key words "facet joints," "zygapophyseal joints," "osteoarthritis," "low back pain," and "spondyloarthritis." All relevant articles in English were reviewed. Pertinent secondary references were also retrieved. RESULTS 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 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. Because the most prominent changes occur in bone, the best method of evaluation of the FJ is computed tomography. Risk factors for lumbar FJ osteoarthritis include advanced age, relatively more sagittal orientation of the FJ, and a background of intervertebral disk degeneration. CONCLUSIONS An up-to-date knowledge of this subject can be helpful in the development of diagnostic techniques and in the prevention of lumbar FJ osteoarthritis and low back pain and can assist in the determination of future research goals.

[1]  M. C. Powell,et al.  PREVALENCE OF LUMBAR DISC DEGENERATION OBSERVED BY MAGNETIC RESONANCE IN SYMPTOMLESS WOMEN , 1986, The Lancet.

[2]  Stefan Milz,et al.  Immunohistochemical analysis of the extracellular matrix in the posterior capsule of the zygapophysial joints in patients with degenerative L4-5 motion segment instability. , 2003, Journal of neurosurgery.

[3]  A. King,et al.  Experimental verification of facet load transmission by direct measurement of facet lamina contact pressure. , 1989, Journal of biomechanics.

[4]  T. Getchell,et al.  The effects of controlled mechanical loading on group-II, III, and IV afferent units from the lumbar facet joint and surrounding tissue. An in vitro study. , 1992, The Journal of bone and joint surgery. American volume.

[5]  P. C. Jackson,et al.  99mTc HMDP bone scanning in generalised nodal osteoarthritis. II. The four hour bone scan image predicts radiographic change. , 1986, Annals of the rheumatic diseases.

[6]  L. Twomey,et al.  Age Changes in Lumbar Zygapophyseal Joints: Observations on Structure and Function , 1986, Spine.

[7]  S. Eisenstein,et al.  The lumbar facet arthrosis syndrome. Clinical presentation and articular surface changes. , 1987, The Journal of bone and joint surgery. British volume.

[8]  Tanner Schmidt,et al.  Lumbar facet joint tropism does not accelerate degeneration of the facet joints. , 1997, AJNR. American journal of neuroradiology.

[9]  M. Merrilees,et al.  Synovial Cysts of the Lumbar Facet Joints in a Symptomatic Population: Prevalence on Magnetic Resonance Imaging , 2004, Spine.

[10]  H Y Kressel,et al.  Normal and degenerative posterior spinal structures: MR imaging. , 1987, Radiology.

[11]  Guangju Zhai,et al.  A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. , 2005, Osteoarthritis and cartilage.

[12]  V. Haughton,et al.  Facet joint menisci of the cervical spine: correlative MR imaging and cryomicrotomy study. , 1987, Radiology.

[13]  J. Polak,et al.  Immunohistochemical Demonstration of Subclasses of Inflammatory Cells and Active, Collagen‐Producing Fibroblasts in the Synovial Plicae of Lumbar Facet Joints , 1990, Spine.

[14]  D Resnick,et al.  Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. , 1987, Radiology.

[15]  W. Tassanawipas,et al.  The orientation of facet joints and transverse articular dimension in degenerative spondylolisthesis. , 2005, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[16]  N. Bogduk.  International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. , 1997, The Clinical journal of pain.

[17]  S. Peleg,et al.  Facet Tropism and Interfacet Shape in the Thoracolumbar Vertebrae: Characterization and Biomechanical Interpretation , 2005, Spine.

[18]  J. Polak,et al.  Silver Impregnation and Immnunohistochemical Study of Nerves in Lumbar Facet Joint Plical Tissue , 1991, Spine.

[19]  E. Wojtys,et al.  Substance P innervation of lumbar spine facet joints. , 1993, Spine.

[20]  V M Haughton,et al.  Computed tomography of the lumbar facet joints. , 1980, Radiology.

[21]  D. Long,et al.  Percutaneous Lumbar Medial Branch Neurotomy: A Modification of Facet Denervation , 1980, Spine.

[22]  V. Mooney,et al.  The facet syndrome. , 1976, Clinical orthopaedics and related research.

[23]  N. Bogduk,et al.  The Menisci of the Lumbar Zygapophyseal Joints: A Review of Their Anatomy and Clinical Significance , 1984, Spine.

[24]  N. Obuchowski,et al.  Magnetic Resonance Imaging of the lumbar spine in people without back pain , 2017, AL-QADISIYAH MEDICAL JOURNAL.

[25]  K. Ha,et al.  Expression of Estrogen Receptor of the Facet Joints in Degenerative Spondylolisthesis , 2005, Spine.

[26]  N. Arden,et al.  The value of SPECT scans in identifying back pain likely to benefit from facet joint injection. , 1996, British journal of rheumatology.

[27]  C. Badgley.  The articular facets in relation to low-back pain and sciatic radiation , 1941 .

[28]  G. Andersson,et al.  Discs Degenerate Before Facets , 1990, Spine.

[29]  N. Bogduk,et al.  The human lumbar dorsal rami. , 1982, Journal of anatomy.

[30]  J. Cauley,et al.  Lumbar Olisthesis and Lower Back Symptoms in Elderly White Women: The Study of Osteoporotic Fractures , 1998, Spine.

[31]  N. Bogduk,et al.  Precision percutaneous blocking procedures for localizing spinal pain: part 2. The lumbar neuroaxial compartment , 1993 .

[32]  N. Roberts,et al.  The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males , 2005, European Spine Journal.

[33]  Stefan Milz,et al.  Detailed pathological changes of human lumbar facet joints L1–L5 in elderly individuals , 2006, European Spine Journal.

[34]  F. Sturmans,et al.  Injection therapy for subacute and chronic benign low back pain. , 2001, Spine.

[35]  E. Ornstein.  Hip revisions with impacted morselized allograft bone and cement , 2002, Acta orthopaedica Scandinavica. Supplementum.

[36]  T. Getchell,et al.  Mechanosensitive afferent units in the lumbar facet joint. , 1990, The Journal of bone and joint surgery. American volume.

[37]  J. Glover.  Arthrography of the joints of the lumbar vertebral arches. , 1977, The Orthopedic clinics of North America.

[38]  J. Houwing-Duistermaat,et al.  Urinary CTX-II levels are associated with radiographic subtypes of osteoarthritis in hip, knee, hand, and facet joints in subject with familial osteoarthritis at multiple sites: the GARP study , 2005, Annals of the rheumatic diseases.

[39]  N. Semmer,et al.  The Diagnostic Accuracy of Magnetic Resonance Imaging, Work Perception, and Psychosocial Factors in Identifying Symptomatic Disc Herniations , 1995, Spine.

[40]  N. Bogduk,et al.  The menisci of the lumbar zygapophysial joints. , 1982, Journal of anatomy.

[41]  R. Louis,et al.  Spinal stability as defined by the three-column spine concept , 2005, Anatomia Clinica.

[42]  R A Deyo,et al.  Cost, controversy, crisis: low back pain and the health of the public. , 1991, Annual review of public health.

[43]  K. Yamaguchi,et al.  Orientation of the Lumbar Facet Joints: Association with Degenerative Disc Disease* , 1996, The Journal of bone and joint surgery. American volume.

[44]  King H. Yang,et al.  Mechanism of facet load transmission as a hypothesis for low-back pain. , 1984, Spine.

[45]  N. Bogduk.  The Innervation of the Lumbar Spine , 1983, Spine.

[46]  L. Yahia,et al.  Structure on the capsular ligaments of the facet joints. , 1993, Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft.

[47]  J. Taylor,et al.  Innervation of lumbar zygapophyseal joint synovial folds. , 1987, Acta orthopaedica Scandinavica.

[48]  J. Kellgren,et al.  Osteo-arthrosis and Disk Degeneration in an Urban Population * , 1958, Annals of the rheumatic diseases.

[49]  M. Pollay,et al.  Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. , 1983, Neurosurgery.

[50]  M. Pope,et al.  Etiology of Spondylolisthesis: Assessment of the Role Played by Lumbar Facet Joint Morphology , 1993, Spine.

[51]  B. Vernon‐roberts,et al.  Osteoarthrosis of the facet joints resulting from anular rim lesions in sheep lumbar discs. , 1999, Spine.

[52]  R. Putz.  The functional morphology of the superior articular processes of the lumbar vertebrae. , 1985, Journal of anatomy.

[53]  V. Haughton,et al.  Intraspinal synovial cysts: natural history and diagnosis by CT. , 1982, Radiology.

[54]  J. Polak,et al.  Morphological basis for back pain: The demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum , 1992, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[55]  F. Postacchini.  Management of lumbar spinal stenosis. , 1996, The Journal of bone and joint surgery. British volume.

[56]  D. Resnick.  Diagnosis of Bone and Joint Disorders , 1987 .

[57]  J. M. Dumas,et al.  Intraarticular facet block: diagnostic test or therapeutic procedure? , 1984, Radiology.

[58]  Nikolai Bogduk,et al.  Clinical Anatomy of the Lumbar Spine , 1987 .

[59]  M. Barry,et al.  Facet joint hypertrophy: The cross-sectional area of the superior articular process of L4 and L5 , 2005, European Spine Journal.

[60]  P. Qvist,et al.  Collagen type II C-telopeptide fragments as an index of cartilage degradation. , 2001, Bone.

[61]  E. Ma,et al.  Innervation of the lumbar spine. , 1976 .

[62]  R. Jackson.  The facet syndrome. Myth or reality? , 1992, Clinical orthopaedics and related research.

[63]  R. Fraser,et al.  Degenerative spondylolisthesis. Developmental or acquired , 1999 .

[64]  N. Langrana,et al.  Role of Ligaments and Facets in Lumbar Spinal Stability , 1995, Spine.

[65]  A B Lippitt,et al.  The Facet Joint and Its Role in Spine Pain: Management With Facet Joint Injections , 1984, Spine.

[66]  Manohar M. Panjabi,et al.  Clinical Biomechanics of the Spine , 1978 .

[67]  M. Zanetti,et al.  MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. , 1998, Radiology.

[68]  T. Lewin,et al.  OSTEOARTHRITIS IN LUMBAR SYNOVIAL JOINTS. A MORPHOLOGIC STUDY. , 1964, Acta orthopaedica Scandinavica. Supplementum.

[69]  J M Links,et al.  Planar and high-resolution SPECT bone imaging in the diagnosis of facet syndrome. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[70]  D. Resnick,et al.  Degenerative Disease of the Spine , 2005 .

[71]  R A Deyo,et al.  The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: Baseline Data , 2001, Spine.

[72]  M. Dougados,et al.  Uncoupling of type II collagen synthesis and degradation predicts progression of joint damage in patients with knee osteoarthritis. , 2002, Arthritis and rheumatism.

[73]  G. Buirski,et al.  The symptomatic lumbar disc in patients with low-back pain. Magnetic resonance imaging appearances in both a symptomatic and control population. , 1993, Spine.

[74]  A. Nachemson,et al.  Newest knowledge of low back pain. A critical look. , 1992, Clinical orthopaedics and related research.

[75]  T Videman,et al.  Magnetic Resonance Imaging Findings and Their Relationships in the Thoracic and Lumbar Spine: Insights Into the Etiopathogenesis of Spinal Degeneration , 1995, Spine.

[76]  L. Manchikanti,et al.  Prevalence of lumbar facet joint pain in chronic low back pain. , 1999, Pain physician.

[77]  Seung-Ho Han,et al.  Morphometry of the lumbar zygapophyseal facet capsule and cartilage with special reference to degenerative osteoarthritic changes: an anatomical study using fresh cadavers of elderly Japanese and Korean subjects , 2004, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[78]  Nicholas,et al.  Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. , 1990, The Journal of bone and joint surgery. American volume.

[79]  S. Peleg,et al.  Facet Orientation in the Thoracolumbar Spine: Three-dimensional Anatomic and Biomechanical Analysis , 2004, Spine.

[80]  B. Vernon‐roberts,et al.  Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. , 1977, Rheumatology and rehabilitation.

[81]  N. Bogduk,et al.  The Ability of Computed Tomography to Identify a Painful Zygapophysial Joint in Patients With Chronic Low Back Pain , 1995, Spine.

[82]  L. Giles,et al.  Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. , 1987, British journal of rheumatology.

[83]  D. Kubein-Meesenburg,et al.  Elements of a general theory of joints. 7. Mechanical structures of the relative motion of adjacent vertebrae. , 1992, Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft.

[84]  Howard S. An,et al.  The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study , 1999, European Spine Journal.

[85]  Dominik Weishaupt,et al.  MR imaging and CT in osteoarthritis of the lumbar facet joints , 1999, Skeletal Radiology.

[86]  M. Osteaux,et al.  Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. , 1998, Radiology.

[87]  G B Andersson,et al.  The Effect of Disc Degeneration and Facet Joint Osteoarthritis on the Segmental Flexibility of the Lumbar Spine , 2000, Spine.

[88]  W. Baker.  On the formation of synovial cysts in the leg in connection with disease of the knee-joint. 1877. , 1994, Clinical orthopaedics and related research.

[89]  J E Smeathers,et al.  Human lumbar apophyseal joint damage and intervertebral disc degeneration. , 1995, Annals of the rheumatic diseases.

[90]  M. Adams,et al.  The Mechanical Function of the Lumbar Apophyseal Joints , 1983, Spine.

[91]  B. Latimer,et al.  The Thoracic and Lumbar Vertebrae , 1993 .

[92]  N. Rosenberg.  Degenerative spondylolisthesis. Predisposing factors. , 1975, The Journal of bone and joint surgery. American volume.

[93]  Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiscal structures of the spinal column and perispinal soft tissues. , 2004 .

[94]  M. Panjabi,et al.  Articular Facets of the Human Spine Quantitative Three‐Dimensional Anatomy , 1993, Spine.

[95]  V. Haughton,et al.  Age‐related changes in the lumbar facet joints , 1989 .

[96]  J. Weinreb,et al.  Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women. , 1989, Radiology.

[97]  W C Hutton,et al.  The effect of posture on the role of the apophysial joints in resisting intervertebral compressive forces. , 1980, The Journal of bone and joint surgery. British volume.

[98]  R. Jackson,et al.  1988 Volvo Award in Clinical Sciences: Facet Joint Injection in Low-Back Pain: A Prospective Statistical Study , 1988, Spine.

[99]  N. Bogduk,et al.  Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. , 1995, Annals of the rheumatic diseases.

[100]  M. Benjamin,et al.  An Immunohistochemical Study of the Dorsal Capsule of the Lumbar and Thoracic Facet Joints , 2001, Spine.

[101]  W. Hutton,et al.  The tensile strength of the capsular ligaments of the apophyseal joints. , 1981, Journal of anatomy.

[102]  W C Hutton,et al.  Disc space narrowing and the lumbar facet joints. , 1984, The Journal of bone and joint surgery. British volume.

[103]  O. Lévrier,et al.  Retrospective study of 77 patients harbouring lumbar synovial cysts: Functional and neurological outcome , 2005, Acta Neurochirurgica.

[104]  J. Hipp,et al.  Low back pain: prediction of short-term outcome of facet joint injection with bone scintigraphy. , 2006, Radiology.

[105]  Casey K. Lee,et al.  The Lumbar Facet Syndrome , 1988, Spine.

[106]  S P Raskin,et al.  Degenerative changes of the lumbar spine: assessment by computed tomography. , 1981, Orthopedics.

[107]  M. Modic,et al.  Magnetic resonance imaging of intervertebral disk disease. Clinical and pulse sequence considerations. , 1984, Radiology.

[108]  V. Goldberg,et al.  Estrogens and Osteoarthritis , 1986, Clinical orthopaedics and related research.

[109]  M. Adams.  The Biomechanics of Back Pain , 2002 .

[110]  C. Warfield,et al.  Facet joint degeneration as a cause of low back pain. , 1986, Clinical orthopaedics and related research.

[111]  J. Wolff.  Das Gesetz der Transformation der Knochen , 1893 .

[112]  A. Nachemson,et al.  Lumbar intradiscal pressure. Experimental studies on post-mortem material. , 1960, Acta orthopaedica Scandinavica. Supplementum.

[113]  James D. Kang,et al.  Lumbar spine listhesis in older African American women. , 2003, The spine journal : official journal of the North American Spine Society.

[114]  I. F. Duff,et al.  Age-sex specific prevalence of radiographic abnormalities of the joints of the hands, wrists and cervical spine of adult residents of the Tecumseh, Michigan, Community Health Study area, 1962-1965. , 1970, Journal of chronic diseases.

[115]  D. W. Bühler,et al.  Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism , 1998, European Spine Journal.

[116]  S. Herring,et al.  Lumbar zygapophysial (facet) joint injections. , 1995, Spine.

[117]  P. Ševčík,et al.  [Meniscoids of the intervertebral joints]. , 2002, Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca.

[118]  W. Baker.  On the formation of synovial cysts in the leg in connection with disease of knee-joint , 1877 .

[119]  N. Bogduk,et al.  Clinical Features of Patients with Pain Stemming from the Lumbar Zygapophysial Joints: Is the Lumbar Facet Syndrome a Clinical Entity? , 1994, Spine.

[120]  B. Walker,et al.  The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. , 2000, Journal of spinal disorders.

[121]  Misop Han,et al.  Radiofrequency lumbar facet denervation: analysis of prognostic factors , 1994, Pain.

[122]  A. Patwardhan,et al.  Load-bearing characteristics of lumbar facets in normal and surgically altered spinal segments. , 1983, Spine.

[123]  L. Manchikanti,et al.  The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents , 2000, Current review of pain.

[124]  J. E. Goldthwait.  The Lumbo-Sacral Articulation; An Explanation of Many Cases of "Lumbago," "Sciatica" and Paraplegia , 1911 .

[125]  B. Vernon‐roberts,et al.  Early histologic changes in lower lumbar discs and facet joints and their correlation , 2000, European Spine Journal.

[126]  H. An,et al.  Orientation and Osteoarthritis of the Lumbar Facet Joint , 2001, Clinical orthopaedics and related research.