The correlation between radiographic and pathologic grading of lumbar facet joint degeneration

BackgroundBefore performing spine non-fusion surgery that retains the facet joints, choosing an accurate radiographic method to evaluate the degree of facet joint degeneration is extremely important. Therefore, the objective of this study was to determine the accuracy and reliability of different radiographic classifications by analyzing the correlation between radiographic and pathologic grading of lumbar facet joint degeneration. Taking the pathologic examination as standard, the consistency of computed tomography (CT) and magnetic resonance imaging (MRI) assessment of lumbar facet joint degeneration was compared.MethodsA total of 74 facet joints obtained from 42 patients who underwent posterior lumbar surgery were evaluated. All patients underwent CT and MRI before surgery. The pathologic grade was evaluated with a method based on hematoxylin-eosin and toluidine blue staining. The radiographic grade was evaluated using the methods proposed by different authors.ResultsThere was a moderate consistency between pathologic and radiographic grading for facet joint degeneration. The weighted kappa coefficients comparing pathologic with radiographic grading were 0.506 for CT, 0.561 for MRI, and 0.592 for CT combined with MRI, respectively. Taking the pathologic examination as standard, the consistency of CT and MRI examination was also moderate, and the weighted kappa coefficient was 0.459.ConclusionThe radiographic examination has moderate accuracy and reliability for evaluating degeneration of facet joints. Therefore, a more accurate method for evaluating the degeneration of facet joints is necessary before performing spine non-fusion surgery that retains the facet joints.

[1]  Laxmaiah Manchikanti,et al.  Prevalence of facet joint pain in chronic low back pain in postsurgical patients by controlled comparative local anesthetic blocks. , 2007, Archives of physical medicine and rehabilitation.

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

[3]  Kazuteru Doi,et al.  Computed Tomography of the Facet Joints in Lumbal Canal Stenosis , 1986 .

[4]  L. Duong,et al.  Characterization of articular cartilage and subchondral bone changes in the rat anterior cruciate ligament transection and meniscectomized models of osteoarthritis. , 2006, Bone.

[5]  H. Hall,et al.  Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease , 2001, European Spine Journal.

[6]  A Guermazi,et al.  Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults. , 2013, Osteoarthritis and cartilage.

[7]  Jeffrey N. Katz,et al.  Osteoarthritis of the spine: the facet joints , 2013, Nature Reviews Rheumatology.

[8]  Harrie Weinans,et al.  A role for subchondral bone changes in the process of osteoarthritis; a micro-CT study of two canine models , 2008, BMC musculoskeletal disorders.

[9]  J. Jordan,et al.  Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related? , 2013, Current Rheumatology Reports.

[10]  J. Mcclure,et al.  The normal human chondro-osseous junctional region: evidence for contact of uncalcified cartilage with subchondral bone and marrow spaces , 2006, BMC musculoskeletal disorders.

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

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

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

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

[15]  H Weinans,et al.  Cartilage damage pattern in relation to subchondral plate thickness in a collagenase-induced model of osteoarthritis. , 2008, Osteoarthritis and cartilage.

[16]  Toru Okano,et al.  Role of subchondral bone in osteoarthritis development: a comparative study of two strains of guinea pigs with and without spontaneously occurring osteoarthritis. , 2007, Arthritis and rheumatism.

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

[18]  Christian Woiciechowsky,et al.  The short- and mid-term effect of dynamic interspinous distraction in the treatment of recurrent lumbar facet joint pain , 2009, European Spine Journal.

[19]  D. Burr,et al.  Anatomy and physiology of the mineralized tissues: role in the pathogenesis of osteoarthrosis. , 2004, Osteoarthritis and cartilage.

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

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

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

[23]  M. Müller-Gerbl,et al.  A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITÉ™ Artificial Disc , 2006, European Spine Journal.

[24]  M. Modic,et al.  Magnetic resonance imaging in the evaluation of low back pain. , 1991, The Orthopedic clinics of North America.

[25]  Leonid Kalichman,et al.  Lumbar facet joint osteoarthritis: a review. , 2007, Seminars in arthritis and rheumatism.

[26]  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.

[27]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[28]  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.

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

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

[31]  Harrie Weinans,et al.  Osteoarthritis induction leads to early and temporal subchondral plate porosity in the tibial plateau of mice: an in vivo microfocal computed tomography study. , 2011, Arthritis and rheumatism.