Atsushi Fujiwara, Kazuya Tamai, Minoru Yamato, Howard S.

An, Hiroyuki Yoshida, Koichi Saotome, Akira Kurihashi Eur Spine J (1999) 8 : 396–401

Patrick William Gading Examiner : dr.Nyimas Diana Yulisa, SpRad(K)

 Disc degeneration & facet joint OA play an important

role in spinal degeneration .  Previous studies  incidence of these changes increases with age and disc degeneration usually proceeds facet joint OA  MRI  diagnostic test of choice in evaluating disc degeneration  not evaluate facet joint OA as accurately as CT

.  Determine the relationship between disc degeneration and facet joint OA.  A grading system for facet joint OA relationship between disc degeneration & facet joint OA  determined more accurately.Purpose  Evaluate the accuracy of MRI in assessing facet joint OA.

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Average age  52.7 yrs (22–75 yrs). Shimadzu 150SMT) and CT (Xforce or TCT-900S.Assessment of facet joint OA on MRI  84 lumbar facet joints  14 candidates (7 male & 7     female) for lumbar spine surgery with degenerative disc disease Analyzed  MRI (a 1. Toshiba). Parallel to disc spaces at L3-4. Degrees of OA  Pathria’s criteria for grading of facet joint OA on CT .5-T unit. with 5-mm consecutive slice thickness. L4-5. and L5-S1 levels.

Grade 1 Normal .

Grade 2 Mild (joint space narrowing or mild osteophyte) .

Grade 3 Moderate (sclerosis or moderate osteophyte) .

Grade 4 Severe (marked osteophyte) .

traumatic or tumorous disorders.2 yrs (13 to 81 yrs). Excluded  Previous back surgery. L3-4. 88 patients male and 95 female. L4-5. . congenital anomalies.8 ± 18. and L5-S1 were examined. 1.5 T) & x-rays of the lumbar spine.Relationship between disc degeneration and facet joint OA  183 consecutive patients with LBP and/or leg     symptoms  both MRI (SHIMADZ SMT 150GUX. or infectious. Average age  46.

. endplate and vertebral body.  Facet joint OA  four grades on axial spin echo T1weighted images  To minimize bias  disc degeneration and facet joint OA were scored independently. Disc degeneration  Thompson’s grading system (5 grades on T2-weighted midsagittal images)  degenerative status of the nucleus. annulus.

05. Median grade of disc degeneration & facet joint OA was calculated at each intervertebral level. Correlation between disc degeneration and facet joint OA  Kendall’s tau-b test. Mean age  determined at each grade of disc     degeneration & facet joint OA Differences between the grades  one-way ANOVA. . Statistical significance  P < 0.

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and 6 joints (7%) as grade 4. and 8 (9. . 12 joints (15%) as grade 3.  MRI reader 1  36 joints (44%) as grade 1. 25 (31%) grade 3.Assessment of facet joint OA on MRI  82 facet joints were evaluated on both CT & MRI.  CT scans  30 joints (37%) were considered to be grade 1.  MRI reader 2  29 joints (35%) as grade 1. and 6 joints (7%) as grade 4. 36 joints (44%) as grade 2. 19 (23%) grade 2.8%) grade 4. 28 joints (34%) as grade 2. 11 joints (13%) as grade 3.

 30 facet joints regarded as normal on CT:  MRI Reader 1  normal in 28 joints  MRI Reader 2  normal in 26 joints • Sensitivity for MRI  88% and 98% • Specificity for MRI  90% and 87%  Accuracy for MRI  93% and 94% . 52 facet joints regarded as having OA on CT:  MRI Reader 1  OA in 46 joints  MRI Reader 2  OA in 51 joints.

 The calculated kappa value for perfect agreement was 0. Perfect interobserver agreement in MRI in 62 of 82 joints (76%). and agreement to within one grade in an additional 20 joints (24%).636. .

.Disc degeneration and facet joint OA  183 intervertebral levels in L3-4.7 years). female: 45. and 173 in L5-S1.  No significant differences  mean age between male and female patients (male: 48.  No significant sex difference  grade of facet joint OA at each intervertebral level. 181 in L4-5.  No significant sex difference  grade of disc degeneration at each intervertebral level.0 years.

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 Most facet joint OA appeared at the intervertebral levels with grade IV or V disc degeneration. .001).460 at the L4-5 level. Table 2  relationship between disc degeneration and facet joint OA  No facet joint OA was found in the absence of disc degeneration.  The calculated correlation coefficient value was 0.584 at the L3-4 level. and 0.310 at the L5-S1 level. 0.  There was a significant correlation between severity of disc degeneration and facet joint OA (P < 0.

 Over the age 60. .05)  no significant differences between L3-4 and L5-S1. most of the discs were markedly degenerated.  Degree of disc degeneration varied among individuals under 40 years of age. and between L4-5 and L5-S1. Median of disc degeneration grade at the L3-4  significantly lower than L4-5 and L5-S1 levels (P < 0.  Median grade of facet joint OA at L4-5 significantly higher than that at L3-4 (P < 0.001)  no significant difference in the grade of disc degeneration between L4-5 and L5-S1.

8 years for grade V.8 years for grade III.2 years for grade IV. Mean age of each grade of disc degeneration L4-5:  23.  52.  35.5 years for grade II.  41.1 years for grade I. except for the difference between grades II and III .  Mean age significantly increased with the progression of disc degeneration grade.  61.

 Mean age of each grade of facet joint OA  35. Osteoarthritic changes  facet joints were minimal under 40 years of age  after that age facets gradually degenerated. 57.001).05). and 68. 65.5 years for grade 3. and between grades 2 and 4 (P < 0. .  The mean age increased with the progression of facet joint OA  but statistical significance  only between grade 1 and all other grades (P < 0.8 years for grade 4.5 years for grade 2.9 years for grade 1.

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 Conventional radiography  common screening method to evaluate these changes  has significant limitations in detecting early facet joint OA  CT  depict the facet joint in the axial plane and has accurately demonstrated the osteoarthritic changes of the facet joint.Assessment of facet joint OA on MRI  Osteoarthritic changes  pathologically defined as cartilage loss. and osteophyte formation.  MRI  axial and sagittal images of the lumbar facet joints in degenerative spinal disease  but capability of depicting facet joint OA has been less examined in the literature . subchondral bone sclerosis.

 The present study supported their results and demonstrated the 93% accuracy.8 years and the prevalence of facet joint OA was 38%. although they used T2-weighted spin echo images.8. .  This study  patients’ mean age was 46.  accuracy of facet joint OA against CT  MRI accuracy in assessing facet joint OA was 95%.  presence of facet joint OA using CT. Weishaupt et al.  Butler et al. with a mean age of 41.  consistent with previous CT studies. 21% of their patients. showed OA.

MRI can be a substitute for CT in assessing OA of the lumbar facet joints.  MRI  less sensitive in depicting the bony cortex margin & thinning of the cartilage can not be measured accurately with MRI  partial volume effect & chemical-shift artifact. .  Accuracy and interobserver agreement of MRI for assessing OA of the lumbar facet joints are acceptable.  Therefore. MRI  tends to underestimate the severity of OA as compared with CT.

Miller et al. . Males > females  disc degeneration and the L4-5 and L5-S1 levels > degenerated than the L3-4 level.  study of a large sample of autopsies  L3-4 and L4-5 discs > degenerated than the L5-S1 discs This study also showed that there is a relationship between disc degeneration and aging.Disc degeneration and facet joint OA  Postmortem and radiographic studies  close     relationship between disc degeneration & aging. The L4-5 and L5-S1 discs were more significantly degenerated than the L3-4 discs in our study.

 The present study demonstrated a similar prevalence of facet joint OA. subchondral sclerosis and osteophytes became common phenomena. The prevalence of facet joint OA also increases with age.  After 45  advanced chondral changes.  Lewin  facet joints showed only minor chondral changes before the age of 45. .

 Lewin  apart from the L5-S1 motion segment.  Also determined  an inverse relationship between severity of OA and the preservation of the disc structure. as facet joints degenerate as a result of disc degeneration. disc degeneration did not seem to be the sole or dominant factor predisposing to the onset and development of OA of the lumbar synovial joints. Previous studies  intervertebral disc as initial site of spinal degeneration. .  Vernon-Roberts & Pirie  disc degeneration was the primary event leading to osteophyte formation and to facet joint changes.

 Butler et al. facet degeneration preceded disc degeneration. and concluded that discs degenerated before facets. . Videman et al.  MRI and CT scans to determine disc     degeneration to determine the occurrence of facet joint OA. Also supports the concept that it may take many years to develop facet joint OA following the onset of disc degeneration. Our results  facet joint OA was not found without disc degeneration & most facet joint OA was associated with the grade IV or V disc degeneration.  20% of degenerative spines. This study supports the hypothesis that “disc degeneration precedes facet joint OA”.

such as minor chondral changes and synovial inflammation. can not detect early changes of facet joint OA.  Further studies are needed in assessing the morphology and pathogenesis of facet joint OA . Limitations  Routine MRI or CT.  Clinically. it is important to know whether the facet joint is painful or not  limits imaging studies based on the morphological changes of facet joint OA.

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 This paper showed that MRI is a reasonable tool for assessment of facet joint OA. which can be helpful in research as well as clinically.  It is clear that discs degenerate prior to facets become arthritic.  The relationship between disc degeneration and facet joint OA is an expected finding.  A grading system to assess the severity of the facet joint OA is presented. . and facet joint OA is usually associated with advanced disc degeneration. but this paper showed that disc degeneration is more closely associated with aging than with facet joint OA.

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