OBJECTIVE: To evaluate the effectiveness of the single-stage anterior eccentric kyphotic distraction reduction technique (EKD-RT) for treating lower cervical dislocation with locked facet joints, assessing its reduction success rate, neurological improvement, and safety. METHODS: A retrospective analysis was conducted on 67 patients with lower cervical dislocation and locked facet joints (21 unilateral, 46 bilateral) treated between January 2015 and January 2024. There were 39 males and 28 females, with an average age of 49.5 years (range, 22-75 years). The injured segments included C _{3, 4} in 4 cases, C _{4, 5} in 13 cases, C _{5, 6} in 22 cases, and C _{6, 7} in 28 cases. The interval between injury and admission ranged from 2 hours to 2 days (mean, 5.6 hours). Preoperative Frankel grading included grade A in 9 cases, grade B in 28 cases, grade C in 17 cases, grade D in 11 cases, and grade E in 2 cases. Japanese Orthopaedic Association (JOA) score was 7.0±1.4. All patients underwent single-stage anterior cervical discectomy and fusion. Following discectomy at the dislocated level, the EKD-RT was applied to unlock and reduce the locked facet joints, followed by internal fixation. Operation time, blood loss, reduction success rate, and complications were recorded. Interbody fusion status was evaluated using Bridwell criteria. Neurological status was assessed pre- and post-operatively using Frankel grading. Spinal cord function was scored using the 17-point JOA score, and the improvement rate was calculated. RESULTS: Successful reduction of the locked facet joints achieved in all cases. The operation time was 41-85 minutes (range, 63.3 minutes), and intraoperative blood loss was 50-360 mL (range, 125.0 mL). Complications included cerebrospinal fluid leakage in 2 cases; no severe complications such as major vascular injury or recurrent laryngeal nerve injury occurred. All patients were followed up 12-24 months (mean, 17.9 months). At last follow-up, radiological examination confirmed interbody fusion in all patients, with no implant failure or migration. The Frankel grading included grade A in 3 cases, grade B in 9 cases, grade C in 13 cases, grade D in 16 cases, and grade E in 26 cases; the JOA score reached 13.7±2.3; all of which significantly improved compared to preoperative levels ( P<0.05). The improvement rate of JOA score was 66.1%±24.7%. CONCLUSION The EKD-RT is an effective surgical approach for lower cervical dislocation with locked facet joints. It enables safe and efficient reduction of the locked facet joints via a single incision, resulting in significant neurological improvement with a low complication rate.
Humans ; Male ; Middle Aged ; Female ; Cervical Vertebrae/diagnostic imaging* ; Retrospective Studies ; Adult ; Aged ; Zygapophyseal Joint/injuries* ; Joint Dislocations/diagnostic imaging* ; Treatment Outcome ; Spinal Fusion/methods* ; Young Adult ; Kyphosis/surgery*

OBJECTIVE: To compare and analyze the feasibility of autologous facet joint bone block as an alternative to polyetheretherketone (PEEK) cage in lumbar intervertebral fusion surgery for patients with osteoporosis. METHODS: From December 2018 to June 2021, the case data of patients with osteoporosis (T value ≤ -2.5 on dual energy X-ray bone density) who underwent posterior lumbar interbody fusion in the Fourth Medical Center, Chinese PLA General Hospital were retrospectively reviewed. All the cases were followed up for no less than 12 months and were divided into two groups according to the differences of interbody fusion materials: the autologous facet joint bone block group (autogenous bone group) and the PEEK cage group (PEEK group). The general data [such as age, gender, body mass index (BMI), primary diagnosis, distribution of fusion segments, bone mineral density of lumbar (BMD), incidence of preoperative complications], the perioperative data (such as duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate), and the incidence of postoperative complications were compared between the two groups. Imaging parameters (disc height, lumbar lordosis angle, segment lordosis angle, segmental lordosis angle, disc height improvement rate, and fusion rate) and lumbar functional scores [visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedics Association (JOA) score for lower back pain] were compared to evaluate the clinical efficacy between the kinds of intervertebral fusion materials 1 week, 3 months and 6 months postoperative and at the last follow-up. RESULTS: A total of 118 patients were enrolled, including 68 cases in the autogenous bone group and 50 cases in the PEEK group, there were no statistical differences in age, gender, BMI, primary diagnosis, distribution of fusion segments, BMD, incidence of preoperative complications, duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate, incidence of postoperative complications, all the preoperative imaging parameters and all the lumbar function scores between the two groups (P>0.05). Postoperative superficial surgical site infections occurred in 3 patients in the autogenous bone group and 2 patients in the PEEK group. At the last follow-up, 3 cases of intervertebral graft collapse occurred in the autogenous bone group and 5 cases in the PEEK group, 1 case of graft subsidence in the autogenous bone group and 1 case in the PEEK group. All the imaging parameters showed significant differences between postoperation and preoperation (P < 0.05), and all the imaging parameters showed significant differences between 1 week and 3 months postoperative in both groups (P < 0.05). The height, angle of fusion gap in the autogenous bone group were lower than those in the PEEK group 1 week postoperatively (P < 0.05), and the fusion gap height improvement rate in the autogenous bone group was lower than that in the PEEK group (P < 0.05). The cases in both groups started to show final fusion 3 months after surgery, and the fusion rate in the autogenous bone group was 75% 6 months postoperatively, which was significantly higher than the rate of 56% in the PEEK group (P < 0.05), and there was no statistically significant difference in the final fusion rate between the two groups (P>0.05). The ODI, the postoperative VAS score was significantly lower than that in preoperation, while the postoperative JOA score was significantly higher than that in preoperation (P < 0.05). The ODI was lower while the JOA score was higher of the autogenous bone group than that of the PEEK group 6 months postoperatively (P < 0.05). CONCLUSION In osteoporosis patients, good interbody fusion rate and improvement of lumbar vertebral function can be obtained by using autologous facet joint bone block or PEEK cage, while the fusion rate and the improvement of lumbar function with autologous facet joint bone block are better than those with PEEK cage 6 months post-operatively. PEEK cage is superior to autologous facet joint bone block in intervertebral distraction and improvement of lumbar lordosis. Significant disc space subsidence occurred in osteoporotic patients within 3 months after lumbar interbody fusion, and the subsidence of PEEK cage was more obvious than that of autologous facet joint bone block.
Humans ; Retrospective Studies ; Lordosis ; Zygapophyseal Joint ; Spinal Fusion/methods* ; Polyethylene Glycols/therapeutic use* ; Treatment Outcome ; Ketones ; Lumbar Vertebrae/surgery* ; Osteoporosis ; Blood Loss, Surgical ; Postoperative Complications ; Postoperative Hemorrhage

OBJECTIVE: To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation. METHODS: A retrospective analysis was performed on 138 patients who underwent L₅S₁ posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L_4,5 facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L_4,5 intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed. RESULTS: There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L_4,5 intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (P<0.001), with no significant difference between the groups(P>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (P<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (P<0.0167, Bonferroni correction). CONCLUSION Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.
Humans ; Intervertebral Disc Degeneration/surgery* ; Zygapophyseal Joint/surgery* ; Retrospective Studies ; Spinal Fusion/adverse effects* ; Lumbar Vertebrae/surgery* ; Spondylosis ; Treatment Outcome

OBJECTIVES: Quantitative magnetic resonance imaging has been successfully applied to assess the status of cartilage biochemical components. This study aimed to investigate the performance of 3.0T magnetic resonance imaging T mapping combined with texture analysis for evaluating the early degeneration of lumbar facet joints. METHODS: A total of 38 patients (20 in the asymptomatic group and 18 in the symptomatic group) were enrolled. All patients underwent 3.0T magnetic resonance imaging conventional sequences, water excitation three-dimensional spoiled gradient echo sequence (3D-WATSc), and T mapping scans. The bilateral L and L/S lumbar facet joints were morphological graded using the Weishaupt criteria, T values, and texture parameters derived from T mapping of cartilage. The Kruskal-Wallis test was used to compare the differences of parameters among different groups. Multivariate logistic regression analysis was used to obtain the independent predictive factors for evaluating the early degeneration of lumbar facet joints. Receiver operating characteristic (ROC) curve was performed and the area under curve (AUC) was calculated. Spearman correlation analysis was used to evaluate the correlation of the independent predictors of cartilage T value and texture parameters with the subjects' Japanese Orthopedic Association (JOA) score or Visual Analogue Scale (VAS) score. RESULTS: A total of 148 facet joints were selected, including 70 in Weishaupt 0 (normal) group, 58 in Weishaupt 1 group, and 20 in Weishaupt 2-3 group. T value, entropy, and contrast increased significantly as the exacerbation of facet joint degeneration (all <0.05), while the inverse difference moment, energy, and correlation decreased (all <0.05). Entropy among different groups was significantly different (all <0.05), and the differences of T value, contrast, inverse difference moment, and energy between Weishaupt 0 and Weishaupt 1 groups, or Weishaupt 0 and Weishaupt 2-3 groups were statistically significant (all <0.05). Multivariate logistic regression analysis suggested that T value and inverse difference moment were the independent predictors for evaluating early degeneration of facet joints. The combination of T value with inverse difference moment achieved the best performance in distinguishing Weishaupt 0 from Weishaupt 1 (AUC=0.85), with sensitivity and specificity at 92.7% and 76.5%, respectively. In the symptom group, the cartilage T value combined inverse difference moment was positively correlated with JOA score (=0.475, <0.05) and VAS score (=0.452, <0.05). CONCLUSIONS 3.0T magnetic resonance imaging T mapping combined with texture analysis is helpful to quantitatively evaluate the early degeneration of lumbar facet joints, in which the T value and inverse difference moment show an indicative significance．.
Algorithms ; Humans ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Sensitivity and Specificity ; Spondylosis ; Zygapophyseal Joint

OBJECTIVE: To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin’s safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy.METHODS: Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin’s triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken.RESULTS: The mean root to facet distances at upper end plate level measured on axial sections increased from 3.42±3.01 mm at L12 level to 4.57±2.49 mm at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from 6.07±1.13 mm at L12 level to 12.9±2.83 mm at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin’s triangle increased from 5.67±1.38 mm at L12 level to 9.7±3.82 mm at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin’s triangle also increased from 4.03±1.08 mm at L12 level to 6.11±1 mm at L5S1 level. Only 2% of the 427 bony Kambin’s triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin’s triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view.CONCLUSION: The largest mean diameter of endoscopic cannula passable through “bony” Kambin’s triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through “neural” Kambin’s triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.
Anatomy, Regional ; Catheters ; Diskectomy ; Endoscopy ; Female ; Humans ; Intervertebral Disc ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Zygapophyseal Joint

OBJECTIVE: To investigate the role of lumbar facet joint degeneration in the development of degenerative lumbar scoliosis caused by asymmetric stress. METHODS: Thirty-six New Zealand white rabbits were randomly divided into 3 groups (n=12): Group A with aspiration of the nucleus pulposus to induce disc degeneration; Group B with removal of the left capsule from the facet joints at L3/4 to L5/6 to induce degeneration; and Group C with both treatments. Springs were deployed on the left adjacent facets at L3/4, L5/6 and L5/6 to stress the facet joints. Serial radiographs were taken at 3 and 6 months, and the facet joint tissues were sampled at 6 months for Safranin O-fast green staining to assess the severity of cartilage degeneration based on the Mankin score. RESULTS: The Cobb angle differed significantly among the 3 groups (=24.865, =0.000). In all the groups, the Cobb angles at 6 months increased significantly as compared with that at 3 months ( <0.05). The Cobb angles were significantly greater in group C than in the other 2 groups at both 3 and 6 months ( <0.05) but showed no significant difference between Groups A and B (>0.05). The severity of facet joint degeneration also differed significantly among the 3 groups (= 22.009, =0.000), and was the most severe in group C ( <0.05); facet joint degeneration was more severe in group B than in group A ( <0.05). CONCLUSIONS Facet joint degeneration is an important factor that contributes to the development of degenerative lumbar scoliosis. Disc degeneration and facet joints degeneration can lead to lumbar scoliosis, which in turn aggravates disc degeneration, facet joints degeneration and asymmetric stress, thus forming a vicious circle to further exacerbate lumbar scoliosis.
Animals ; Intervertebral Disc Degeneration ; Lumbar Vertebrae ; Lumbosacral Region ; Rabbits ; Scoliosis ; Stress, Physiological ; Zygapophyseal Joint

joint disk-like structure at the anterior component of the median atlanto-axial joint. At mid-term, the disk-like structure was thick (0.1–0.15 mm) relative to the sizes of bones surrounding the joint. However, it did not completely separate the joint cavity, and was absent in the inferior and/or central part of the cavity. This morphology was similar to the so-called fibroadipose meniscoid of the lumbar zygapophysial joint that is usually seen in adults. In mid-term fetuses, there was evidence suggesting that a mesenchymal tissue plate was separated from a roof of the joint cavity. In late-stage fetuses, the thickness (less than 0.15 mm) was usually the same as, or less than that at mid-term, and the disk-like structure was often flexed, folded and fragmented. Therefore, in contrast to the zygapophysial meniscoid as a result of aging, the present disk-like structure was most likely a temporary product during the cavitation process. It seemed to be degenerated in late-stage fetuses and possibly also in newborns. Anomalies at the craniocervical junction such as Chiari malformations might accompany this disk-like structure at the median atlanto-axial joint even in childhood.]]>
Adult ; Aging ; Atlanto-Axial Joint ; Fetus ; Humans ; Infant, Newborn ; Joints ; Zygapophyseal Joint

No abstract available.
Prolapse ; Tropism ; Zygapophyseal Joint

No abstract available.
Prolapse ; Tropism ; Zygapophyseal Joint

BACKGROUND: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. METHODS: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. RESULTS: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). CONCLUSIONS: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.
Buttocks ; Diagnosis ; Follow-Up Studies ; Humans ; Nerve Block ; Pain, Referred ; Prospective Studies ; Radiculopathy ; Spinal Diseases ; Spinal Stenosis ; Visual Analog Scale ; Zygapophyseal Joint