A Biomechanical Assessment of Soft-Tissue Damage in the Cervical Spine Following a Unilateral Facet Injury

Nadeau, Melissa; McLachlin, Stewart D.; Bailey, Stewart I.; Gurr, Kevin R.; Dunning, Cynthia E.; Bailey, Christopher S.

doi:10.2106/jbjs.k.00694

Cited by 32 publications

(14 citation statements)

References 24 publications

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“…Further refined categorical descriptions of injury and introductions of graphic representations and example cases may result in higher agreement values. Another factor contributing to ambiguity of facet joint injury categories is that some surgeons consider facet joint injuries with the appearance of a unilateral injury on imaging as a bilateral injury by definition [17]. Some authors have advocated the use of magnetic resonance (MR) imaging for classifying facet joint injuries [18], however, a recent systematic review indicated that MR imaging resulted in poor agreement values for detecting discoligamentous injuries of the thoracolumbar spine [19].…”

Section: Discussionmentioning

confidence: 99%

Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

et al. 2015

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Study DesignRadiologic imaging measurement study.PurposeTo assess the accuracy of detecting lateral mass and facet joint injuries of the subaxial cervical spine on plain radiographs using computed tomography (CT) scan images as a reference standard; and the integrity of morphological landmarks of the lateral mass and facet joints of the subaxial cervical spine.Overview of LiteratureInjuries of lateral mass and facet joints potentially lead to an unstable subaxial cervical spine and concomitant neurological sequelae. However, no study has evaluated the accuracy of detecting specific facet joint injuries.MethodsEight spinal surgeons scored four sets of the same, randomly re-ordered, 30 cases with and without facet joint injuries of the subaxial cervical spine. Two surveys included conventional plain radiographs series (test) and another two surveys included CT scan images (reference). Facet joint injury characteristics were assessed for accuracy and reliability. Raw agreement, Fleiss kappa, Cohen's kappa and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules were used for accuracy analysis.ResultsOf the 21 facet joint injuries discerned on CT scan images, 10 were detected in both plain radiograph surveys (sensitivity, 0.48; 95% confidence interval [CI], 0.26-0.70). There were no false positive facet joint injuries in either of the first two X-ray surveys (specificity, 1.0; 95% CI, 0.63-1.0). Five of the 11 cases with missed injuries had an injury below the lowest visible articulating level on radiographs. CT scan images resulted in superior inter- and intra-rater agreement values for assessing morphologic injury characteristics of facet joint injuries.ConclusionsPlain radiographs are not accurate, nor reliable for the assessment of facet joint injuries of the subaxial cervical spine. CT scans offer reliable diagnostic information required for the detection and treatment planning of facet joint injuries.

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Section: Discussionmentioning

confidence: 99%

Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

et al. 2015

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“…Trauma to the cervical spine encompasses a wide spectrum of injuries, ranging from displaced and nondisplaced fractures to subluxed, perched, locked, or dislocated facets, and can be unilateral or bilateral in nature (4,54). The facet capsule, ligamentum flavum, and disc are the most frequently cited areas of soft tissue disruption by these injuries (55)(56)(57). Cervical injuries most frequently occur at levels C5-C6 and C6-C7 (2) and are more common among males (52,58), people 15-45 years old, and people older than 65 (52,58).…”

Section: Facet Joint Injurymentioning

confidence: 99%

Facet Joints of the Spine: Structure–Function Relationships, Problems and Treatments, and the Potential for Regeneration

O’Leary

Paschos

Link

et al. 2018

Annu. Rev. Biomed. Eng.

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The zygapophysial joint, a diarthrodial joint commonly referred to as the facet joint, plays a pivotal role in back pain, a condition that has been a leading cause of global disability since 1990. Along with the intervertebral disc, the facet joint supports spinal motion and aids in spinal stability. Highly susceptible to early development of osteoarthritis, the facet is responsible for a significant amount of pain in the low-back, mid-back, and neck regions. Current noninvasive treatments cannot offer long-term pain relief, while invasive treatments can relieve pain but fail to preserve joint functionality. This review presents an overview of the facet in terms of its anatomy, functional properties, problems, and current management strategies. Furthermore, this review introduces the potential for regeneration of the facet and particular engineering strategies that could be employed as a long-term treatment.

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“…For instance, in an animal study, it was shown that sequential removal of sheep capsular ligaments and cervical facets caused an undue increase in range of motion, especially in axial rotation, flexion and extension with caudal progression [ 31 ]. Human cadaver studies have also indicated that transection or injury of joint capsular ligaments significantly increases axial rotation and lateral flexion [ 32 , 33 ]. Specifically, the largest increase in axial rotation with damage to a unilateral facet joint was 294% [ 33 ].…”

Section: Cervical Capsular Ligamentsmentioning

confidence: 99%

“…Human cadaver studies have also indicated that transection or injury of joint capsular ligaments significantly increases axial rotation and lateral flexion [ 32 , 33 ]. Specifically, the largest increase in axial rotation with damage to a unilateral facet joint was 294% [ 33 ].…”

Section: Cervical Capsular Ligamentsmentioning

confidence: 99%

Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability

Steilen¹,

Hauser²,

Woldin³

et al. 2014

TOORTHJ

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The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain.The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome.When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.

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A Biomechanical Assessment of Soft-Tissue Damage in the Cervical Spine Following a Unilateral Facet Injury

Abstract: The results from this work provide further insight into the expected injury and associated instability present in a traumatic unilateral facet injury in the cervical spine.

Cited by 32 publications

References 24 publications

Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

Facet Joints of the Spine: Structure–Function Relationships, Problems and Treatments, and the Potential for Regeneration

Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability

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