Facet joint arthrography in lumbar spondylolysis: anatomic basis for spread of contrast medium.

Abstract

Facet arthrograms in patients with lumbar spondylolyses show spread of contrast medium through pars interarticularis defects into the adjacent ipsilateral facet joint space and across the midline into the contralateral joint space. Transverse and sagittal sections of facet joints from 141 postmortem lumbar spines were studied. Five examples of spondylolysis were found. Anatomic studies of the relationship of the joint recesses to the pars interarticularis demonstrated the basis for the patterns of spread of contrast medium observed radiographically in this and previous series. The pars interarticularis forms the only boundary between the inferior recess of one facet joint and the superior recess of the adjacent joint. Fracture through the pars interarticularis establishes communication between adjacent ipsilateral joints and opens a communication to the retrodural space, through which contrast medium can track to the contralateral joint.

The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada

“…The pars interarticularis normally shields a likely entry site to the retrodural space; communication may also depend on the configuration of the ventral facet joint capsule. 3,8 Adjacent ipsilateral facet joints can also communicate directly through a pars interarticularis defect. 8,9 The supra-adjacent facet has been shown to communicate with a pars defect in 94% of cases; the infraadjacent facet in 63%.…”

“…3,8 Adjacent ipsilateral facet joints can also communicate directly through a pars interarticularis defect. 8,9 The supra-adjacent facet has been shown to communicate with a pars defect in 94% of cases; the infraadjacent facet in 63%. 9 This anatomy provides the potential for involvement of the posterior ligamentous complex of vertically adjacent spinal segments.…”

“…Finally, the facet joints can communicate with the adjacent neural foramen and the posterior paraspinal soft tissues. 3,8 The retrodural space thus serves as the central nexus permitting multilevel, bilateral communication of these multiple compartments of the posterior ligamentous complex, the epidural space, and the paraspinal soft tissues.…”

Spinal Injections for Pain Management

“…Periarticular corticosteroid injection may offer the same therapeutic benefits as intra-articular corticosteroid administration (31,128). Document the extra-articular leak of contrast material into a synovial cyst, intraligamentous cavity, or retrodural space (125,126,129). At lumbar levels, synovial cyst rupture is feasible by placing the needle into the facet joint with fluoroscopic guidance or directly into the cyst or facet joint with CT guidance (Fig 7).…”

The nature of the spondylolytic defect

“…Radiologists recognise that there are connections between a facet joint and a nearby spondylolytic defect, but this does not appear to have been reported by surgeons. 11 reported that the spondylolyses in five young male cadavers "resembled osteoarthritic joints": three were lined by sclerotic bone or cartilage, with the fragments separated by a clear space, and two were joined by fibrocartilage. In all five the pseudarthrosis communicated with the facet joint above and in three also with the joint below.…”