Grading Systems of Lumbar Facet Joint Inflammatory Changes on Magnetic Resonance Imaging

Abstract

Study Design. A scoping review. Objective. We aimed to identify and characterize grading systems of the inflammatory features of the lumbar facet joints (FJs) noted on magnetic resonance imaging and summarize their reliability. Summary of Background Data. Chronic low back pain is one of the most common causes of disability worldwide and is frequently accompanied by FJ osteoarthritis. Inflammatory changes in the lumbar FJs are commonly noted in imaging studies of patients with FJ osteoarthritis and low back pain. Several grading systems for these inflammatory changes have been developed. However, these grading system’s features and reliability have yet to be reviewed. Materials and Methods. We performed a literature search of studies reporting grading systems for FJ inflammatory changes published in English or Spanish between 1985 and 2022. We collected data on reported interreader reliability measures of each grading system. Finally, we compared the features of inflammation described by each system. Results. Six studies met the inclusion criteria and were used in our analysis. Features commonly graded in these systems are the hyperintensity signal noted within the FJ, bone marrow edema, and the extent of the soft-tissue edema surrounding the FJs. We found that the interreader reliability measures ranged from 0.56 to 0.96. Conclusions. Only 6 studies have reported methods for documenting inflammation in the FJs. Studies varied in the precise tissues and phenomena included in the grading systems. However, the systems were generally reliable. Future studies should document the reliability of these methods when independent investigators are not involved in developing the classification schemes. Further work might combine one or more of these measures to establish a standard and reliable grading system for inflammatory changes in the FJs, including signal intensity within the joint, bone marrow edema, and soft-tissue inflammation.

Reporting of Facet Joint Inflammation in Lumbar Spine MRI Studies in Patients With low Back Pain

“…Facet arthropathy is among the most common imaging findings in patients with low back pain, being identified in as many as 85% of patients 6 . Facet arthropathy may involve an inflammatory process, for which various grading systems have been proposed for assessing the presence and severity of inflammatory features, including facet joint effusion, bone marrow edema, and soft tissue edema 7–10 . Patients with more severe facet morphologic changes are reported to be more likely to respond to intra-articular facet injections or medial branch blocks than patients with less severe morphologic changes 11–13 .…”

“…6 Facet arthropathy may involve an inflammatory process, for which various grading systems have been proposed for assessing the presence and severity of inflammatory features, including facet joint effusion, bone marrow edema, and soft tissue edema. [7][8][9][10] Patients with more severe facet morphologic changes are reported to be more likely to respond to intra-articular facet injections or medial branch blocks than patients with less severe morphologic changes. [11][12][13] While radiologists routinely describe facet morphology in their reports-such as facet bony hypertrophy-inflammatory features of the lumbar facet joints may be underreported.…”

Comprehensive Grading System of Inflammatory Features of the Lumbar Facet Joints on Magnetic Resonance Imaging

“…8,10,[16][17][18][19] However, there is scant data on the reliability of these measures, and existing grading systems include overlapping features. 20 Here, we propose an MRIgrading system of facet joint inflammatory changes that rely on frequently described inflammatory parameters, including facet joint effusion, bone marrow edema, and soft tissue edema. In addition, we propose an atlas with examples to provide visual guidance to grade features of facet joint inflammation for further research and potentially serve as a predictive tool in clinical settings.…”

“…Several grading systems have been developed to quantify lumbar facet joint morphologic and inflammatory changes 8,10,16–19 . However, there is scant data on the reliability of these measures, and existing grading systems include overlapping features 20 . Here, we propose an MRI-grading system of facet joint inflammatory changes that rely on frequently described inflammatory parameters, including facet joint effusion, bone marrow edema, and soft tissue edema.…”