The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges

Abstract

FIGURE 1. Schematic illustrating the anatomy in the periphery of the facet joint and the relevant neuronal connections to the central nervous system. Afferents that innervate the facet joint and its capsular ligament have cell bodies in the DRG and synapse with neurons in the spinal dorsal horn. Nociceptive information is encoded by many types of afferents, including IB4-positive nonpeptidergic neurons and peptidergic fibers that produce neuropeptides, such as CGRP and substance P. Noxious stimuli are translated into electrical (eg, action potentials) and biochemical (eg, neurotransmitter) signals. In persistent pain, central sensitization occurs, with neuronal hyperexcitability and altered neurotransmitter production and release in the spinal dorsal horn. Abbreviations: CGRP, calcitonin gene-related peptide; DRG, dorsal root ganglion; IB4, isolectin B4.

A Nociceptive Role for Integrin Signaling in Pain After Mechanical Injury to the Spinal Facet Capsular Ligament

“…16,34 The magnitude of the imposed strain was computed based on fiducial markers of the joint capsular ligament; strains of the C6/C7 facet capsular ligament were targeted to exceed its maximum physiologic strain (~6%) which is non-painful 16,49 and be below the peak ligament strain (~35%) experienced during painful traumatic loading. 21,22,49 A grid of bead markers was placed on the facet capsule before stretched and was tracked during stretch by a high speed camera (Phantom-v5.1; Vision Research Inc.; Wayne, NJ). The positions of the markers before and at the maximum capsule stretch were used to calculate the applied maximum principal strain (MPS) in LS-DYNA (Livermore Software Technology Corp.; Livermore, CA).…”

Spinal Osteoarthritis as a Cause of Chronic Low Back Pain

“…По мере взросления и старения организма в ФС развиваются изме-С о в е т э к с п е р т о в ны, 7-Д; 12 344015, Ростов-на-Дону, Западный жилой массив, ул. Благодатная, 170; 13 нения, характерные для всех «нагрузочных» суставов и приводящие к формированию морфологической картины, типичной для ОА [13][14][15].…”

“…Поэтому диагноз ОА ФС может быть правомерным лишь в том случае, когда наличие морфологических изменений сустава сопровождается болью в спине. При этом следует учитывать, что источников боли в области позвоночно-двигательного сегмента, помимо ФС, может быть много: связки, мышцы, позвонки и МПД, в которых также развиваются дегенеративные изменения и катаболическое воспаление [13][14][15].…”

Multiscale mechanics of the cervical facet capsular ligament, with particular emphasis on anomalous fiber realignment prior to tissue failure

“…The facet capsular ligament is a fibrous soft tissue primarily comprised of elastin fibers and dense collagen fiber bundles, and is innervated by afferents (Lu et al 2005; Quinn et al 2007; Jaumard et al 2011; Kallakuri et al 2012; Crosby et al 2014). Tensile strains that exceed the physiologic range, but are still below the failure threshold for the facet capsular ligament, induce persistent pain in vivo (Lee et al 2008; Dong et al 2012; Ita et al 2017). However, it is not yet well understood how the microstructural mechanics are altered during ligament loading and may translate the tissue-level deformations into local loading that may influence the afferents embedded in the tissue.…”