Relationship between facet joint opening on CT and facet joint effusion on MRI in patients with lumbar spinal stenosis: analysis of a less invasive decompression procedure

Kentaro Yamada MD, PhD1,2, Hiromitsu Toyoda MD, PhD2, Shinji Takahashi MD, PhD2, Koji Tamai MD, PhD2, Akinobu Suzuki MD, PhD2, Masatoshi Hoshino MD, PhD2, Hidetomi Terai MD, PhD2, and Hiroaki Nakamura MD, PhD2
View More View Less
  • 1 Department of Orthopaedic Surgery, PL Hospital, Tondabayashi City, Osaka, Japan; and
  • | 2 Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

Both facet joint opening (FJO) on CT and facet joint effusion (FJE) on MRI are reportedly indicators of segmental instability in the lumbar facet joints of patients with lumbar spinal stenosis (LSS). However, no study has investigated both parameters simultaneously. Therefore, the association between these findings and which parameter is better for predicting clinical outcomes after surgical treatment remains unclear. The purpose of this study was to investigate the relationship between FJO and FJE in patients who underwent less invasive decompression procedures for LSS and to investigate the impact of these findings on clinical outcomes.

METHODS

This study included 1465 lumbar levels (L1–2 to L5–S1) in 293 patients who underwent less invasive surgery for LSS and had ≥ 5 years of follow-up. FJO was defined as joint space widening ≥ 2 mm on preoperative axial CT images. FJE was defined as fluid effusion in the facet joint on preoperative axial T2-weighted MR images. The characteristics and distributions of FJO and FJE were investigated with other preoperative radiological findings. The association between need for further surgery and FJO/FJE was analyzed according to intervertebral level.

RESULTS

FJO was observed at 402 levels (27%), and FJE was found at 306 levels (21%). The correspondence rate between FJO and FJE was 70% (kappa 0.195, p < 0.01). One hundred thirty-seven levels (9%) had both FJO and FJE. Levels with both FJO and FJE more commonly had lateral olisthesis, lateral wedging, and axial intervertebral rotation than other levels (p < 0.001). Levels with both FJO and FJE were more likely than other levels to need further surgery (OR 2.42, p = 0.027).

CONCLUSIONS

The correspondence rate between FJO and FJE was not high. However, multivariate analysis showed that levels with both FJO and FJE had a higher risk of requiring further surgery than those with other radiological findings, such as lateral olisthesis, lateral wedging, and axial intervertebral rotation. Patients with levels with both FJO and FJE need careful long-term follow-up after undergoing a less invasive decompression procedure.

ABBREVIATIONS

FJE = facet joint effusion; FJO = facet joint opening; LSS = lumbar spinal stenosis.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Ciol MA, Deyo RA, Howell E, Kreif S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc. 1996;44(3):285290.

    • Search Google Scholar
    • Export Citation
  • 2

    Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine (Phila Pa 1976).1986;11(2):107110.

    • Search Google Scholar
    • Export Citation
  • 3

    Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K. Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976).2000;25(14):17541759.

    • Search Google Scholar
    • Export Citation
  • 4

    Blumenthal C, Curran J, Benzel EC, Potter R, Magge SN, Harrington JF Jr, et al. Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis. J Neurosurg Spine. 2013;18(4):340346.

    • Search Google Scholar
    • Export Citation
  • 5

    Hasegawa K, Kitahara K, Shimoda H, Hara T. Facet joint opening in lumbar degenerative diseases indicating segmental instability. J Neurosurg Spine. 2010;12(6):687693.

    • Search Google Scholar
    • Export Citation
  • 6

    Hasegawa K, Shimoda H, Kitahara K, Sasaki K, Homma T. What are the reliable radiological indicators of lumbar segmental instability?. J Bone Joint Surg Br. 2011;93(5):650657.

    • Search Google Scholar
    • Export Citation
  • 7

    Hasegawa K, Kitahara K, Shimoda H, Ishii K, Ono M, Homma T, et al. Lumbar degenerative spondylolisthesis is not always unstable: clinicobiomechanical evidence. Spine (Phila Pa 1976). 2014;39(26):21272135.

    • Search Google Scholar
    • Export Citation
  • 8

    Chaput C, Padon D, Rush J, Lenehan E, Rahm M. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine (Phila Pa 1976). 2007;32(17):18831887.

    • Search Google Scholar
    • Export Citation
  • 9

    Rihn JA, Lee JY, Khan M, Ulibarri JA, Tannoury C, Donaldson WF III, Kang JD. Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease?. Spine (Phila Pa 1976). 2007;32(14):15551560.

    • Search Google Scholar
    • Export Citation
  • 10

    Lattig F, Fekete TF, Kleinstück FS, Porchet F, Jeszenszky D, Mannion AF. Lumbar facet joint effusion on MRI as a sign of unstable degenerative spondylolisthesis: should it influence the treatment decision?. J Spinal Disord Tech. 2015;28(3):95100.

    • Search Google Scholar
    • Export Citation
  • 11

    Tamai K, Kato M, Konishi S, Matsumura A, Hayashi K, Nakamura H. Facet effusion without radiographic instability has no effect on the outcome of minimally invasive decompression surgery. Global Spine J. 2017;7(1):2127.

    • Search Google Scholar
    • Export Citation
  • 12

    Toyoda H, Nakamura H, Konishi S, Dohzono S, Kato M, Matsuda H. Clinical outcome of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis: minimum five-year follow-up. Spine (Phila Pa 1976). 2011;36(5):410415.

    • Search Google Scholar
    • Export Citation
  • 13

    Freedman BA, Horton WC, Rhee JM, Edwards CC II, Kuklo TR. Reliability analysis for manual radiographic measures of rotatory subluxation or lateral listhesis in adult scoliosis. Spine (Phila Pa 1976). 2009;34(6):603608.

    • Search Google Scholar
    • Export Citation
  • 14

    Aaro S, Dahlborn M. Estimation of vertebral rotation and the spinal and rib cage deformity in scoliosis by computer tomography. Spine (Phila Pa 1976).1981;6(5):460467.

    • Search Google Scholar
    • Export Citation
  • 15

    Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):18731878.

    • Search Google Scholar
    • Export Citation
  • 16

    Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenerative disk disease. Radiology. 1988;168(1):177186.

  • 17

    Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):14241434.

    • Search Google Scholar
    • Export Citation
  • 18

    Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):14131423.

    • Search Google Scholar
    • Export Citation
  • 19

    Inose H, Kato T, Yuasa M, Yamada T, Maehara H, Hirai T, et al. Comparison of decompression, decompression plus fusion, and decompression plus stabilization for degenerative spondylolisthesis: a prospective, randomized study. Clin Spine Surg. 2018;31(7):E347E352.

    • Search Google Scholar
    • Export Citation
  • 20

    Minamide A, Yoshida M, Simpson AK, Nakagawa Y, Iwasaki H, Tsutsui S, et al. Minimally invasive spinal decompression for degenerative lumbar spondylolisthesis and stenosis maintains stability and may avoid the need for fusion. Bone Joint J. 2018;100-B(4):499-506.

    • Search Google Scholar
    • Export Citation
  • 21

    Fujiwara A, Lim TH, An HS, Tanaka N, Jeon CH, Andersson GB, Haughton VM. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine (Phila Pa 1976). 2000;25(23):30363044.

    • Search Google Scholar
    • Export Citation
  • 22

    Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982;(165):110123.

  • 23

    Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013;9(4):216224.

  • 24

    Fujishiro T, Nabeshima Y, Yasui S, Fujita I, Yoshiya S, Fujii H. Pseudogout attack of the lumbar facet joint: a case report. Spine (Phila Pa 1976). 2002;27(17):E396E398.

    • Search Google Scholar
    • Export Citation
  • 25

    Kim YK, Lee JW, Kim HJ, Yeom JS, Kang HS. Diagnostic advancement of axial loaded lumbar spine MRI in patients with clinically suspected central spinal canal stenosis. Spine (Phila Pa 1976). 2013;38(21):E1342E1347.

    • Search Google Scholar
    • Export Citation
  • 26

    Wang D, Yuan H, Liu A, Li C, Yang K, Zheng S, et al. Analysis of the relationship between the facet fluid sign and lumbar spine motion of degenerative spondylolytic segment using Kinematic MRI. Eur J Radiol. 2017;94:612.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 264 264 237
Full Text Views 35 35 21
PDF Downloads 58 58 30
EPUB Downloads 0 0 0