"D10-D11 Facet enlargement"

Transcription

1 "D10-D11 Facet enlargement" Poster No.: C-0898 Congress: ECR 2011 Type: Scientific Exhibit Authors: J. Jalal Shokouhi, A. A. Ameri, H. Mohammad pour ; Tehran/IR, tehran/ir Keywords: Spine, Neuroradiology spine DOI: /ecr2011/C-0898 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Purpose Anatomic landmark for film reading in lumbar MRI During daily report knowing about fix landmark and anatomy, help radiologist to define the level of pathology or variant findings. Some points in spine are a landmark to count vertebral body column. These pints are large processes spinatus of C7, Carina at D6 and conus at dorsolumbar junction. D10D11 facet enlargement is a fix point and could use in this way. There is a high incidence of low back pain (LBP) associated with occupations requiring sustained and/or repetitive lumbar flexion (SLF and RLF, respectively), which cause creep of the viscoelastic tissues. The purpose of this study was to determine the effect of creep on lumbar biomechanics and facet joint capsule (FJC) strain. Specimens were flexed for 10 cycles, to a maximum 10 Nm moments at L5-S1, before, immediately after, and 20 min after a 20-min sustained flexion at the same moment magnitude. The creep rates of SLF and RLF were also measured during each phase and compared to the creep rate predicted by the moment relaxation rate function of the lumbar spine. Both SLF and RLF resulted in significantly increased intervertebral motion, as well as significantly increased FJC strains at the L3-L4 to L5-S1 joint levels. These parameters remained increased after the 20 min recovery. Creep during SLF occurred significantly faster than creep during RLF. The moment relaxation rate function was able to accurately predict the creep rate of the lumbar spine at the single moment tested. The data suggest that SLF and RLF result in immediate and residual laxity of joint and stretch of the FJC, which could increased the potential for LBP. Facet joint osteoarthritis of the facet joints occurs in the setting of degenerative spinal disease with increasing age (almost invariably present in people over 60 years of age). Reference number4 Ethiology, pathophysiology, pathogenesis Facet joint degeneration, osteoarthritis of the facet joint in the setting of degenerative spinal disease, reduced disk height and a consequent shift in the axis with disk generation lead to pseudospondylolisthesis and abnormal stresses that in turn cause facet joint degeneration. Page 2 of 12

3 Scoliosis and asymmetry also influence facet joint degeneration, and vice versa. Methods and Materials 2000 patients in 2 years are inspected for this finding and all images were taken by 1.5 tesla machine. Retrospective comparing assessment is made by PACS system. Patient with lumbar MRI had radicular signs, LBP or lumbago and other signs with no relation to D10-D11 facet syndrome clinical signs. Many dorsal spine images are normal (about 95%). Modalities of choice for diagnosis of facet hypertrophy are: Conventional A-P, lateral and oblique radiographs, MRI or X-ray CT indicated when radicular symptoms are present. Findings: 1-X-ray: joint space narrowing, marginal osteophytes, subchondral sclerosis and cysts, deformation synovial cyst. 2-X-ray CT: joint space narrowing, occasional vacuum phenomenon, marginal osteophytes, subchondral sclerosis and cysts with joint deformity 3-MRI: joint space narrowing, cartilage damage, marginal osteophytes, subchondral sclerosis and occasionally effusion or a synovial cyst, subchondral cyst and deformation. (image in page 114,115 refrence4 ) axial CT and MRI Images for this section: Page 3 of 12

4 Fig. 1: Sagittal T2 MRI of D10-D11 facet enlargement Page 4 of 12

5 Fig. 2: Sagittal T2 MRI of D10-D11 facet enlargement,the same patient in another window Page 5 of 12

6 Fig. 3: T1 Sagittal of D9-D10 AND D10-D11 facet enlargements Page 6 of 12

7 Fig. 4: T2 Sagittal of the same patient Page 7 of 12

8 Fig. 5: T2 of D10-D11 facet enlargement in an old patient Page 8 of 12

9 Page 9 of 12

10 Fig. 6: Sagittal T2 of D10-D11 facet enlargement in a 75 years old, male Fig. 7: Zoom of the previous image (Sagittal T2 of D10-D11 facet enlargement in a 75 years old, male) Page 10 of 12

11 Results Facet hypertrophy Facet hypertrophy is a diagnosis which is often blamed for chronic back pain. Hypertrophy of the spinal facet joints is another name for facet joint syndrome. The condition is a normal degenerative process that occurs in the spine, as we age. The majority of people will develop comparable arthritis in the spine as they get older. A minority of these people will experience any pain in their spinal joints. Only a small percentage of this minority will actually have pain due to their degenerated facet joints. The rest are actually suffering from some other form of back pain that has been misdiagnosed. Facet hypertrophy reality (clinical) Many patients diagnosed with facet joint pain are actually suffering from some form of psychological back pain. This is the most common type of all the chronic back pain syndromes. If you are experiencing bouts of unresolved back pain that has resisted all forms of treatment, there is a good chance that you fit into this category. It would be wise to investigate knowledge therapy for an alternate theory on the nature of your pain and the possibility for a true and permanent cure. Facet enlargement has a direct influence and common cause for secondary degenerative canal stenosis. In axial images it could shows trefil shape of canal (page 91 reference number5) Conclusion Corresponding to facet syndromes in moving segments of spine, almost all D10-D11 facet enlargements are detected incidentally (7% in Iranian patients in daily reports). Biomechanical microtraumas could be main cause of D10-D11 facet enlargement. This finding could be a fixed landmark in dorsal MRI for counting number of vertebral body in absent lumbar image as a marker. There was no meaningful relation of patient's age for D10-D11 facet enlargement. Page 11 of 12

12 References MR imaging of the lumbar spine, Juergen Kramemer, odo koester, 2003 george thieme verlag, ISBN (GTV), ISBN (TNY) Interventional computer tomography, Gr#nemeyer.Siebel 1989, ISBN Lumbar spinal imaging in radicular pain and related condition, Jan T.wilmink, ISBN , Springer-verlag Berlin Heidelberg Spinal imaging thieme, H.imhof,et al. Personal Information Page 12 of 12