User:Jeremymormol/sandbox

Artist rendition of facet joint anatomy. Video detailing facet joint anatomy, facet syndrome and treatment. [1]

Facet syndrome

Facet syndrome is a syndrome in which the facet joints (synovial diarthroses, from C2 to S1) cause back pain. Facet joints can hold as much as 33% of the spinal load [9]. Degradation of the facet joints can oftentimes be a direct source of pain b/c it is likely to impinge a spinal nerve, causing pain. [10,11] Facet joints are of critical importance in stabilizing the entire spine. Excision of these joints leads to mechanical instability of the spine [10,11].

Facet joint syndrome occurs in both men and women. It is most common between the ages of 40 and 70 and in those prone to arthritis. It also may develop in people who’ve had a spine injury.

Contents

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• 1Pathophysiology
• 2Facet Joints
• 3Symptoms
• 4Diagnosis
• 5Treatment
• 6See also
• 7References

Facet Joints[edit]

The facet joints are formed by the superior and inferior processes of each vertebra. The first cervical vertebra has an inferior articulating surface but, as it does not restrict lateral or posterior translation, is not always considered a proper zygoma (zygoma is Greek for "yoke," i.e. something that restrains movement). In the lumbar spine, facets provide about 20 percent of the twisting stability in the low back and can bear as much as 33% of the spinal load during certain movements. Biomechanical testing has determined that facet joints are of critical importance to the stabilization of the spine and exicision of these joints causes mechanical instability of the entire spine.

Each facet joint is positioned at each level of the spine to provide the needed support especially with rotation. Facet joints also prevent each vertebra from slipping over the one below. A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Also, each joint has a rich supply of tiny nerve fibers that provide a painful stimulus when the joint is injured or irritated. Inflamed facets can cause a powerful muscle spasm.

Pathophysiology[edit]

55% of facet syndrome cases occur in cervical vertebrae, and 31% in lumbar. Facet syndrome can progress to spinal osteoarthritis, which is known as spondylosis. Pathology of the C1-C2 (atlantoaxial) joint, the most mobile of all vertebral segments, accounts for 4% of all spondylosis.

Symptoms[edit]

Symptoms primarily manifest themselves in the lumbar spine, since the strain is highest here due to the overlying body weight and the strong mobility. Affected persons usually feel dull pain in the cervical or lumbar spine that can radiate into the buttocks and legs. Typically, the pain is worsened by stress on the facet joints, e.g. by diffraction into hollow back (retroflexion) or lateral flexion but also by prolonged standing or walking.

Diagnosis[edit]

Diagnosis of facet joint syndrome requires careful clinical assessment and accurate analysis of radiological exams. Common complaints upon clinical exam include:

• Lower back pain that radiates down to thigh or groin
• Off-center back pain that increases with hyperextension, rotation, lateral bending and walking uphill
• Pain worse when waking up from bed or trying to stand after sitting for a while
• Back stiffness (typically found in the morning)

In terms of radiological exams, there are no specific signs that indicate facet joint syndrome. Using an MRI, non-specific signs of arthrosis, osteophytes, and hypertrophy of flaval ligaments can be assessed. X-rays can provide useful information on column instability as well. Although radiologic images are helpful, fundamental steps in the diagnosis of facet joint syndromes rely on history taking and physical examination of the patient. [8]

Treatment[edit

Non-invasive treatment initially involves anti-inflammatory drugs and consists of a multi-faceted approach. This medical treatment is usually accompanied by physiotherapy to increase back and stomach muscles. Thus, the spine can be both relieved and stabilized. If these conservative measures do not bring about betterment, minimally invasive procedures such as a facet infiltration can be conducted to offer relief. In this procedure, a local anesthetic is injected directly into the respective joint, usually in combination with a cortisone preparation (corticosteroid). The standard treatment for facet joint pain is radiofrequency denervation, which utilizes electrical currents to block nerve fibers that transmit pain. Other treatment options include intra-articular injections and surgery. Many of these treatments, however, are still controversial in its effects.

See also[edit]

• Facet joint arthrosis

References[edit]

1. "Facet Joint Syndrome, Facet arthropathy". www.mayfieldclinic.com. Retrieved 2017-07-12.
2. Cohen, Steven P., Julie HY Huang, and Chad Brummett. "Facet joint pain—advances in patient selection and treatment." Nature Reviews Rheumatology9.2 (2013): 101-116.
3. Cohen, Steven P., and Srinivasa N. Raja. "Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain." Anesthesiology 106.3 (2007): 591-614.
4. Emedicine article on Lumbosacral Facet Syndrome
5. Van de Graaff (2002). Human Anatomy. New York: McGraw Hill, p. 160.
6.  Facet Syndrome www.joimax.com.
7. A. Gangi, J. L. Dietemann, R. Mortazavi, D. Pfleger, C. Kauff, C. Roy: CT-guided interventional procedures for pain management in the lumbosacral spine. In: Radiographics. 18, 1998, S. 621–633.
8. Allegri, Massimo; Montella, Silvana; Salici, Fabiana; Valente, Adriana; Marchesini, Maurizio; Compagnone, Christian; Baciarello, Marco; Manferdini, Maria Elena; Fanelli, Guido (2016-10-11). "Mechanisms of low back pain: a guide for diagnosis and therapy". F1000Research. 5. doi:10.12688/f1000research.8105.2. ISSN 2046-1402. PMC 4926733. PMID 27408698.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
9. King, A. I., Prasad, P., Ewing. C. L: Mechanism of the spinal injury due to cadudocephalad acceleration. Orthop. Clin. North Am., 6:19, 1975
10. Hazlett, J. E., Kinnard, P.: Lumbar apophyseal process excision and spinal instability. Spine, 7:171, 1982
11. Abumi, K., Panjabi, M. M., Duranceau, J. S., Kramer, K.: Instabilities due to partial and total facetectomies of the lumbar spine. 34th Annual Meeting, Orthop. Res. Soc., Atlanta, 1988

Section	Description	Editor	Sources
Description	Example	Example	Example
Synonyms	Example	Example	Example
Technique	Example	Example	Example
Variations	Example	Example	Example
Indications and Contra-indications	Example	Example	Example
Pre-Operative Work-up	Example	Example	Example
Post-Operative Rehabilitation	Example	Example	Example
Time Course of Recovery	Example	Example	Example
Risks and Complications	Example	Example	Example
Controversies	Example	Example	Example
Prognosis	Example	Example	Example
History	Example	Example	Example

Some stuff from my application that we might be able to use (I'm sort of assuming facet joint osteoarthritis is the same as facet syndrome):

These synovial joints exhibit prototypical anatomy: articular cartilage covering each of the facets, resting on a thickened layer of subchondral bone, and a synovial membrane bridging the margins of the cartilaginous portions.¹

Facet joint osteoarthritis (FJ OA) is a very common cause of back and neck pain. FJ OA is defined as “functional failure of synovial facet joints” but this failure involves the subchondral bone, cartilage, ligaments, capsule, and synovium.¹ FJ OA’s prevalence is highest at L4-L5, followed by L5-S1, most likely due to the fact that these facet joints bear the most weight among the lumbar vertebrae (because of the inferior location).^1,2 Even though L5-S1 is located inferior to L4-L5, L5-S1 has a relatively greater stability when compared to L4-L5, which explains why FJ OA is less prevalent in that spinal segment.²

Sources:

1. Gellhorn, Alfred C., Jeffrey N. Katz, and Pradeep Suri. “Osteoarthritis of the Spine: The Facet Joints.” Nature reviews. Rheumatology 9.4 (2013): 216–224. PMC. Web. 18 Feb. 2017
2. Kalichman, Leonid et al. “Facet Joint Osteoarthritis and Low Back Pain in the Community-Based Population.” Spine 33.23 (2008): 2560–2565. PMC. Web. 18 Feb. 2017

Other interesting facts about facet joints:

Facet joints can hold as much as 33% of the spinal load [9]. Degradation of the facet joints can oftentimes be a direct source of pain b/c it is likely to impinge a spinal nerve, causing pain. [10,11] Facet joints are of critical importance in stabilizing the entire spine. Excision of these joints leads to mechanical instability of the spine [10,11]

Sources:

1. King, A. I., Prasad, P., Ewing. C. L: Mechanism of the spinal injury due to cadudocephalad acceleration. Orthop. Clin. North Am., 6:19, 1975
2. Hazlett, J. E., Kinnard, P.: Lumbar apophyseal process excision and spinal instability. Spine, 7:171, 1982
3. Abumi, K., Panjabi, M. M., Duranceau, J. S., Kramer, K.: Instabilities due to partial and total facetectomies of the lumbar spine. 34th Annual Meeting, Orthop. Res. Soc., Atlanta, 1988

The 1st source has a good picture that can be used to diagram facet joints as it can be sort of hard to understand without a picture.

Some more possible pictures: https://drive.google.com/file/d/0B-97jLeMKuQiN1F3OEc4cG4zbFE/view?usp=sharing

Article Evaluation

- facet joints article: The article is straight forward. It does a good job of explaining the basic function of the facet joints, but neglects to talk about pathologies a whole lot. It also lacks citations, so I suppose I could find ways to cite it. There isn't a whole lot going on in the "talk" section, just one thing about a synonym of the facet and a couple sentences about chiropractors.

Diagnosis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/#ref-57

There's a section on diagnosing Facet Syndrome that could pretty much replace the current section (after we reword it, etc.). There's also a discussion of symptoms, structure, etc. that we could pull information from.

Treatment

Treatment initially involves anti-inflammatory drugs and consists of a multi-faceted approach. Other treatment options include intra-articular injections, surgery and radiofrequency denervation. Many of these treatments, however, are still controversial in its effects. [1]

Sources:

1. Cohen, Steven P., and Srinivasa N. Raja. "Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain." Anesthesiology 106.3 (2007): 591-614.

Some novel options: Radiofrequency ablation, PRP injection

Archive

knee joint; hip; facet joints; arthroscopy; surgical outcomes; joint replacement; pain; lumbar spine; bone quality; bone mineral density; radiographic imaging; Total Knee Replacement

Orthopedic surgery

Create a new section on pain management/outcomes for orthopedic surgeries. Another option would be to talk about medications/anesthetics given depending on the type of surgery and the recovery. Improve the "Arthroplasty" section with relevant citations. Provide information on training for orthopedics in countries outside of the United States.