Lumbar Facet Cyst as a Rare Cause of L5 Radiculopathy: A Case Report

Lumbar facet cysts arise from zygapophyseal joints and are commonly associated with spondylosis. They are a rare cause of symptomatic nerve root compression. We are presenting a rare case of L4/5 lumbar facet cyst compressing the nerve root in a patient presenting with L5 radiculopathy. The clinical picture of a facet cyst in this case is similar to intervertebral disc disease.

The frequency of degenerative-dystrophic lesions of the joints of the spine in young and middle-aged patients with dorsopathy

Introduction. Degenerative-dystrophic lesion of the spinal joints or spondylarthrosis is one of the most common diseases of the spine. The signs of non-infl ammatory changes in the joints can be detected even in children. The reason for this is the repetitive biomechanical microtrauma. The goal of research — to study the frequency of degenerative-dystrophic lesions of the spinal joints at all the levels in young and middle-aged patients suffering from dorsopathy.Materials and methods. Radiography of all the regions of the spine was performed with the description of system models of 507 patients: 211 men and 296 women, suffering from dorsopathy. The method of integral study of the spine roentgenograms was used. Systemic models of patients with determined diagnosis of ankylosing spondylitis (Bekhterev disease) were excluded from the general population. The reason for this was a signifi cant morphological change in the joints and in the spinal column as a whole, due to chronic infl ammation, which is the main manifestation of this disease. Statistical processing was carried out using Microsoft Offi ce Excel 2007.Results. It was established that with age the frequency of appearance of radiological signs of spondylarthrosis increases. Signs of arthrosis of the zygapophyseal joints appear in the fi rst turn and are the most frequent ones. Arthrosis of the zygapophyseal joints is diagnosed in 70–90 % of patients. Spondylarthrosis of the semilunar joints is diagnosed in almost 80 % of patients. Most often arthrosis of the semilunar joints was observed in the vertebrae CV and CVI. Athrosis of costovertebral joints was registered in 32,7 % of patients. In most cases the joints TVII–TX were affected by this disease. Arthrosis of the sacroiliac joints was diagnosed in an average of 63,8 % of patients, equally often on the left and on the right sides. The interspinal neoarthrosis (Baastrup symptom) was diagnosed at the level of LIII–LV(VI) in 22,6 % of patients and at the level of CI–CII in 2 % of patients.Conclusion. Radiological manifestations of spondylarthrosis are markers of static and dynamic biomechanical overload of the spinal joints.

Congenital absence of a lumbosacral facet joint: A case report

Background: Congenital absence of the lumbosacral facet joint is extremely rare, with only 26 cases reported in the literature. Here, we present a patient with the unilateral absence of the left fifth lumbar inferior articular process and reviewed the relevant literature. Case Description: A 32-year-old gentleman, who had undergone right L4-5 lumbar microdiscectomy 3 months ago now presented with acute low back and left leg pain following a fall. He is now presented with acute low back and left leg pain following a fall. Plain radiographs of the L-S spine revealed an absent left L5–S1 zygapophyseal joint. The magnetic resonance imaging and computed tomography studies additionally confirmed an absent unilateral left L5 lumbar inferior articular process. Conclusion: Patients presenting for lumbar surgery may have unilaterally absent lumbosacral zygapophyseal joints, which may impact the outcome of surgical treatment.

Inter-Rater Reliability of Pain Provocation Tests for Painful Lumbar Facet Joints. A Pilot Study

Background With a life-time prevalence of 39%, low back pain (LBP) is one of the most common musculoskeletal disorders. Correct diagnosis of underlying causes is commonly seen as a prerequisite for successful therapy of LBP. Currently, there is no useful, non-invasive clinical test to diagnose painful lumbar zygapophyseal joints. Clinical tests with high diagnostic accuracy are therefore desirable. Inter-rater reliability is commonly seen as a prerequisite of test validity. The objective of this pilot study was thus to evaluate inter-rater reliability of new clinical pain provocation tests for diagnosing painful lumbar zygapophyseal joints. If a clinically significant level of inter-rater reliability were to be determined, this study could constitute a first step towards establishing the clinical utility of this new set of tests in the structural diagnosis of low back disorders. Material and Methods Patients participating in this study were recruited in a specialist hospital throughout June 2015 until September 2016. Both female and male patients with current LBP, with or without buttock or lower extremity symptoms were screened for inclusion. Patients had preferably to be 50 years or older in order to be included in this study. The upper age limit was set at 90 years. They also had to be fluent in German to be able to follow verbal instructions. Exclusion criteria comprised the presence of red flags, surgical spinal fusion at any level of the lumbar spine, discectomy within the past 12 months, radiculopathy and/or radicular pain, interventional treatments for the IVD, SIJs or ZAJs within the past three months, psychiatric disorders, current litigation issues concerning back pain, and central nervous system diseases. Three certified manual therapy instructors tested patients independently. Fleissʼ kappa values and percent agreements were calculated. Results Subjects included a sample of 48 patients (15 males and 33 females) with a mean age of 66.48 years (range 33 – 90) presenting at a specialist hospital with low back pain. The new pain provocation tests for lumbar zygapophyseal joints showed moderate reliability (Fleissʼ κ = 0.46) and an overall percent agreement of 68.8%. Separate tests for the zygapophyseal joints of L5–S1 showed fair reliability (Fleissʼ κ = 0.37) and an overall percent agreement of 64.6%. Unidimensional tests that were used in the study to exclude the intervertebral disc as a nociceptive generator showed fair reliability as well (average κ of 0.28 and 0.39, respectively). Neither drop outs nor adverse events occurred. Conclusion The new pain provocation tests for lumbar zygapophyseal joints showed clinically significant levels of inter-rater reliability. Validation of these tests against fluoroscopy-guided medial branch blocks is warranted.

Reliability of Cervical Spine Palpation

Palpitation is an important component of a comprehensive musculoskeletal and neurologic examination of the cervical spine in individuals with neck pain, but examiners should not base diagnostic conclusions (eg, facetogenic pain) and interventional procedures on palpatory findings alone. A methodological approach to palpation of the posterior neck includes evaluation of the paraspinal musculature, the tissues that overlie the facet (zygapophyseal) joints, and the midline spinous processes. Although studies have shown low interexaminer reliability, palpation is an important component of the physical examination for determining general anatomic regions of symptoms and in establishing rapport with the examinee. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, the diagnosis-related estimate (DRE) or injury method lists both muscle spasm and muscle guarding as potential physical exam findings by palpation. In this edition, the range-of-motion method for rating spinal impairment states that an examiner cannot find muscle spasm on exam and rate the individual's impairment on the same day because, by definition, the individual is not at maximum medial improvement. Despite acceptance by the AMA Guides, Fifth Edition, neither spasm nor guarding appears to be a reliable finding on palpation. The AMA Guides, Sixth Edition, provides a different method for determining spinal impairment, and the authors recommend limiting physical examination findings used in impairment rating to those with acceptable interrater reliability.

Evolutionary GEM: The Evolution of the Primate Prehensile Tail

The evolution of the prehensile tail illustrates the impact habitat can have on structural traits. Prehensile primates are able to support their entire body weight using only their tail, which opens up new feeding opportunities in their arboreal environments. This trait evolved separately in two families of New World monkeys. A transitional behaviour in its proposed evolutionary mechanism is tail-assisted hind limb suspension during locomotion in these dense forests. The evolution of more robust vertebrae, shorter distal vertebrae, a greater number of zygapophyseal joints, as well as larger and more convex articular surfaces, result in a stronger and more flexible tail. Prehensile tails have more expanded muscle attachments that can bear greater loading forces. A naked tactile pad that improves grip is present only in atelids. These differences in bone and muscle morphology make the prehensile tail more sturdy and dexterous, allowing prehensile primates to use their tails for an alternative function.

Zygapophyseal Joint Fusion in Ankylosing Spondylitis Assessed by Computed Tomography: Associations with Syndesmophytes and Spinal Motion

Objective.Because zygapophyseal joints (ZJ) are difficult to visualize on radiographs, little is known about the relationship of ZJ fusion to other features of spinal damage in ankylosing spondylitis (AS). We used computed tomography (CT) to investigate the concordance of ZJ fusion and syndesmophytes, and examined the contribution of both features to spinal motion.Methods.We performed thoracolumbar CT scans (T10–T11 to L3–L4) on 55 patients. Two readers scored scans for ZJ fusion, which were compared to syndesmophyte height and extent of bridging, measured by computer algorithm at the same levels. We used multiple regression analysis to evaluate the relative contributions of ZJ fusion and syndesmophytes to spinal mobility.Results.Fifty-one percent of patients had ZJ fusion in at least 1 vertebral level. Fusion was present in 129 of 652 individual ZJ. Syndesmophytes and bridging were often present in vertebral levels without ZJ fusion, suggesting that syndesmophytes most often develop first. ZJ fusion was present in 34% of vertebral levels with syndesmophytes and 55.9% of levels with bridging, suggesting a closer association with bridging. Syndesmophytes and ZJ fusion had similar associations with the modified Schober test, but syndesmophytes were more strongly associated with limitations in lateral thoracolumbar flexion. ZJ rarely showed new fusion over 4 years.Conclusion.Thoracolumbar ZJ fusion in AS is rarely present at vertebral levels without syndesmophytes. Syndesmophytes, therefore, likely appear before ZJ fusion at a given vertebral level. Both syndesmophytes and ZJ fusion contribute to limited forward lumbar flexion, but syndesmophytes contribute more to limited lateral flexion.