• Investigative Magnetic Resonance Imaging
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• v.22 no.1
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• pp.18-25
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• 2018

Purpose: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. Materials and Methods: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. Results: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. Conclusion: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.

• Journal of the Korean Orthopaedic Association
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• v.56 no.5
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• pp.413-418
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• 2021

Purpose: To investigate the effect of facet tropism on the degeneration of facet joint and intervertebral disc in the cervical spine. Materials and Methods: From January 2017 to December 2018, cervical tropism of 100 patients at the C5/6 level was analyzed retrospectively. In computed tomography (CT), the orientation and tropism of the facet joint with respect to the sagittal, coronal, and horizontal planes were measured. Regression of the facet joint in magnetic resonance imaging (MRI) and CT was assessed using a grading system. Intervertebral disc degeneration was assessed and divided into five grades on MRI. For the left and right asymmetry, a difference between two facet angles of less than 7° was classified as the control group, more than 7° was classified as the tropism group. Results: The mean age of the patients was 55.44±12.3 years (31-81 years) in the tropism group and 55.66±10.7 years (32-76 years) in the control group. In the tropism group, 32 were male and 18 were female. In the control group, 24 were male and 26 were female. Facet joint degeneration was identified in 24 patients (48.0%) in the tropism group and 14 patients (28.0%) in the control group, showing a significant difference. Intervertebral disc degeneration was identified in 29 patients (58.0%) in the tropism group and 17 patients (34.0%) in the control group, showing a significant difference. Multivariate revealed, tropism to be a factor that affected the facet joint and intervertebral disc degeneration. Conclusion: Facet joint and intervertebral disc degeneration occurred significantly in the tropism group, and tropism is a factor affecting the degeneration of facet joint and intervertebral disc in the C5/6 level.

• Journal of Acupuncture Research
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• v.32 no.4
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• pp.187-194
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• 2015

Objectives : The purpose of this study was to observe the correlation between modic type changes 2 and facet joint arthrosis. Methods : We randomly selected the 93 patients with Lumbar MRI films who had been admitted to Haeundae Jaseng Korean Medicine Hospital from January to June 2015. Modic type changes 2 and facet joint arthrosis data were collected and statistically analyzed. Results : In this study, if the findings of the MRI showed modic type changes 2, the cases of facet joint arthrosis increased. Conclusions : There was a significant correlation between modic type changes 2 and facet joint arthrosis.

• Journal of the Korean Orthopaedic Association
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• v.52 no.1
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• pp.65-72
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• 2017

Purpose: The purpose of this study was to evaluate the radiologic features of juxtafacet cyst and determine the correlation between these features and clinical outcome. Materials and Methods: We analyzed a total of 23 patients. The degree of facet joint degeneration was classified using the Fujiwara method. The facet joint angles were measured with an magnetic resonance imaging to determine whether there was a difference between the cystic lesion that was occupied and the cystic lesion that was not occupied. Disc degeneration was measured by the Pfirrmann classification method. The clinical result was evaluated using the Oswestry disability index score and visual analogue scale. Results: The L4-5 level of juxtafacet cyst was mostly affected, as found in previous studies. Facet joint arthritis was more severe within the side with the cystic lesion. Significant correlation was found between disc degeneration and juxtafacet joint cyst. All patients underwent wide decompression and fusion. Clinical result was excellent. No patients had signs of recurrence during the follow-up periods. Conclusion: Juxtafacet cyst has a significant correlation with facet joint degeneration. Therefore, aggressive surgical treatment-not just simple cyst excision-should be considered as the treatment option for juxtafacet cyst associated with degenerative lumbar disease.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.308-313
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• 2011

Posterior cervical foraminotomy is an attractive therapeutic option in selected cases of cervical radiculopathy that maintains cervical range of motion and minimize adjacent-segment degeneration. The focus of this procedure is to preserve as much of the facet as possible with decompression. Posterior cervical inclinatory foraminotomy (PCIF) is a new technique developed to offer excellent results by inclinatory decompression with minimal facet resection. The highlight of our PCIF technique is the use of inclinatory drilling out for preserving more of facet joint. The operative indications are radiculopathy from cervical foraminal stenosis (single or multilevel) with persistent or recurrent root symptoms. The PCIFs were performed between April 2007 and December 2009 on 26 male and 8 female patients with a total of 55 spinal levels. Complete and partial improvement in radiculopathic pain were seen in 26 patients (76%), and 8 patients (24%), respectively, with preserving more of facet joint. We believe that PCIF allows for preserving more of the facet joint and capsule when decompressing cervical foraminal stenosis due to spondylosis. We suggest that our PCIF technique can be an effective alternative surgical approach in the management of cervical spondylotic radiculopathy.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.243-250
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• 2018

Objective : To compare the morphometry of subaxial cervical spine between cerebral palsy (CP) and normal control. Methods : We retrospectively analyzed 72 patients with CP, as well as 72 patients from normal population. The two groups were matched for age, sex, and body mass index. Pedicle, lateral mass (LM), and vertebral foramen were evaluated using computed tomography (CT) imaging. Pedicle diameter, LM height, thickness, width and vertebral foramen asymmetry (VFA) were measured and compared between the two groups. Cervical dynamic motion, disc and facet joint degeneration were investigated. Additionally, we compared the morphology of LM between convex side and concave side with cervical scoliotic CP patients. Results : LM height was smaller in CP group. LM thickness and width were larger in CP group at mid-cervical level. In 40 CP patients with cervical scoliosis, there were no height and width differences between convex and concave side. Pedicle outer diameter was not statistically different between two groups. Pedicle inner diameter was significantly smaller in CP group. Pedicle sclerosis was more frequent in CP patients. VFA was larger in CP group at C3, C4, and C5. Disc/facet degeneration grade was higher in the CP group. Cervical motion of CP group was smaller than those of the control group. Conclusion : LM morphology of CP patients was different from normal population. Sclerotic pedicles and vertebral foramen asymmetry were more commonly identified in CP patients. CP patients were more likely to demonstrate progressive disc/facet degeneration. This data may provide useful information on cervical posterior instrumentation in CP patients.

• Journal of Korean Neurosurgical Society
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• v.37 no.5
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• pp.364-369
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• 2005

Objective: Spinal instrumentation without fusion often fails due to biological failure of intervertebral joints (spontaneous fusion, degeneration, etc). The purpose of this study is to investigate the influence of fixation rigidity on viability of intervertebral joints. Methods: Twenty pigs in growing period were subjected to posterior segmental fixation. Twelve were fixed with a rigid fixation system(RF) while eight were fixed with a flexible unconstrained implant(FF). At the time of the surgery, a scoliosis was created to monitor fixation adequacy. The pigs were subjected to periodic radiological examinations and 12pigs (six in RF, six in FF) were euthanized at 12-18months postoperatively for analysis. Results: The initial scoliotic curve was reduced from $31{\pm}5^{\circ}$ to $27{\pm}8^{\circ}$ in RF group (p=0.37) and from $19{\pm}4^{\circ}$ to $17{\pm}5^{\circ}$ in FF group (p=0.21). Although severe disc degeneration and spontaneous fusion of facet joints were observed in RF group, disc heights of FF group were well maintained without major signs of degeneration. Conclusion: The viability of the intervertebral joints depends on motion spinal fixation. Systems allowing intervertebral micromotion may preserve the viability of intervertebral discs and the facet joint articular cartilages while maintaining a reasonably stable fixation.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.358-365
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• 2001

Objectives : Although posterior lumbar fusion operations had been reported to accelerate spinal degeneration, there have been only a few studies for their biomechanical effects. We have studied the change of motion range at the vertebral joint one level above the fusion(UVJ) in pedicle screw fixation group(PSF)(n=13) where facet capsule was destroyed and in posterior lumbar interbody fusion group(PLIF)(n=8) where it was spared. Patients and Methods : The patients were divided into early(3 to 6 months) and late(over 12 months) according to postoperative follow-up period. The flexion, extension and flexion-extension angles(FA, EA, FEA) were measured at the UVJ with pre-operative, early and late post-operative films. Results : Mean age and male to female ratio were $52.7{\pm}9.3$ and 1 : 3.2. Mean follow-up periods were $144.1{\pm}30.0$ and $528.8{\pm}160.3$ days in early and late groups, respectively. The FEA and FA in the late PSF($11.8{\pm}3.1$, $8.5{\pm}2.9$) were significantly greater than pre-operative angles($7.8{\pm}3.9$, $5.1{\pm}3.7$)(p<0.01, p<0.05). All angles in the PLIF showed no significant changes with time. The FEA and FA in the late PSF($11.8{\pm}3.1$, $8.5{\pm}2.9$) were significantly greater than those of the late PLIF($7.6{\pm}2.3$, $3.4{\pm}2.0$)(p<0.01, p<0.001). All angles at early follow-up period were similar between PSF and PLIF. The EA showed no significant change in relation with follow-up period or fusion method. Conclusion : As a result, the facet capsule injury in pedicle screw fixation seems to be related with increased flexion angle or degeneration of the adjacent joint above the fused vertebra in the late phase.

• Journal of Korean Neurosurgical Society
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• v.45 no.1
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• pp.24-31
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• 2009

Objective : To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). Methods : Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. Results : The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. Conclusion : This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.368-373
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• 2013

Background: Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS. Methods: All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. The patients underwent interventional pain procedures for diagnosis and pain relief. Response to the therapy was assessed based on VAS and ODI scores. A 50% decrease in VAS score or a VAS score less than 3 would be considered adequate pain relief. Results: All 20 patients diagnosed with BS during the 6-month observation period had scoliosis. Common causes of back pain were the ipsilateral L5-S1 facet joint, neoarticulation, the SI joint, and disc degeneration. Responses to various interventions for pain relief were different and inconsistent from patient to patient. In particular, responses to interventions for neoarticular pain were generally poor. Conclusions: Pain in patients with BS does not usually respond to interventional pain treatment. A very dynamic treatment approach must be pursued while managing BS patients, and the treatment plan must be individualized at various stages in order to obtain satisfactory pain relief.