The prevalence and degree of asymptomatic cervical and lumbar facet joint arthritis: Retrospective study

Mohammed Emam1, Ferdinand Chan2, Soo Yeon Kim1, Alok D. Sharan2

Department of Physical Medicine and Rehabilitation 1 Department of Orthopedics 2

Montefiore Medical Center,

Albert Einstein College of Medicine

AAPM&R Annual Assembly

October 4th, 2015

Boston, MA

Disclosures:

I have NO RELEVANT financial disclosures

LOE Level II

Introduction• Facet joint arthritis has been implicated in axial neck and low

back pain. The entity of facet joints arthritis being the primary generator of axial spinal pain remains an area of controversy.

• CT scan is sensitive for evaluation of facet joints. Many people can have significant imaging findings without correlating symptoms.

• Studies have examined the prevalence of facet arthritis in symptomatic patients or in cadavers. This study is aiming at understanding the prevalence of facet arthritis in asymptomatic individuals

Objective

To determine the prevalence and degree of asymptomatic cervical and lumbar facet joint arthritis.

Materials and MethodsInstitutional PACS database (GE Centricity, Milwaukee, WI, USA) was queried to identify a cohort of patients imaged for non-spinal clinical indications.

2 distinct cohorts

Group 1

Patients who underwent CT of the neck, which was used for cervical facet joint analysis

Group 2

Patients who underwent CT of the abdomen and pelvis, which was used for lumbar facet joint analysis

Figure 1:

Etiology of non-spinal pathology indications for CT scans for [a] neck pathologies and [b] abdominal and pelvic pathologies.

30%

16%

14%

12%

8%

6%

4%4%

4%

2%

Cervical CT Scans Neck mass

Foreign body ingestion

Abscess

Lymphadenopathy

Surgical pre-op

Investigation of fever

Mental status issues

Dyspnea

Hoarsness

Jagular DVT

42%

22%

8%

6%

4%

4%4%

4%4%

2%Abdominal CT scans

Abdominal painCancerLymphomaInflammationDonorGallbladder pathologyAbdominal massKidney pathologyAscitisLiver pathology

Selection CriteriaA comprehensive review of each patient’s electronic medical record performed prior to inclusion, to assure that patients fit the pre-specified exclusion criteria.

Inclusion Criteria Exclusion Criteria

• Age 20-70

• Cervical or lumbar imaging for non-spinal indication with adequately visualized facet joints

• No prior cervical or lumbar spine imaging (X-ray, MRI, CT scan) in PACS database

• Patients with any evidence of history of neck or back pain

• Patient seen for: diagnosis of neck or back pain; history of fracture within the spine; or any prior spine surgery.

Subjects

• 100 patients met the inclusion criteria among 5 age groups (20-30, 30-40, 40-50, 50-60, 60-70).

• A total of 500 cervical facet joints in 50 patients and 500 lumbar facet joints from another 50 patients were reviewed.

• 19 males and 31 females were included in the cervical facet review while 26 females and 24 males were included for the lumbar facet review.

Image Evaluation

Figure 2. Criteria for grading arthritis of the facet joints adapted from Weishaupt et al. [16] (a) Grade 0, (b) Grade 1, (c) Grade 2, (d) Grade 3. Disregard arrows in (c) and (d). (With kind permission from Springer Science+Business Media: Weishaupt D et al. Skeletal Radiol, MR imaging and CT in osteoarthritis of the lumbar facet joints, Skeletal Radiol 1999, vol 28, pp 216.

Grade Criteria

0 No narrowing, sclerosis or osteophytes

1 Joint space narrowing or irregularity

2 Narrowing plus sclerosis and/or hypertrophy with osteophyte formation

3 Complete narrowing, sclerosis and/or severe osteophyte formation

Statistical Analysis

• Chi-square tests were used to compare data between arthritic changes and non-arthritic facet joints across the different age groups.

• Two sample t-tests were used to test significant differences in arthritis with age at each joint level.

• Grades 1, 2, and 3 were combined to represent the arthritic group.

Results

Grade

Cervical Lumbar

# of Arthritic Joints # of Arthritic Joints

0 333 (67%) 320 (63%)

1 93 (19%) 118 (24%)

2 57 (11%) 44 (9%)

3 17 (3%) 18 (4%)

Table 2: In prevalence and severity of arthritic changes in cervical and lumbar facet joints.The prevalence of asymptomatic cervical facet arthritis was 33% and lumbar facet arthritis was 37%

Figure 3:

The prevalence of no arthritic changes (Group 0) decreases with age, while arthritis (Group 1, 2, 3) increases among the different age groups.

20-29 30-39 40-49 50-59 60-690

10

20

30

40

50

60

70

80

90

100

No ArthritisArthritis

Arthritis in Cervical Facet Joints

20-29 30-39 40-49 50-59 60-690

10

20

30

40

50

60

70

80

90

100Arthritis in Lumbar Facet Joints

No Arthritis

Arthritis

Age

Fre

quen

cy

Figure 4:

Each bar represents the number of facet joints in each spinal level per age group with signs of degeneration (Grades 1, 2, 3). (a) Cervical (b) Lumbar.

20-29 30-39 40-49 50-59 60-69

0

5

10

15

20

C2-C3C3-C4

C4-C5C5-C6

C6-C7

Cervical Facets with Arthritis

Age (years)

Fac

et a

rth

riti

s (#

of

join

ts)

20-2930-39

40-4950-59

60-69

0

5

10

15

20

L1-L2L2-L3

L3-L4L4-L5

L5-S1

Lumbar Facets with Arthritis

Fac

et a

rthr

itis

(#

of

join

ts)

Age (years)

Summary

• This study evaluated the CT scans of 500 cervical facet joints in 50 patients and 500 lumbar facet joints from another 50 patients and found the prevalence of asymptomatic facet arthritis to be 33% and 37%, respectively.

• The study suggests that arthritic changes in the cervical and lumbar facet joints are prevalent in asymptomatic patients and are progressively more common with increasing age and lower spinal levels.

Conclusion

• Arthritic changes in the cervical and lumbar facet joints are highly prevalent among patients and often do not contribute to any symptoms.

• It is typically more common with increasing age and lower cervical and lumbar spinal levels.

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