Facet Joints Flashcards by Daniel Part

What is the articulation of a Zygapophyseal joint between?

Inferior facet of the superior vertebra and superior facet of inferior vertebra

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What is the purpose of the capsular ligament of the zygapophyseal joints?

Increase stability

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Where are the capsular ligaments biggest and why? (Reference?)

Cervical region
?Due to highest range of movement
(Winkelstein et al., 2000)

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How much of the spinal load do the facet joints carry during axial compression?

3-25%

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What is the arterial supply to the facet joints?

Vertebral arteries
Deep cervical arteries
Ascending pharyngeal arteries
Superior intercostal arteries

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What is the venous drainage of the facet joints?

Intervertebral veins

Internal vertebral plexus

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What muscles attach to the facet joints and what point of the joint do they attach to?

Multifidus
Semispinalis capitis
Attach to joint capsule

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What receptors are found in the facet joint capsules? (References?)

Nociceptors and low-threshold mechanoreceptors

Persson et al., 2016; Gunter et al., 2001

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Apart from the facet joints, what other facets exist in the vertebral column?

Facet for dens (on posterior surface of anterior arch of atlas)
Transverse costal facet for rib tubercle (on transverse processes of thoracic vertebrae)
Inferior and superior costal facets for head of ribs (on thoracic vertebral bodies)

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What is the shape and structure of the superior facets of the atlas?

Concave
Elongated and kidney-shaped
Direction:
- Superior
- Medial
- Posterior

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Why is the superior facet of the atlas not considered a ‘true’ facet joint?

It articulates with the convex occipital condyles

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What movements does the superior facet joint of the atlas permit?

Flexion and extension of head (YES movement - nodding)

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What is the shape and structure of the inferior facet of the atlas?

Relatively flat
Smaller and rounder than superior facet of C1
Direction:
- Inferior
- Medial

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What movements does the inferior facet of C1 permit?

Rotation (NO movement)

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What are the references for the facet joints of the atlas?

Singh, 1965
White and Panjabi, 1990
Kakarla et al., 2010

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What is the shape and structure of the superior articular facet of C2?

Large (allows transmission of weight of head to body of C2)
Slightly convex
Face superolaterally

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What movement does the superior articular facet of C2 allow?

Gliding during rotation (NO movement)

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What is the shape and structure of the inferior facets of C2?

Slightly concave

Face inferoanteriorly

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What is the reference for the articular facets of C2?

Palastanga et al., 2012

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What ligaments act as atlanto-occipital stabilisers?

Nuchal ligament
Anterior atlanto-occipital membrane
Posterior atlanto-occipital membrane

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What forms the cruciate ligament?

Transverse ligament of atlas

Longitudinal bands superiorly and inferiorly

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What does the tectorial membrane continue as?

Posterior longitudinal ligament

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What ligaments act as atlantoaxial stabilisers?

Cruciate ligament
Apical ligament
Alar ligament
Tectorial membrane

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What is the shape and orientation of the superior facets of C3-C7?

Convex
Oriented:
- Superolaterally
- Posteriorly

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What is the shape and orientation of the inferior facets of C3-C7?

Concave Oriented: - Inferomedially - Anteriorly

How does the orientation of the facet joints change as the cervical spine is descended?

Become more vertical | C7 facets face more anteriorly than inferiorly

What features of the facet joints in C3-C7 allow a wide range of movement? (Reference?)

Joints oriented ~45 degrees from transverse plane Thing and flexible joint capsule (Gellhorn et al., 2013)

What is the nerve innervation to facet joints in the cervical spine? (Reference?)

Medial branches of corresponding dorsal cervical rami E.g. C5/C6 facet innervates by C5 and C6 dorsal rami (Binder and Nampiaparampil, 2009)

In what direction are the facets of thoracic vertebrae elongated?

Vertically

What is the shape and direction of the superior facets of thoracic vertebrae?

Convex | Directed posterolaterally

What is the shape and direction of the inferior facets of thoracic vertebrae?

Concave | Directed anteromedially

What are the inclinations of the articular facets of thoracic vertebrae?

Inclined 60 degrees from transverse plane | Inclined 20 degrees in coronal plane (posteriorly)

How does the orientation/inclination of the articular facets in the thoracic region affect the movements possible here?

Limits flexion/extension Permits: - Rotarion (primarily) - Some lateral flexion

What is the innervation to the facet joints of thoracic vertebrae?

Medial branches of dorsal rami C8-T12 | Rami of superior vertebra involved in joint and vertebra superior to that eg. C8 and T1 innervates T1/T2 joint

What is the structure and direction of the superior facets of the lumbar vertebrae?

Situated further apart that inferior facets | Directed medially to posteromedially

What is the direction of the inferior facets of the lumbar vertebrae?

Laterally to anterolaterally

What movements does the sagittal orientation of the articular facets of the first few lumbar vertebrae limit and permit?

Severely limits rotation | Permits Flexion and extension

As the lumbar vertebrae are descended, the articular facets change from lying in the sagittal plane to the coronal plane, how does this affect the movements possible at the facet joints?

Allows some more rotation | Flexion and extension are still primary movements

Why is there less flexion possible in the lumbar spine versus the cervical spine? (Reference?)

Joint capsule in lumbar spine is: - Shorter - Less slack/pliable (Binder and Nampiaparampil, 2009)

What is the innervation to the facet joints of the lumbar spine?

Medial branches of lumbar dorsal rami from superior vertebra involved in joint and vertebra superior to that Eg. L2/L3 innervated by L1 and L2

Why are there no facet joints within sacrum itself?

It is fused

What is the orientation of the facets involved in the L5-S1 articulation? What does this prevent? (Reference?)

Coronal in orientation Inferior facet of L5 faces anterolaterally Superior facet of S1 faces posteromedially Prevents anterior gliding of spine (Derrick et al., 2014)

What movements does the L5-S1 facet articulation allow?

Flexion-extension Lateral flexion Prohibits rotation

What is the function of sacral vertebrae?

Provides strength and stability to pelvis | Transmits forces to pelvic girdle via SIJs

What type of joint is the sacrococcygeal intervertebral joint?

Usually a symphysis (secondary cartilaginous): - Fused OR - Synovial

What are the articulations of the sacrococcygeal intervertebral joint? (Reference?)

Coccygeal cornu: - 2 articular processes on posterior aspect of Co1 - Each articulate/fuse with sacral cornu on S5 (Woon and Stringer, 2013)

What is the first column of the spine?

ALL | Anterior half of vertebral bodies and IV discs

What is the second column of the spine?

PLL | Posterior half of vertebral bodies and IV discs

What is the third column of the spine?

Facet joints Interspinous ligaments Pedicles Spinous processes

Why are the spinal columns useful? (Reference?)

Used when assessing Spinal stability Spine is stable until 2 of the 3 columns are disrupted (Jaumard et al., 2011)

What does the posterior sacrococcygeal ligament do?

Limits flexion

What is the alternate name of the superficial part of the posterior sacrococcygeal ligament and what is its course?

Sacrococcygeal membrane | Spans from sacral hiatus to posterior surface of coccyx

What is the course of the deep part of the sacrococcygeal ligament?

Extends within sacral canal between posterior vertebral bodies of S5 and Co1

What is the deep part of the sacrococcygeal ligament equivalent to?

PLL

Apart from the posterior sacrococcygeal ligament, what other sacrococcygeal ligaments are there?

Anterior sacrococcygeal ligament Lateral sacrococcygeal ligament Ligament connecting sacral cornu and Co1 transverse processes

What is the reference for sacrococcygeal ligaments?

Woon and Stringer, 2013

How can a whiplash injury be described?

Sudden jolt to body resulting in force transferred through neck and vertebral column compression

What is the pathophysiology of whiplash injuries?

Increased muscle tonicity Inflammation Neurovascular compression

What structures can be injured in whiplash injuries?

Anterior IV discs (can rupture) Articular surfaces Facet joint capsules

Whiplash injuries can also been seen in NAIs when a child is shaken. How would this present? (References?)

``` Convulsions Irritability Bulging fontanelles Paralysis Vomiting Vision loss (at 5-6 years of age) (Caffey, 1974; Scholten-Peeters et al., 2003) ```

What is step 1 of movement analysis of whiplash?

S-shape/Sigmoid shape: - Initial extension of C5/C6 - Flexion of more cranial cervical vertebrae

What is step 2 of movement analysis of whiplash?

Hyperextension: - Anterior portions of vertebral bodies separate - Facet joints are impacted

What is step 3 of movement analysis of whiplash?

Hyperflexion: - Posterior portions of vertebral bodies separate (may damage ligaments) - Facets and capsules stretched to point of damage

What is the reference for movement analysis of whiplash?

Grauer et al., 1997

What are the main symptoms of whiplash?

``` Confusion Difficulty concentrating Dizziness Visual issues Tinnitus ```

Where are the highest compressive forces in whiplash and what is this responsible for?

C5/C6 posteriorly | Responsible for most of the pain experienced (~50%)

How is whiplash classified and what are the extremes of this scale?

(Modified) Quebec Task Force Classification No neck pain = 0 points Spinal stenosis/fracture/dislocation = 4 points

What does Sterling, (2011) say about whiplash injuries?

Lesions are not visible on imaging

In what joints does 50% of the pain arise following whiplash?

Zygapophyseal joints

What is the physiological cause of pain in whiplash?

Impingement of meniscoid (synovial fold) detected by joint capsule nociceptors

What percentage of patients never fully recover from whiplash pain?

50%

What usually precedes facet joint degeneration? (Reference?)

Degenerative disc disease | Gellhorn et al., 2013

How can facet joint degeneration affect degenerative disc disease?

1. Facet joints important in weight bearing so poorer weight bearing 2. Reduced stability 3. Reduced mechanical integrity 4. Pressure imbalance shifted to IV discs 5. DDD

What are the main causes of facet joint degeneration?

Ageing Injury Infection Inflammation

How does ageing result in facet joint degeneration?

Can shift orientation of joints to different plane | Alters range of movement

What are the indicators of facet joint degeneration?

``` Loss of articular cartilage and joint space Osteophytes Subchondral cysts Subchondral sclerosis Capsule calcification ```

How are the stages of facet joint degeneration determined? (Reference?)

What is stage 1 of facet joint degeneration?

Loss of joint space

What is stage 2 of facet joint degeneration?

Sclerosis of Subchondral bone

What is stage 3 of facet joint degeneration and what is the sequelae of this?

Osteophytes of joint margins (final stage of OA) Impinge on nerves in IV foramina: - Shooting pains (eg. Sciatica in lumbar region)