Facet Joints Flashcards
What is the articulation of a Zygapophyseal joint between?
Inferior facet of the superior vertebra and superior facet of inferior vertebra
What is the purpose of the capsular ligament of the zygapophyseal joints?
Increase stability
Where are the capsular ligaments biggest and why? (Reference?)
Cervical region
?Due to highest range of movement
(Winkelstein et al., 2000)
How much of the spinal load do the facet joints carry during axial compression?
3-25%
What is the arterial supply to the facet joints?
Vertebral arteries
Deep cervical arteries
Ascending pharyngeal arteries
Superior intercostal arteries
What is the venous drainage of the facet joints?
Intervertebral veins
Internal vertebral plexus
What muscles attach to the facet joints and what point of the joint do they attach to?
Multifidus
Semispinalis capitis
Attach to joint capsule
What receptors are found in the facet joint capsules? (References?)
Nociceptors and low-threshold mechanoreceptors
Persson et al., 2016; Gunter et al., 2001
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)
What is the shape and structure of the superior facets of the atlas?
Concave Elongated and kidney-shaped Direction: - Superior - Medial - Posterior
Why is the superior facet of the atlas not considered a ‘true’ facet joint?
It articulates with the convex occipital condyles
What movements does the superior facet joint of the atlas permit?
Flexion and extension of head (YES movement - nodding)
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
What movements does the inferior facet of C1 permit?
Rotation (NO movement)
What are the references for the facet joints of the atlas?
Singh, 1965
White and Panjabi, 1990
Kakarla et al., 2010
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
What movement does the superior articular facet of C2 allow?
Gliding during rotation (NO movement)
What is the shape and structure of the inferior facets of C2?
Slightly concave
Face inferoanteriorly
What is the reference for the articular facets of C2?
Palastanga et al., 2012
What ligaments act as atlanto-occipital stabilisers?
Nuchal ligament
Anterior atlanto-occipital membrane
Posterior atlanto-occipital membrane
What forms the cruciate ligament?
Transverse ligament of atlas
Longitudinal bands superiorly and inferiorly
What does the tectorial membrane continue as?
Posterior longitudinal ligament
What ligaments act as atlantoaxial stabilisers?
Cruciate ligament
Apical ligament
Alar ligament
Tectorial membrane
What is the shape and orientation of the superior facets of C3-C7?
Convex
Oriented:
- Superolaterally
- Posteriorly
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?
- Facet joints important in weight bearing so poorer weight bearing
- Reduced stability
- Reduced mechanical integrity
- Pressure imbalance shifted to IV discs
- 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?)
CT
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)
