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Vertebral Column > Facet Joints > Flashcards

Facet Joints Flashcards

1
Q

Describe the zygapophyseal (facet) joint

A
  • Located posteriorly in the vertebral column on articular processes of the vertebrae.
    • Between the inferior facet of one vertebra and the superior facet of the one below.
  • Synovial plane joints - allows gliding movements
  • Function - allows movement between the vertebrae
  • Carry 3-25% of spinal loading in axial compression
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2
Q

What surrounds the facet joint?

A

Capsular ligament surrounds the facet joint increasing stability

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3
Q

Where does arterial supply of the facet joints come from?

A
  • Vertebral
  • Deep cervical
  • Ascending pharyngeal
  • Superior intercostal artery
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4
Q

Where does venous drainage of the facet joints go?

A
  • Intervertebral veins
  • Internal vertebral plexus (within the epidural space in the vertebral canal)
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5
Q

Which muscles attach on the facet joint capsules?

What are the other features of the facet joint capsule?

A
  • Multifidus
  • Semispinalis capitis
  • Muscle attachments possibly increase the integrity / strength of the capsule.
  • Facet capsules contain nociceptors (pain) and low threshold mechanoreceptors (mechanical pressire).
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6
Q

What are the ‘other’ facet joints of the vertebral column?

A
  • Facet for dens - on the anterior arch of the atlas
  • Transverse costal facet for tubercle of rib - on transverse process of thoracic vertebrae.
  • Inferior and superior costal facets for the head of the rib - on the body of thoracic vertebrae.
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7
Q

What is a facet joint?

A

The area between 2 facets.

A facet is simply a flat surface on a bone which allows for articulation.

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8
Q

Describe the anatomy of the superior facet joint of C1 (atlas)

A
  • Concave superior facet (although some are planar due to variation) - articulates with convex occipital condyles of the skull.
    • For this reason, the atlanto-occipital joint is not a true facet joint because the articulation is not between two vertebrae.
  • Elongated, kidney-shaped
  • Occupies most of the lateral mass of the superior aspect of the atlas.
  • Direction - superior, medial, posterior
  • Permits the YES movement
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9
Q

Describe the anatomy of the inferior facet joint of C1 (atlas)

A
  • Relatively flat inferior facet - articulate with the convex superior articular facets of C2.
  • Smaller and rounder than the superior facet of C1.
  • Direction - faces inferior and medial
  • Permits the NO movement
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10
Q

Describe the anatomy of the superior articular facets of C2 (axis)

A
  • Articulate with inferior facets of the atlas
  • Large surface to transmit the weight of the head to its body.
  • Very slightly convex
  • Face superiorly and laterally - allows gliding motion
  • Permits NO movement
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11
Q

List the stabilisers of the atlanto-occipital joint

A
  • Nuchal ligament
  • Anterior atlanto-occipital membrane - densely packed fibres
  • Posterior atlanto-occipital membrane
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12
Q

List the stabilisers of the atlanto-axial joint

A
  • Cruciate ligament formed from the transverse ligament of axis and longitudinal bands superiorly and inferiorly
  • Apical ligament
  • Alar ligament
  • Tectorial ligament continues as the posterior longitudinal ligament
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13
Q

Describe the anatomy of the superior facet joints of the typical cervical vertebrae (C3-C7)

A
  • Orientated superiorly
  • Convex
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14
Q

Describe the anatomy of the inferior facet joints of the typical cervical vertebrae (C3-C7)

A
  • Orientated inferiorly, anteriorly and medially
  • Concave
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15
Q

Describe the general features of the facet joints of typical cervical vertebrae

A
  • Orientated approximately 45° from the transverse plane
  • Thin and flexible joint capsule
  • Allows a wide range of motion for the neck
  • Facets become more vertical towards the bottom of the cervical spine
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16
Q

Which nerves innervate the cervical facet joints?

A

Medial branches of cervical dorsal rami.

This pattern of innervation is found only in the cervical region due to the presence of an 8th cervical spinal nerve with no corresponding vertebra.

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17
Q

Describe the anatomy of the superior facet joints of the thoracic vertebrae

A
  • Directed posterolaterally
  • Convex
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18
Q

Decribe the anatomy of the inferior facet joints of the thoracic vertebrae

A
  • Directed anteromedially
  • Concave
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19
Q

Describe the general features of the facet joints of the thoracic vertebrae

A
  • Orientation of the facet joints
    • Inclined 60° from the transverse plane
    • Inclined 20° posteriorly from the coronal plane
  • Allows rotation and lateral flexion
  • Articular processes of thoracic vertebrae are elongated vertically
  • Flexion and extension movements are very limited due to the orientation of the facet joints
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20
Q

Which nerves innervate the facet joints of the thoracic vertebrae?

A

Medial branches of the dorsal rami C8-T12, corresponding to the superior facets involved in the joint and the vertebra superior to that.

Example: T7-T8 innervated by medial branches of T6 and T7 dorsal rami.

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21
Q

Describe the anatomy of the superior facet joints of the lumbar vertebrae

A
  • Directed medially initially
  • Directed posteromedially at the lower lumbar levels because facets move into the coronal plane as they descend.
22
Q

Describe the anatomy of the inferior facet joints of the lumbar vertebrae

A
  • Directed laterally initially
  • Directed anterolaterally at the lower lumbar levels because facets move into the coronal plane as they descend.
23
Q

Describe the general features of the facet joints of the lumbar vertebrae

A
  • Facets are originally orientated in the sagittal plane, but move towards the coronal plane at lower levels.
  • Primary movements: flexion and extension
  • Secondary movements: some rotation of the lower lumbar spine
  • Facets are elongated vertically
  • Superior facets situated further apart than the inferior processes
24
Q

Which nerves innervate the facet joints of the lumbar vertebrae?

A

Medial branches of the dorsal rami T12-L5

25
Q

What is the purpose of the sagittaly orientated facet joint of the superior lumbar vertebrae?

A

To severely limit rotational movements and facilitate only flexion and extension movements

26
Q

What is the purpose of the coronally orientated facet joints in the lower lumbar vertebrae?

A

To allow a small degree of rotation, but the primary movements are still flexion and extension.

27
Q

Describe the joint capsules between the lumbar vertebrae and relate their structure to function

A
  • Shorter and less slack / pliable than the joint capsules present between the cervical vertebrae.
  • Therefore, there is a smaller degree of flexion in the lumbar spine compared to cervical.
28
Q

What happens if the facets of the lumbar vertebrae are damaged?

A

An alternate method of weight-bearing forms - loads are transferred to the annulus fibrosus and the anterior longitudinal ligament for support.

Although destruction of facet joints alone will not cause instability of the spine, more force will be transmitted to the intervertebral disc which may accelerate disc degeneration.

29
Q

Describe the anatomy of the facet joints of the sacral vertebrae

A
  • No facets within the sacrum due to fusion, with the exception of S1 which fuses with L5.
    • The facet joint between L5 and S1 faces medially and posteriorly to prevent anterior gliding of the spine.
    • It facilitates flexion and extension, but prohibits rotation.
30
Q

Describe the anatomy of the facet joints of the coccyx

A
  • The first coccygeal vertebra articulates with the sacrum (S5) at the sacrococcygeal joint.
  • The joint is usually a symphysis (secondary cartilaginous), but can sometimes be fused or synovial.
  • Have 2x coccygeal cornua - processes on Co1 which articulate with S5.
31
Q

Describe the coccygeal cornua

A
  • 2x articular processes on the posterior aspect of the first coccygeal segment.
  • Each articulate / fuse with the sacral cornu on S5
  • The articulation between the cornua and the sacrum isn’t a true facet joint but is the equivalent of a facet joint in this region of the vertebral column.
32
Q

Describe the first column of the spine

A
  • 1st column (anterior)
    • Anterior longitudinal ligament
    • Anterior half of the vertebral body and IV discs
33
Q

Describe the second column of the spine

A
  • 2nd column (middle)
    • ​Posterior longitudinal ligament
    • Posterior half of vertebral body and IV discs
34
Q

Describe the third column of the spine

A
  • 3rd column
    • ​Facet joints
    • Interspinous ligaments
    • Pedicles
    • Spinous processes
35
Q

Describe the method of clinically determining stability of the spine?

A
  • When assessing spinal instability, clinicians classify the spine as a 3 column system.
  • The spine is considered stable until 2 of the 3 columns are damaged
36
Q

Which ligaments limit extension of the spine?

A

Anterior longitudinal ligament

37
Q

Which ligaments limit flexion of the spine?

A
  • Posterior longitudinal ligament
  • Ligamenta flava
  • Interspinous ligaments
  • Supraspinous ligaments
  • Intertransverse ligaments
  • Nuchal ligament (cervical region only)
38
Q

What are the ligaments of the sacrococcygeal joint?

A
  • Anterior sacrococcygeal ligament
  • Posterior sacrococcygeal ligament (superficial and deep)
  • Lateral sacrococcygeal ligament
  • Ligament connecting sacral cornu and transverse process of 1st coccygeal vertebra
39
Q

Describe the posterior sacrococcygeal ligament

A
  • Divided into superficial and deep parts
  • Superficial component is called the sacrococcygeal membrane - spans from the sacral hiatus to the posterior surface of the coccyx
  • Deep component extends within the sacral canal between the posterior aspects of the 5th sacral and 1st coccygeal vertebrae.
40
Q

What injuries are associated with hyperextension / hyperflexion (particularly at high velocity)?

A
  • Increased muscle tonicity, inflammation and possibly impingement of nerves and vessels.
  • Possible injuries:
    • Anterior intervertebral disc rupture
    • Lesions to the articular surfaces and capsules of the zygapophyseal joints
    • Whiplash associated disorder develops - symptomatic side effects of a motor vehicle crash
41
Q

Describe whiplash which results from child abuse

A
  • Can be seen in a child where vigorous shaking has occurred
  • Signs include:
    • Convulsions
    • Irritability
    • Bulging fontanelle
    • Paralysis
    • Vomitting
  • At age 5-6 vision loss and hearing loss become apparent
42
Q

Describe step 1 of sustaining a whiplash injury

A
  • S-shape
  • Initial extension of C5-C6
  • Flexion at the cranial end of the cervical spine
  • Causes a sigmoid shape
43
Q

Describe step 2 of sustaining a whiplash injury

A
  • Hyperextension
  • During this, the anterior portion of the vertebral bodies separate
  • The facet joints are impacted
44
Q

Describe step 3 of sustaining a whiplash injury

A
  • Hyperflexion
  • During this, the posterior portion of the vertebral bodies separate (sometimes causing ligamentous damage)
  • Facets and surround capsules are stretched to the point of damage
45
Q

What are the symptoms of whiplash?

A
  • Confusion
  • Difficulty concentrating
  • Dizziness
  • Visual issues
  • Tinnitus
46
Q

What causes most of the pain associated with a whiplash injury?

A
  • The highest compressive forces are on posterior aspect of the lower cervical spine (C5/C6)
  • This area is responsible for most of the pain associated with whiplash
  • Zygapophyseal pain accounts for ~50% of the pain associated with whiplash.
  • Impingement of the meniscoid (synovial fold) is another cause of pain.
    • Impingement is registered by the nociceptors within the capsule, sending pain signals.
  • 50% of people who suffer from whiplash will never fully recover.
47
Q

How is whiplash classified?

A
  • Using the QTFC or MQTFC - Quebec task force classification / modified Quebec task force classification 0-4.
  • 0 = no neck pain
  • 4 = spinal stenosis, fracture or dislocation
48
Q

Describe facet joint degeneration and include a list of its main causes

A
  • Closely associated with degenerative disc disease and can induce the onset of facet joint degeneration.
  • Causes instability of a vertebral motion segment (because facet joints are important for weight bearing of the spine) - puts extra stress on the intervertebral disc, resulting in further deterioration.
  • Main causes of facet joint degeneration:
    • Ageing
    • Injury
    • Infection
    • Inflammation
49
Q

List the indicators of facet joint degeneration

A
  • Loss, wear and tear or necrosis of articular cartilage
  • Sclerosis
  • Subchondral bone exposure
  • Calcification of the capsule
  • Formation of osteophytes
50
Q

Describe the stages of facet joint deneration

A
  1. Grade 1 - narrowing space within facet joint
  2. Grade 2 - indication of sclerosis or hypertrophy of subchondral bone
  3. Grade 3 - formation of osteophytes around the margins of facet joints
    • This growth can cause narrowing of the IV foramen which can impinge on the spinal nerve causing shooting pains, such as sciatica in the lumbar region.

Pathria et al. (1987) created this grading system

Vertebral Column (13 decks)

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