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Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis?

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Abstract

Purpose

The term “segmental instability” of the lumbar spine is not clearly defined, especially as it relates to degenerative spondylolisthesis (DS) and rotational translation (RT). We investigated whether facet joint effusion on conventional supine MRI indicated increased abnormal motion in DS and RT.

Methods

160 patients (119 female, 41 male, mean age 68.8 years, range 38.8–89.3 years) who had undergone decompression only or decompression with instrumented fusion for degenerative spondylolisthesis with different degrees of narrowing of the spinal canal were identified retrospectively from our spine surgery database. All had preoperative upright X-rays in AP and lateral views as well as supine MRI. The imaging studies were assessed for the following parameters: percent of slippage, absolute value of facet joint effusion, facet angles, degree of facet degeneration and spinal canal central narrowing, disc height, presence of facet cysts and the presence of rotational translation in the AP X-ray.

Results

40/160 patients showed no facet joint effusion, and in these the difference in the values for the % slip on upright X-ray and % slip on supine MRI was ≤3%. A further 12 patients also showed a difference ≤3%, but had some fluid in the joints (0.44 ± 0.38 mm). In 108 patients, the difference in the % slip measured on X-ray and on MRI was >3% (mean 10.6%, range 4–29%) and was associated with a mean facet effusion size of 2.15 ± 0.85 mm. The extent of effusion correlated significantly with the relative slippage difference between standing and supine positions (r = 0.64, p < 0.001), and the extent of the left/right difference in effusion was associated with the presence of rotational translation (RT 1.31 ± 0.8 mm vs. no-RT 0.23 ± 0.17 mm, p < 0.0001).

Conclusions

Facet joint effusion is clearly correlated with spontaneous reduction of the extent of slippage in the supine position compared to the upright position. Also, the greater the difference in right and left facet effusion, the higher the likelihood of having a RT. Future studies should assess whether analysis of facet joint effusion measured on routine MRI can help in decision-making regarding the optimal surgical treatment to be applied (decompression alone or combined with fusion).

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Acknowledgments

We would like to thank Gordana Balaban, Dave O’Riordan, Julian Amacker, Kirsten Clift, and Sara Preziosa for their help with the Spine Tango Registry documentation.

Conflict of interest

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. RKU Universitäts- und Rehabilitationskliniken, Oberer Eselsberg 45, 89081, Ulm, Germany

    Friederike Lattig

  2. Schulthess Klinik, 8008, Zürich, Switzerland

    Friederike Lattig, Tamás F. Fekete, Dieter Grob, Frank S. Kleinstück, Dezsö Jeszenszky & Anne F. Mannion

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  1. Friederike Lattig
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  2. Tamás F. Fekete
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  3. Dieter Grob
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  4. Frank S. Kleinstück
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  6. Anne F. Mannion
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Correspondence to Friederike Lattig.

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Lattig, F., Fekete, T.F., Grob, D. et al. Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis?. Eur Spine J 21, 276–281 (2012). https://doi.org/10.1007/s00586-011-1993-1

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  • DOI: https://doi.org/10.1007/s00586-011-1993-1

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