RESUMO
BACKGROUND: Nowadays, ultrasound is increasingly used with a great accuracy in performing nerve blocks for facet joint disease. OBJECTIVES: To measure sonoanatomic characteristics for the facet joints of lumbar vertebras in patients with facetogenic pain and healthy volunteers. STUDY DESIGN: Cross-sectional, observational study. SETTING: University-affiliated Specialty Clinic for Pain Management. PATIENTS: Twenty patients with facet joint disease (FJD) and 40 healthy volunteers (HVGs) were matched for age and sex, height, and weight. Patients with FJD were referred with complaints of pain in the left lumbar facet joints that twice responded favorably to ultrasound guided medial branch blocks. INTERVENTION: Medial branch blocks. MEASUREMENT: The interfacet joint distance (IFJD) between the third, the fourth, and the fifth lumbar vertebras and their depth from the level of skin (DFS) were measured bilaterally, using a high-resolution ultrasound in both groups. RESULTS: Thirty-one men and 29 women with average age of 41.5±9.5 years were enrolled. The IFJD for L3-L4 was 31.5±4.0 mm on the left side and 31.8±4.0 mm on the right side. The IFJD for L4-L5 was 31.3±4.4 mm on the left side and 31.5±4.0 mm on the right side. The IFJD was uniformly 2.2 mm shorter in the FJD group than those in the HVG group (P=.021). The measurements of DFS increased in lower vertebras (L3Assuntos
Dor Lombar/patologia
, Vértebras Lombares/patologia
, Doenças da Coluna Vertebral/patologia
, Articulação Zigapofisária/patologia
, Adulto
, Estudos de Casos e Controles
, Estudos Transversais
, Feminino
, Humanos
, Dor Lombar/diagnóstico por imagem
, Dor Lombar/terapia
, Vértebras Lombares/diagnóstico por imagem
, Masculino
, Pessoa de Meia-Idade
, Bloqueio Nervoso
, Fatores Sexuais
, Doenças da Coluna Vertebral/diagnóstico por imagem
, Doenças da Coluna Vertebral/terapia
, Ultrassonografia/métodos
, Articulação Zigapofisária/diagnóstico por imagem
RESUMO
OBJECTIVE: The purpose of this study was (1) to evaluate the association of trunk muscle density assessed by computed tomography (CT) with age, gender, and BMI and (2) to evaluate the association between trunk muscle CT density and degenerative disc and facet joint disease of the lumbar spine. MATERIAL AND METHODS: The study was IRB approved and HIPAA compliant. The study group comprised 100 subjects (mean age 44.4 ± 22.2 years, 51 % male) who underwent CT of the abdomen and pelvis without intravenous contrast. Exclusion criteria included prior abdominal or spine surgery, active malignancy and scoliosis. CTs were reviewed and the attenuation of the rectus abdominis, transverse abdominis, internal and external obliques, psoas, multifidus, longissimus and gluteus maximus were measured bilaterally at consistent levels. Degenerative disc and bilateral facet joint disease were scored using established methods. Univariate analyses were performed using linear regression. Multivariate linear regression was performed to adjust for age, gender and BMI. RESULTS: CT density of each trunk muscle correlated inversely with age (p < 0.001) and BMI (p < 0.001). CT density of each trunk muscle correlated inversely with degenerative disc and facet joint disease in the univariate analyses (p < 0.001); however, only the gluteus maximus and the transverse abdominis remained significant predictors of degenerative disc and facet joint disease respectively in the multivariate analysis. CONCLUSION: Fatty infiltration of trunk musculature increases with age and BMI. Fatty infiltration of the gluteus maximus and transverse abdominis are associated with degenerative disc and facet joint disease, independent of age, gender and BMI.
Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Tronco/diagnóstico por imagem , Adulto JovemRESUMO
The facet joint has been increasingly implicated as a potential source of lower back pain. Diagnosis can be challenging as there is not a direct correlation between facet joint disease and clinical or radiological features. The purpose of this article is to review the diagnosis, treatment, and current imaging modality options in the context of degenerative facet joint disease. We describe each modality in turn with a pictorial review using current evidence. Newer hybrid imaging techniques such as single photon emission computed tomography/computed tomography (SPECT/CT) provide additional information relative to the historic gold standard magnetic resonance imaging. The diagnostic benefits of SPECT/CT include precise localization and characterization of spinal lesions and improved diagnosis for lower back pain. It may have a role in selecting patients for local therapeutic injections, as well as guiding their location with increased precision.