Exploring the Influence of Facet Orientation and Tropism on Neutral Zone Properties.

Lumbar spine pathologies have been linked independently to both neutral zone (NZ) properties and facet joint anatomical characteristics; however, the effect of facet joint orientation (FO) and tropism (FT) on NZ properties remains unclear. The aim of the present study was to investigate how axial plane FO and FT relate to NZ range and stiffness in the human lumbar spine and porcine cervical spine. Seven human lumbar functional spine units (FSUs) and 94 porcine cervical FSUs were examined. FO and FT were measured, and in vitro mechanical testing was used to determine anterior-posterior (AP) and flexion-extension (FE) NZ range and stiffness. FO and FT were found to have no significant relationship with AP and FE NZ range. Increases in FT were associated with greater FE and AP NZ stiffness in human FSUs, with no FT-NZ stiffness relationship observed in porcine specimens. A significant relationship (p < 0.001) between FO and FE NZ stiffness was observed for both porcine and human FSUs, with a more sagittal orientation of the facet joints being associated with decreased FE NZ stiffness. Given the link between NZ stiffness and pathological states of the lumbar spine, further research is warranted to determine the practical significance of the observed facet joint anatomical characteristic-NZ property relationship.

Facet Joints of the Spine: Structure-Function Relationships, Problems and Treatments, and the Potential for Regeneration.

The zygapophysial joint, a diarthrodial joint commonly referred to as the facet joint, plays a pivotal role in back pain, a condition that has been a leading cause of global disability since 1990. Along with the intervertebral disc, the facet joint supports spinal motion and aids in spinal stability. Highly susceptible to early development of osteoarthritis, the facet is responsible for a significant amount of pain in the low-back, mid-back, and neck regions. Current noninvasive treatments cannot offer long-term pain relief, while invasive treatments can relieve pain but fail to preserve joint functionality. This review presents an overview of the facet in terms of its anatomy, functional properties, problems, and current management strategies. Furthermore, this review introduces the potential for regeneration of the facet and particular engineering strategies that could be employed as a long-term treatment.

Vertebral numbers and human evolution.

Ever since Tyson (1699), anatomists have noted and compared differences in the regional numbers of vertebrae among humans and other hominoids. Subsequent workers interpreted these differences in phylogenetic, functional, and behavioral frameworks and speculated on the history of vertebral numbers during human evolution. Even in a modern phylogenetic framework and with greatly expanded sample sizes of hominoid species, researchers' conclusions vary drastically, positing that hominins evolved from either a "long-backed" (numerically long lumbar column) or a "short-backed" (numerically short lumbar column) ancestor. We show that these disparate interpretations are due in part to the use of different criteria for what defines a lumbar vertebra, but argue that, regardless of which lumbar definition is used, hominins are similar to their great ape relatives in possessing a short trunk, a rare occurrence in mammals and one that defines the clade Hominoidea. Furthermore, we address the recent claim that the early hominin thoracolumbar configuration is not distinct from that of modern humans and conclude that early hominins show evidence of "cranial shifting," which might explain the anomalous morphology of several early hominin fossils. Finally, we evaluate the competing hypotheses on numbers of vertebrae and argue that the current data support a hominin ancestor with an African ape-like short trunk and lower back.

Multisegment Kinematics of the Spinal Column: Soft Tissue Artifacts Assessment.

A major challenge in the assessment of intersegmental spinal column angles during trunk motion is the inherent error in recording the movement of bony anatomical landmarks caused by soft tissue artifacts (STAs). This study aims to perform an uncertainty analysis and estimate the typical errors induced by STA into the intersegmental angles of a multisegment spinal column model during trunk bending in different directions by modeling the relative displacement between skin-mounted markers and actual bony landmarks during trunk bending. First, we modeled the maximum displacement of markers relative to the bony landmarks with a multivariate Gaussian distribution. In order to estimate the distribution parameters, we measured these relative displacements on five subjects at maximum trunk bending posture. Then, in order to model the error depending on trunk bending angle, we assumed that the error grows linearly as a function of the bending angle. Second, we applied our error model to the trunk motion measurement of 11 subjects to estimate the corrected trajectories of the bony landmarks and investigate the errors induced into the intersegmental angles of a multisegment spinal column model. For this purpose, the trunk was modeled as a seven-segment rigid-body system described using 23 reflective markers placed on various bony landmarks of the spinal column. Eleven seated subjects performed trunk bending in five directions and the three-dimensional (3D) intersegmental angles during trunk bending were calculated before and after error correction. While STA minimally affected the intersegmental angles in the sagittal plane (<16%), it considerably corrupted the intersegmental angles in the coronal (error ranged from 59% to 551%) and transverse (up to 161%) planes. Therefore, we recommend using the proposed error suppression technique for STA-induced error compensation as a tool to achieve more accurate spinal column kinematics measurements. Particularly, for intersegmental rotations in the coronal and transverse planes that have small range and are highly sensitive to measurement errors, the proposed technique makes the measurement more appropriate for use in clinical decision-making processes.

Sex estimation using the second cervical vertebra: a morphometric analysis in a documented Portuguese skeletal sample.

Biological sex estimation is one of the main parameters required in the construction of a biological profile of an unknown deceased person. In corpses in an advanced state of decomposition, skeletonized or severely mutilated, bone analysis may provide the only way to access biological sex. Although the hip bones are the most dimorphic and useful bones for sex estimation, they are often badly preserved and/or fragmented or may not even be present in some cases. For that reason, it is necessary to develop sex estimation methods based on bones less dimorphic. In this study, 13 dimensions of the second cervical vertebra were measured in order to quantify sex-related variation and to generate a simple predictive model based on logistic regression analysis. For logistic regression fitting, 190 individuals from the Coimbra Identified Skeletal Collection were used as a training sample. The resulting model was also evaluated in an independent test sample composed of 47 individuals from the Identified Skeletal Collection of the 21st Century (University of Coimbra). The developed logistic regression model correctly estimated known sex in 86.7 to 89.7 % of the cases. The second cervical vertebra demonstrated to be a useful alternative for sex estimation when other skeletal elements are not available or suitable for analysis. This method seems promising but more reliability studies are required for a more robust validation.

A Cervico-Thoraco-Lumbar Multibody Dynamic Model for the Estimation of Joint Loads and Muscle Forces.

Computational musculoskeletal models have been developed to predict mechanical joint loads on the human spine, such as the forces and moments applied to vertebral and facet joints and the forces that act on ligaments and muscles because of difficulties in the direct measurement of joint loads. However, many whole-spine models lack certain elements. For example, the detailed facet joints in the cervical region or the whole spine region may not be implemented. In this study, a detailed cervico-thoraco-lumbar multibody musculoskeletal model with all major ligaments, separated structures of facet contact and intervertebral disk joints, and the rib cage was developed. The model was validated by comparing the intersegmental rotations, ligament tensile forces, facet joint contact forces, compressive and shear forces on disks, and muscle forces were to those reported in previous experimental and computational studies both by region (cervical, thoracic, or lumbar regions) and for the whole model. The comparisons demonstrated that our whole spine model is consistent with in vitro and in vivo experimental studies and with computational studies. The model developed in this study can be used in further studies to better understand spine structures and injury mechanisms of spinal disorders.

Morphological and biomechanical analyses of the subchondral mineralized zone in human sacral facet joints: Application to improved diagnosis of osteoarthritis.

The anatomy of the facet joint subchondral mineralized zone (SMZ) is the main parameter used in diagnosing osteoarthritis. Usually, a single CT scan slice is used to measure the thickness, but the measurement is highly location-dependent. Bone mineral density (BMD) and porosity could be more reliable than thickness for detecting SMZ sclerosis, and linking them to stiffness can provide insights into the mechanism of osteoarthritis progression. The goal of this study was two-fold: (1) to assess spatial heterogeneity in thickness, BMD, and porosity within the non-pathological human facet joint SMZ; (2) to correlate these measurements with the static modulus of elasticity (MOEsta ). Four non-pathological facet joints were excised and imaged using micro-computed tomography (µCT) to measure SMZ thickness, BMD, and porosity. A total of eight parallelepiped SMZ samples were similarly analyzed and then mechanically tested. The mean SMZ BMD, porosity, and thickness (± Standard Deviation) of the whole facet joints were 611 ± 35 mgHA/cc, 9.8 ± 1.3%, and 1.39 ± 0.41 mm, respectively. The mean BMD, porosity, and MOEsta of the eight SMZ samples were 479 ± 23 mgHA/cc, 12 ± 0.01%, and 387 ± 138 MPa, respectively, with a positive rank correlation between BMD and porosity. BMD and porosity were more homogeneous within the facet joint than thickness and they could be more reliable parameters than thickness for detecting SMZ sclerosis. The values for the physiological SMZ and MOEsta of human facets joints obtained here were independent of BMD. SMZ BMD and porosity were related to each other.

The anatomy and morphometry of cervical zygapophyseal joint meniscoids.

PURPOSE: Meniscoids are folds of synovial membrane that project into the articular cavities of zygapophyseal joints throughout the cervical spine. These structures have been implicated in musculoskeletal neck pain; however, their anatomy has not been extensively investigated. The purpose of this study was to explore the morphometry and composition of the cervical zygapohyseal joint meniscoids. METHODS: Twelve adult cadaveric hemi-spines were dissected and their C2-3 to C6-7 zygapophyseal joints disarticulated (six female; six left; mean 81.5 years, SD 7.3 years). Meniscoids were identified and their surface area, protrusion length and articular cartilage degeneration measured. Specimens were then sectioned sagittally, stained with haematoxylin and eosin, and examined with a light microscope. Data were analysed descriptively and using non-parametric hypothesis testing (significance p < 0.05). RESULTS: Meniscoids were identified in 86% of zygapophyseal joints examined; 50% contained both ventral and dorsal meniscoids, 7% contained a ventral meniscoid only and 29% contained a dorsal meniscoid only. Meniscoids were classified as adipose (4%), fibrous (74%), or fibroadipose (22%) based upon histological composition. There were no significant associations between meniscoid size (surface area or protrusion length) and gender, position in joint, spinal level, or articular degeneration. Increased articular degeneration was associated with fibrous meniscoid classification. CONCLUSIONS: The morphological patterns observed, such as the association of fibrous meniscoids with cartilage degeneration, may provide insight into the significance of the zygapophyseal joint meniscoids in neck pathology. Further investigation is needed to explore the morphological qualities of these structures in a pathological population.

Basic aspects in MR imaging of degenerative lumbar disk disease.

Degenerative disease may lead to spinal canal stenosis and long-lasting pain. It is among the leading cause of disability that may affect the ability to work. It has become more common in an increasingly aging population. MRI is the most comprehensive imaging modality and provides detailed morphologic information. A standardized terminology facilitates communication with referring physicians. Yet imaging findings need careful interpretation in conjunction with the results of clinical tests and symptoms to truly help guide therapeutic decision making. This review summarizes aspects of normal anatomy of the intervertebral disk, pathologic mechanisms, terminology, and examples of the imaging spectrum of disk degeneration and herniation.

[Establishment and validation of three dimensional finite element model of lower cervical bilateral facet locking].

OBJECTIVE: To establish the three dimensional finite element model of bilateral cervical articular process locking and verify its effectiveness. METHODS: A healthy adult male underwent cervical thin-layer computed tomography (CT) scan. The software programs of Simpleware3.0, Geomagic8.0, Hypermesh9.0, Abaqus6.9 and Rhino4.0 were employed to establish a complete C4, C5 segment (including intervertebral disc and ligament tissue) finite element model. A spring force load of 180 n was applied along the direction of cervical curvature. The locking of articular process was simulated. And its effectiveness was compared with previous experiments. RESULTS: Detailed anatomy structure of cervical spine was established. Simulated bilateral joints in journey finally formed. The load-displacement situations and experiment results of small joint ligament were consistent. And shear forces and displacement differences of modeling was insignificant. CONCLUSION: The three dimensional finite element model of bilateral cervical articular process locking has excellent biological fidelity. And it is suitable for clinical applications.

Mamillo-accessory notch and foramen: distribution patterns and correlation with superior lumbar facet structure.

The mamillary (MP) and the accessory (AP) processes are two important anatomical landmarks in the lumbar vertebral morphology. These two processes form the mamillo-accessory notch (MAN) between them. In the living, the MP and the AP are connected together by the mamillo-accessory ligament (MAL). The medial branches of lumbar dorsal rami pass underneath the MAL. The MAL often undergoes varied degrees of ossification with diverse notching at the junction of these two processes, often with formation of a discrete foramen (MAF). Reports on the distribution of these notches (MAN) and foramina (MAF) are very few and most of them do not discuss such ossification in context of morphology of adjoining structures in the vertebrae. Lumbar vertebral and sacral specimens were screened for three different categories of narrowing at the mamillo-accessory junction: firstly >1/2 notch, secondly ¾ notch, and thirdly MAF and their distribution patterns were mapped along the lumbar spine. Transverse dimensions of superior facet articulating surfaces [length (a)] and widths of MPs [length (b)] were recorded. Relative widths of the MPs were calculated as index M (a/b). Results suggest associations between the degrees of assimilation of the MPs into the facet joints, the index M values, and the different types of mamillo-accessory junctional anatomy. This study may help to understand if MAN and MAF related dorsal rami entrapment neuropathies arise merely due to osteoarthritic ossification of the MAL or could also be accounted for by facet dimensions or degree of MP-facet fusions that abut close to the mamillo-accessory junctions.

[Biometric and biomechanic analysis of lumbar posterior facets based on a CT-scan database]. / Analyse biométrique et biomécanique des articulaires lombaires postérieures au sein d'une base de données scanographique.

AIM OF THE STUDY: Our knowledge on anatomy of lumbar spine is based on few cadaver's study with old and few subjects. CT-scan is very precise for lumbar facet's morphology. We have analysed 400 subjects. The aim of this study is to measure different distances, angles and circles to better understand the mechanical function of the lumbar facets. PATIENTS AND METHODS: We have analysed 720 CT-scan. We had 217 men and 183 women with 59 years of mean age. We used native slices of 1.25 mm thick from L1 to S1. We created transversal plan and we put different mark point. We took their coordinates and we have calculated different distances, angles and mechanical circles. We have compared different axis of rotation of the facets. RESULTS: From L1 to S1, the facets goes near to the posterior wall and far from themselves. Moreover, the posterior angle between both facets increase down to the sacrum. The radius of the left side circle and the right one are very closed in 50% of the cases but the three radius are close only in 10% of cases. CONCLUSION: This study based on 400 subjects shows that there is not a unique axis of rotation for both lumbar posterior facets. We have had only 50% of symmetry between both sides whatever the level studied.

[Feasibility and accuracy of ultrasound-guided methodology in the examination of lumbar spine facet joints].

OBJECTIVE: To investigate the feasibility, accuracy of B ultrasound in the examination of joint space of lumbar spine facet joints compared with CT scan. METHODS: Ten healthy adult volunteers were enrolled. The joint space of lumbar facet joints was measured by ultrasound. To identify the spinal levels, the posterior parasagittal sonograms were obtained at levels L1 to S1. The lumbar facet joints were delineated with the help of transverse sonograms at each level. Meanwhile, the lumbar facet joints were evaluated by spiral CT on the same plane, reformatted to 1-mm axial slices. RESULTS: A total of 88 lumbar facet joints from L1 to S1 were clearly visualized in the 10 volunteers. Both ultrasound and CT measurements showed the same average depth and lateral distance of lumbar facet joint space (P > 0.05). CONCLUSION: The lumbar facet joint space can be accurately demonstrated by ultrasound.

Internal morphology of human facet joints: comparing cervical and lumbar spine with regard to age, gender and the vertebral core.

Back pain constitutes a major problem in modern societies. Facet joints are increasingly recognised as a source of such pain. Knowledge about the internal morphology and its changes with age may make it possible to include the facets more in therapeutic strategies, for instance joint replacements or immobilisation. In total, 168 facets from C6/7 and L4/5 segments were scanned in a micro-computed tomography. Image analysis was used to investigate the internal morphology with regard to donor age and gender. Additional data from trabecular bone of the vertebral core allowed a semi-quantitative comparison of the morphology of the vertebral core and the facets. Porosity and pore spacing of the cortical sub-chondral bone does not appear to change with age for either males or females. In contrast, bone volume fraction decreases in females from approximately 0.4 to 0.2 , whereas it is constant in males. Trabecular thickness decreases during the ageing process in females and stays constant in males , whereas trabecular separation increases during the ageing process in both genders. The results of this study may help to improve the understanding of pathophysiological changes in the facet joints. Such results could be of value for understanding back pain and its treatment.

Prediction of the human thoracic and lumbar articular facet joint morphometry from radiographic images.

The articular facet joints (AFJ) play an important role in the biomechanics of the spine. Although it is well known that some AFJ dimensions (e.g. facet height/width or facet angles) play a major role in spinal deformities such as scoliosis, little is known about statistical correlations between these dimensions and the size of the vertebral bodies. Such relations could allow patient-specific prediction of AFJ morphometry from a few dimensions measurable by X-ray. This would be of clinical interest and could also provide parameters for mathematical modeling of the spine. Our purpose in this study was to generate prediction equations for 20 parameters of the human thoracic and lumbar AFJ from T1 to L4 as a function of only one given parameter, the vertebral body height posterior (VBHP). Linear and nonlinear regression analyses were performed with published anatomical data, including linear and angular dimensions of the AFJ and vertebral body heights, to find the best functions to describe the correlations between these parameters. Third-order polynomial regressions, in contrast to the linear, exponential and logarithmic regressions, provided moderate to high correlations between the AFJ parameters and vertebral body heights; e.g. facet height superior and interfacet width (R², 0.605-0.880); facet height inferior, interfacet height and sagittal/transverse angle superior (R², 0.875-0.973). Different correlations were found for facet width and transverse angle inferior in the thoracic (R², 0.703-0.930) and lumbar (R², 0.457-0.892) regions. A set of 20 prediction equations for AFJ parameters was generated (P-values < 0.005, anova). Comparison of the AFJ predictions with experimental data indicated mean percent errors <13%, with the exception of the thoracolumbar junction (T12-L1). It was possible to establish useful predictions for human thoracic and lumbar AFJ dimensions based on the size of the vertebral bodies. The generated set of equations allows the prediction of 20 AFJ parameters per vertebral level from the measurement of the parameter VBHP, which is easily performed on lateral X-rays. As the vertebral body height is unique for each person and vertebral level, the predicted AFJ parameters are also specific to an individual. This approach could be used for parameterized patient-specific modeling of the spine to explore the clinically important mechanical roles of the articular facets in pathological conditions, such as scoliosis.

New vertebral and rib material point to modern bauplan of the Nariokotome Homo erectus skeleton.

The double S shape of the vertebral column is one of the most important evolutionary adaptations to human bipedal locomotion, providing an optimal compromise between stability and mobility. It is commonly believed that a six element long lumbar spine facilitated the critical adoption of lumbar lordosis in early hominins, which contrasts with five lumbars in modern humans and four in chimpanzees and gorillas. This is mainly based on the juvenile Homo erectus skeleton KNM-WT 15000 from Nariokotome, Kenya. Yet, the biomechanical advantage of a long lumbar spine is speculative. Here we present new vertebral and rib fragments of KNM-WT 15000. They demonstrate that the sixth to the last presacral vertebra possesses rib facets and therefore indicate the presence of only five lumbar and twelve thoracic segments, as is characteristic of modern humans. Moreover, they show that no additional element was located between the sixth to the last presacral vertebra and Th11 as suggested in the original description. The transition from thoracic to lumbar type orientation of the facet joints that takes place at Th11 is thus at the same segment as in over 40% of modern humans, suggesting an identical lumbar mobility and capacity for lordosis. Taken together, KNM-WT 15000 had one vertebra less than previously thought irrespective of whether rib-free lumbar vertebrae or vertebrae that bear lumbar-like articular processes are counted. Furthermore, the new rib fragments imply a rearrangement of the ribs that results in a symmetrical rib cage. This challenges previous claims for idiopathic or congenital scoliosis. We conclude that the bauplan of the hominin axial skeleton is more conservative than previously thought.

Preconditioning is correlated with altered collagen fiber alignment in ligament.

Although the mechanical phenomena associated with preconditioning are well-established, the underlying mechanisms responsible for this behavior are still not fully understood. Using quantitative polarized light imaging, this study assessed whether preconditioning alters the collagen fiber alignment of ligament tissue, and determined whether changes in fiber organization are associated with the reduced force and stiffness observed during loading. Collagen fiber alignment maps of facet capsular ligaments (n = 8) were generated before and after 30 cycles of cyclic tensile loading, and alignment vectors were correlated between the maps to identify altered fiber organization. The change in peak force and tangent stiffness between the 1st and 30th cycle were determined from the force-displacement response, and the principal strain field of the capsular ligament after preconditioning was calculated from the fiber alignment images. The decreases in peak ligament force and tangent stiffness between the 1st and 30th cycles of preconditioning were significantly correlated (R ≥ 0.976, p < 0.0001) with the change in correlation of fiber alignment vectors between maps. Furthermore, the decrease in ligament force was correlated with a rotation of the average fiber direction toward the direction of loading (R = -0.730; p = 0.0396). Decreases in peak force during loading and changes in fiber alignment after loading were correlated (p ≤ 0.0157) with the average principal strain of the unloaded ligament after preconditioning. Through the use of a vector correlation algorithm, this study quantifies detectable changes to the internal microstructure of soft tissue produced by preconditioning and demonstrates that the reorganization of the capsular ligament's collagen fiber network, in addition to the viscoelasticity of its components, contribute to how the mechanical properties of the tissue change during its preconditioning.

Finite element lumbar spine facet contact parameter predictions are affected by the cartilage thickness distribution and initial joint gap size.

Current finite element modeling techniques utilize geometrically inaccurate cartilage distribution representations in the lumbar spine. We hypothesize that this shortcoming severely limits the predictive fidelity of these simulations. Specifically, it is unclear how these anatomically inaccurate cartilage representations alter range of motion and facet contact predictions. In the current study, cadaveric vertebrae were serially sectioned, and images were taken of each slice in order to identify the osteochondral interface and the articulating surface. A series of custom-written algorithms were utilized in order to quantify each facet joint's three-dimensional cartilage distribution using a previously developed methodology. These vertebrae-dependent thickness cartilage distributions were implemented on an L1 through L5 lumbar spine finite element model. Moments were applied in three principal planes of motion, and range of motion and facet contact predictions from the variable thickness and constant thickness distribution models were determined. Initial facet gap thickness dimensions were also parameterized. The data indicate that the mean and maximum cartilage thickness increased inferiorly from L1 to L5, with an overall mean thickness value of 0.57 mm. Cartilage distribution and initial facet joint gap thickness had little influence on the lumbar range of motion in any direction, whereas the mean contact pressure, total contact force, and total contact area predictions were altered considerably. The data indicate that range of motion predictions alone are insufficient to establish model validation intended to predict mechanical contact parameters. These data also emphasize the need for the careful consideration of the initial facet joint gap thickness with respect to the spinal condition being studied.

Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions.

The facet joint is a crucial anatomic region of the spine owing to its biomechanical role in facilitating articulation of the vertebrae of the spinal column. It is a diarthrodial joint with opposing articular cartilage surfaces that provide a low friction environment and a ligamentous capsule that encloses the joint space. Together with the disc, the bilateral facet joints transfer loads and guide and constrain motions in the spine due to their geometry and mechanical function. Although a great deal of research has focused on defining the biomechanics of the spine and the form and function of the disc, the facet joint has only recently become the focus of experimental, computational and clinical studies. This mechanical behavior ensures the normal health and function of the spine during physiologic loading but can also lead to its dysfunction when the tissues of the facet joint are altered either by injury, degeneration or as a result of surgical modification of the spine. The anatomical, biomechanical and physiological characteristics of the facet joints in the cervical and lumbar spines have become the focus of increased attention recently with the advent of surgical procedures of the spine, such as disc repair and replacement, which may impact facet responses. Accordingly, this review summarizes the relevant anatomy and biomechanics of the facet joint and the individual tissues that comprise it. In order to better understand the physiological implications of tissue loading in all conditions, a review of mechanotransduction pathways in the cartilage, ligament and bone is also presented ranging from the tissue-level scale to cellular modifications. With this context, experimental studies are summarized as they relate to the most common modifications that alter the biomechanics and health of the spine-injury and degeneration. In addition, many computational and finite element models have been developed that enable more-detailed and specific investigations of the facet joint and its tissues than are provided by experimental approaches and also that expand their utility for the field of biomechanics. These are also reviewed to provide a more complete summary of the current knowledge of facet joint mechanics. Overall, the goal of this review is to present a comprehensive review of the breadth and depth of knowledge regarding the mechanical and adaptive responses of the facet joint and its tissues across a variety of relevant size scales.

The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading.

We present a two-part review article on the current state of knowledge of lumbar facet joint pathology. This first article discusses the functional anatomy, biomechanics, and radiological grading systems currently in use in clinical practice and academic medicine. Facet joint degeneration is presented within the larger context of degenerative disc disease to enable the reader to better understand the anatomical changes underlying facet-mediated lower back pain. Other less-common, but equally important etiologies of lumbar facet joint degeneration are reviewed. The existing grading systems are discussed with specific reference to the reliability of CT and MR imaging in the diagnosis of lumbar facet osteoarthritis. It is hoped that this discussion will stimulate debate on how best to improve the diagnostic reliability of these tests so as to improve both operative and non-operative treatment outcomes.