The images were reviewed by two spine surgeons, by five orthopedists in training in the specialty of spine surgery and one radiologist to evaluate and quantify the presence of hypersignal lumbar facet and the Pfirrmann Classification for disc degeneration. There was no statistically significant relationship between facet arthrosis and disc degeneration. The results confirm that there is good inter-observer relationship for the classification of Facet Hypersignal and for the Classification of Pfirrmann. However, in spite of a positive relationship, a correlation between facet arthrosis and disc degeneration was not statistically significant. Today, low back pain has reached epidemic levels, with several studies citing it as one of the main causes of emergency medical care, second only to the common cold.
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The images were reviewed by two spine surgeons, by five orthopedists in training in the specialty of spine surgery and one radiologist to evaluate and quantify the presence of hypersignal lumbar facet and the Pfirrmann Classification for disc degeneration.
There was no statistically significant relationship between facet arthrosis and disc degeneration. The results confirm that there is good inter-observer relationship for the classification of Facet Hypersignal and for the Classification of Pfirrmann.
However, in spite of a positive relationship, a correlation between facet arthrosis and disc degeneration was not statistically significant. Today, low back pain has reached epidemic levels, with several studies citing it as one of the main causes of emergency medical care, second only to the common cold. Facet joint syndrome was first described as one of its causes around Discogenic pain is present as the result of structural changes in the disc, without the presence of nerve root compression or even changes in disc shape.
Magnetic resonance is the most commonly used examination for disc disorders. The intensity of the signal, particularly in T2, reflects the changes caused by aging or degeneration. Standardization in the comparison of data is paramount for the advancement and correlation of the various investigations of disc disorders, as Pfirrmann et al. The facet joint hypersignal, revealed by magnetic resonance as a sign of facet joint arthrosis, was first correlated with chronic low back pain and vertebral disc degeneration by Yang and Yang et al.
Given the current evidence, the objective of this study is to analyze whether there is a strong correlation between degenerative disc and facet joint changes, as shown by magnetic resonance, given that both are indicated as important causal agents of low back pain, and to analyze the inter-observer reproducibility of the Pfirrmann classification of lumbar facet joint arthrosis.
The lumbar levels between L1 and S1 of 24 patients were analyzed. The study group was comprised of 9 men and 15 women ranging from 35 to 79 years of age with an average age of 48 years and 1 month. T2 weighted magnetic resonance at 1 Tesla was used, with axial and sagittal cuts. The images that were selected and included in this study are part of a database of images obtained from patients in outpatient treatment for degenerative lumbar disease in a study approved by the Institutional Review Board CAAE: All patients signed the Informed Consent Form.
We used the Longmuir and Conley classification system to grade the degeneration process in the facet joints Chart 1 , Figures 1 — 4. A : grade 0 normal facet joint.
E : grade IV bone erosion. Grading of disc degeneration was obtained by means of the Pfirrmann et al. Subsequently, statistical tests were conducted to correlate the two variables and observe to strength of the relationships. The evaluations were carried out by eight individuals: two spine surgeons, five orthopedists in training for spinal surgery, and one radiologist. For the assessment of concordance among observers Tables 1 , 2 , the Cronbach's alpha statistical method was used showing that the values are statistically high, from which we can infer, a priori, that the data present internal consistency, i.
Therefore, based on what was calculated and exposed, the sample can be considered to have a high degree of reliability, between 0.
Next, we applied Spearman's correlation analysis to determine the degree of correlation between the exposure variables. Table 2. For the other pairs of variables, the results showed statistically insignificant relationships. Table 3. Facet joint arthrosis is a common finding in radiographs and has long been reported as a source of low back pain.
Thus, when subjected to excessive movement and increased load, degenerative changes tend to develop that potentially cause impairment or disability. A considerable number of studies point to the intervertebral disc as the zero mark for degenerative spinal changes, among them, facet arthrosis. Morphological and cell changes occur as part of the normal aging process 14 , 19 , 16 and the changes revealed by resonance are a common finding both in asymptomatic patients and those with low back pain, but there is a strong correlation between low back pain and the presence of disc degeneration.
A biomechanical study showed that the loss of disc height would increase the pressure on the facet joint at supra-physiological levels. Classification of facet joint arthrosis, the principal parameter of which is the hypersignal in T2, 11 , 22 presents good correlation with the pathological changes and good inter-observer concordance.
The article by Marcondes and Miller et al. The objective of our study was to correlate the above-mentioned degenerative events using the two classifications existing in the literature, in search of what Pfirrmann et al. The Spearman correlation analysis method showed certain significance between disc degeneration at one level and facet joint changes in the subsequent lower lumbar levels, as follows: L3-L4 with L4-L5, L4-L5 with L5-S1, and L5-S1 with L5-S1, respectively.
However, from the data we could not infer that the same relationship is valid for all levels. The association between a cascade of degenerative spinal changes and the presence of low back pain is well described, so the search for a method that can merge the two main marks involved in its genesis, disc degeneration and facet joint arthrosis, is extremely valid.
Both classifications demonstrate good inter-observer concordance, showing their easy applicability and objectivity and agreeing with the literature on the subject. However, in the statistical analysis, the direct correlation between facet joint arthrosis and disc degeneration is weak and does not allow us to make any generalizations.
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Services on Demand Journal. Conclusions: The results confirm that there is good inter-observer relationship for the classification of Facet Hypersignal and for the Classification of Pfirrmann.
RESULTS For the assessment of concordance among observers Tables 1 , 2 , the Cronbach's alpha statistical method was used showing that the values are statistically high, from which we can infer, a priori, that the data present internal consistency, i.
Received: April 28, ; Accepted: November 28, Lorena, cj. How to cite this article.
Síndrome facetario y su manejo
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