Hypertrophic synovitis and osteoarthritis of the cervical facet joint. Report of two cases

Hypertrophic synovial mass resulting in C8 radiculopathy--case report

A 58-year-old man presented with a hypertrophic synovial mass manifesting as left C8 radiculopathy. Computed tomography revealed hypertrophic changes in the left C7-T1 facet joint and widening of the interarticular space. Magnetic resonance imaging showed left C7-T1 foraminal stenosis attributable to a periarticular mass enhanced with gadolinium. Decompression surgery of the left C8 nerve root was performed. During left C7-T1 facetectomy we detected inflamed soft tissue occupying the interarticular space with extension toward the intervertebral foramen. The mass markedly compressed the left C8 nerve root and was gross totally removed. The histological diagnosis was proliferated fibrous connective tissue compatible with hypertrophic synovial tissue. Postoperatively, his neurological condition improved remarkably. The surgical and pathological findings in our patient indicate that this clinical condition is important in the differential diagnosis in adult patients presenting with cervical radiculopathy.

Radiographic cervical spine osteoarthritis progression rates: a longitudinal assessment

Relative to other sites, the cervical spine has received little attention in the osteoarthritis (OA) literature. Using data from a longitudinal study, we provide age-specific progression rates of radiographic cervical spine OA, by gender. Data from cohort subjects (ages 40+) from the Clearwater Osteoarthritis Study were analyzed (N = 707). All study subjects' demonstrated radiographic cervical spine OA at baseline (2+). Lateral cervical spine radiographs were taken biennially. The study outcome was radiographic disease progression. A grade increase of 1, or more, by the Lawrence and Kellgren ordinal scale was considered progression. Incidence rates were calculated as per 100 person-years of observation. We show that the progression rates for cervical spine OA increase with age. For all ages combined, men demonstrated higher rates of progression compared with women. However, among subjects in their forties and fifties, women were more likely to experience worsening of their disease when compared with men. Progression rates were similar for men and women in their sixties (8.2 and 8.0, respectively). Among subjects in their seventies, men demonstrated a significantly higher rate of progression compared with women (12.5 and 8.6, respectively). As the baby-boomer population continues to increase, cervical spine OA progression assessment can be a useful tool for health-care resource planning. Cervical spine OA research offers an abundance of opportunities. Instability as a precursor to the development of cervical spine OA warrants further research. Epidemiological studies addressing demographic differences (e.g., gender, age) in the incidence of cervical spine OA will contribute to the current knowledge base.

Treatment of severe retromastoid pain secondary to C1-2 arthrosis by using cervical fusion

OBJECT

In this report the authors review their 5-year experience in the diagnosis and management of nine patients with severe retromastoid pain secondary to C 1-2 arthrosis. Patients with symptomatic joints unresponsive to nonoperative therapy underwent cervical fusion procedures.

METHODS

The mean age of the patients was 71 years, and the onset of prior symptoms ranged from 6 months to 18 years. All patients suffered similar discrete nonneuropathic pain without radicular symptoms ipsilateral to the diseased facet joint. Four patients experienced relief from pain with the use of nonoperative therapy. Five patients continued to experience intractable pain and underwent C1-2 fusion. The follow-up period ranged from 6 to 26 months. The cervical fusion procedure was successful in treating the retromastoid pain in all patients. In patients who underwent surgery, complete relief of pain was demonstrated in four and significantly reduced in the fifth.

CONCLUSIONS

The authors have drawn several conclusions. First, C1-2 arthrosis has a rather unique presentation and is a potential cause of upper posterior neck and head pain predominantly in elderly patients. Second, nonoperative management significantly improved the pain in nearly half of their patients and should be the first line of treatment. Last, C1-2 fusion was successful in treating the pain in patients in whom nonoperative management had failed to resolve symptoms.

Use of computed tomography image processing for mapping of human cervical facet surface geometry

Vertebral facets transmit a significant percent of spinal loading, provide translational, rotational, and axial stability for the spine, and are responsible for the coupling between lateral bending and rotational motions. The shape and the orientation of vertebral facets vary with level and are influenced by degenerative processes. These variations may play an important role in many cases of neck pain, back pain, and instability. To determine whether the shape and orientation of cervical facets can be accurately measured from computed tomography (CT) data, the surfaces of 39 human cervical facets were non-invasively digitized from reconstructed three-dimensional CT data and then invasively digitized using a hand-held three-dimensional probe before and after bleaching away the cartilage. Digitized data describing the facet surfaces were fit to both plane and spherical surfaces. For the adult cervical vertebrae that we measured, the presence of cartilage had no significant effect on the measured shape or orientation of the facets. The orientation of the facet surfaces measured from CT data was within 11 deg of that measured using the hand-held probe. Quantitative measurements of facet shape (flat or spherical) and surface irregularity were similar between CT and hand digitized surfaces. These results suggest that individual facet geometries can be accurately quantified using non-invasive CT examinations. Non-invasively determined variations in facet geometries may assist in the diagnosis of back pain, neck pain and instability.