Skip to main content
Log in

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

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop 1982; 110–3.

  2. Fujiwara A, Lim TH, An HS, et al. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine. 2000;25(23):3036–44.

    Article  CAS  PubMed  Google Scholar 

  3. Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine. 1994;19(12):1371–80.

    Article  CAS  PubMed  Google Scholar 

  4. Grobler LJ, Robertson PA, Novotny JE, Pope MH. Etiology of spondylolisthesis. Assessment of the role played by lumbar facet joint morphology. Spine. 1993;18(1):80–91.

    Article  CAS  PubMed  Google Scholar 

  5. White AA, Panjabi MM. Clinical biomechanics of the spine. 2nd edn. Philadelphia: Lippincott; 1990.

    Google Scholar 

  6. Adams MA, Bogduk N. The biomechanics of back pain. Edinburgh: Churchill Livingstone; 2002. p. 121–3.

    Google Scholar 

  7. Adams MA, Hutton WC. The mechanical function of the lumbar apophyseal joints. Spine. 1983;8:327–30.

    Article  CAS  PubMed  Google Scholar 

  8. Yang KH, King AI. Mechanism of facet load transmission as a hypothesis for low back pain. Spine. 1984;9:557–65.

    Article  CAS  PubMed  Google Scholar 

  9. Jinkins JR. Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiscal structures of the spinal column and peripheral soft tissues. Eur J Radiol. 2004;50:134–58.

    Article  PubMed  Google Scholar 

  10. Wong DA, Transfeldt E. Macnab’s Backache. 4th edn. Philadelphia: Lippincott Williams & Wilkins; 2007.

    Google Scholar 

  11. Haefeli M. The course of macroscopic degeneration in the human lumbar intervertebral disc. Spine. 2006;31(14):1522–31.

    Article  PubMed  Google Scholar 

  12. Butler D, Trafimow JH, Andersson GBJ, McNeill TW, Huckman MS. Discs degenerate before facets. Spine. 1990;15:111–3.

    Article  CAS  PubMed  Google Scholar 

  13. Vernon-Roberts B, Pirie CJ. Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil. 1977;16:13–21.

    Article  CAS  PubMed  Google Scholar 

  14. Bywaters EGC. The pathological anatomy of idiopathic low back pain. Idiopathic low back pain. In: White AA, Gordon S, editors. St. Louis: Mosby; 1982. p. 144–175.

  15. Horst M, Brinckmann P. Measurement of the distribution of axial stress on the end-plate of the vertebral body. Spine. 1981;6(3):217–32.

    Article  CAS  PubMed  Google Scholar 

  16. Adams MA, McNally DS, Dolan P. “Stress” distributions inside intervertebral discs: the effects of age and degeneration. J Bone Jt Surg. 1996;78B(6):965–72.

    Article  Google Scholar 

  17. Nachemson A. Lumbar intradiscal pressure. Acta Orthop Scand. 1960;43(suppl):1–104.

    CAS  Google Scholar 

  18. Cyron BM, Hutton WC. The tensile strength of the capsular ligaments of the apophyseal joints. J Anat. 1981;132:145–50.

    CAS  PubMed  Google Scholar 

  19. Yahia LH, Garzon S. Structure of the capsular ligaments of the facet joints. Ann Anat. 1993;175:185–8.

    CAS  PubMed  Google Scholar 

  20. Tanno I, Murakami G, Oguma H, Sato S, Lee UY, Han SH, et al. Morphometry of the lumbar zygapophyseal facet capsule and cartilage with special reference to degenerative osteoarthritic changes: an anatomical study using fresh cadavers of elderly Japanese and Korean subjects. J Orthop Sci. 2004;9:468–77.

    Article  PubMed  Google Scholar 

  21. Thompson JP, Pearce RH, Schechter MT, et al. Preliminary evaluation of a scheme for grading the gross morphology of the human intervertebral disc. Spine. 1990;15:411–5.

    Article  CAS  PubMed  Google Scholar 

  22. Grogan J, Nowicki BH, Schmidt TA, et al. Lumbar facet joint tropism does not accelerate degeneration of the facet joints. Am J Neuroradiol. 1997;18:1325–9.

    CAS  PubMed  Google Scholar 

  23. Tischer T, Aktas T, Milz S, Putz RV. Detailed pathological changes of human lumbar facet joints L1-L5 in elderly individuals. Eur Spine J. 2006;15:308–15.

    Article  PubMed  Google Scholar 

  24. Eisenstein SM, Parry CR. The lumbar facet arthrosis syndrome. Clinical presentation and articular surface changes. J Bone Jt Surg Br. 1987;69:3–7.

    CAS  Google Scholar 

  25. Twomey LT, Taylor JR. Age changes in the lumbar articular triad. Aust J Physiother. 1985;31:106–12.

    Google Scholar 

  26. Macnab I. Spondylolisthesis with an intact neural arch—the so-called pseudospondylolisthesis. J Bone Jt Surg Br. 1950;32:325–33.

    Google Scholar 

  27. Berlemann U, Jeszensky DJ, Buhler DW, et al. Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism. Eur Spine J. 1998;7:376–80.

    Article  CAS  PubMed  Google Scholar 

  28. Cinotti G, Postacchini F, Fassari F, Urso S. Predisposing factors in degenerative spondylolisthesis. A radiographic and CT study. Int Orthop. 1997;21(5):337–42.

    Article  CAS  PubMed  Google Scholar 

  29. Kim NH, Lee JW. The relationship between isthmic and degenerative spondylolisthesis and the configuration of the lamina and facet joints. Eur Spine J. 1995;4(3):139–44.

    Article  CAS  PubMed  Google Scholar 

  30. Nagaosa Y, Kikuchi S, Hasue M, Sato S. Pathoanatomic mechanisms of degenerative spondylolisthesis. A radiographic study. Spine. 1998;23(13):1447–51.

    Article  CAS  PubMed  Google Scholar 

  31. Sato K, Wakamatsu E, Yoshizumi A, Watanabe N, Irei O. The configuration of the laminas and facet joints in degenerative spondylolisthesis. A clinicoradiologic study. Spine. 1989;14(11):1265–71.

    Article  CAS  PubMed  Google Scholar 

  32. Dai LY. Orientation and tropism of lumbar facet joints in degenerative spondylolisthesis. Int Orthop. 2001;25:40–2.

    Article  CAS  PubMed  Google Scholar 

  33. Boden SD, Riew DK, Yamaguchi K, Branch TP, Schellinger D, Wiesel SW. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Jt Surg Am. 1996;78-A:403–11.

    Google Scholar 

  34. Brailsford JF. Deformities of the lumbosacral region of the spine. Br J Surg. 1928;16:562–627.

    Article  Google Scholar 

  35. Chaput C, Padon D, Rush J, Lenehan E, Rahm M. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine. 2007;32(17):1883–7.

    Article  PubMed  Google Scholar 

  36. Hagen T, Daschner H, Lensch T. Juxta-facet cysts: magnetic resonance tomography diagnosis. Radiologe. 2001;41(12):1056–62.

    Article  CAS  PubMed  Google Scholar 

  37. Epstein NE. Lumbar synovial cysts: a review of diagnosis, surgical management, and outcome assessment. J Spinal Disord Tech. 2004;17(4):321–5.

    Article  PubMed  Google Scholar 

  38. Schmid G, Willburger R, Jergas M, Pennekamp W, Bickert U, Koster O. Lumbar intraspinal juxtafacet cysts: MR imaging and CT-arthrography. Rofo. 2002;174(10):1247–52.

    CAS  PubMed  Google Scholar 

  39. Kusakabe T, Kasama F, Aizawa T, Sato T, Kokubun S. Facet cyst in the lumbar spine: radiological and histopathological findings and possible pathogenesis. J Neurosurg Spine. 2006;5(5):398–403.

    Article  PubMed  Google Scholar 

  40. Christophis P, Asamoto S, Kuchelmeister K, Schachenmayr W. “Juxtafacet cyst”, a misleading name for cystic formations of mobile spine (CYFMOS). Eur Spine J. 2007;16(9):1499–505.

    Article  PubMed  Google Scholar 

  41. Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J. 2006;15:705–18.

    Article  PubMed  Google Scholar 

  42. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic measurement. Radiology. 1987;164:227–30.

    CAS  PubMed  Google Scholar 

  43. Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol. 1999;28:215–9.

    Article  CAS  PubMed  Google Scholar 

  44. Coste J, Judet O, Barre O, Siaud JR, Cohen de Lara A, Paolaggi JB. Inter-and intra-observer variability in the interpretation of computed tomography of the lumbar spine. J Clin Epidemiol. 1994;47(4):375–81.

    Article  CAS  PubMed  Google Scholar 

  45. Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J. 1999;8:396–401.

    Article  CAS  PubMed  Google Scholar 

  46. Carrera GF, Williams AL, Haughton VM. Computed tomography in sciatica. Radiology. 1980;137:433–7.

    CAS  PubMed  Google Scholar 

  47. Grenier N, Kressel HY, Schiebler ML, Grossman RI, Dalinka MK. Normal and degenerative posterior spinal structures: MR imaging. Radiology. 1987;165:517–25.

    CAS  PubMed  Google Scholar 

  48. Leone A, Aulisa L, Tamburrelli F, Lupparelli S, Tartaglione T. The role of computed tomography and magnetic resonance in assessing degenerative arthropathy of the lumbar articular facets. Radiol Med Torino. 1994;88:547–52.

    CAS  PubMed  Google Scholar 

  49. Carrera GF, Haughton VM, Syvertsen A, Williams AL. Computed tomography of the facet joints. Radiology. 1980;134:145–8.

    CAS  PubMed  Google Scholar 

  50. Kos J, Hert J, Sevcik P. Meniscoids of the intervertebral joints. Acta Chir Orthop Traumatol Cech. 2002;69:149–57. Abstract.

    CAS  PubMed  Google Scholar 

  51. Rihn JA, Lee JY, Khan M, Ulibarri JA, Tannoury C, Donaldson WF, et al. Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease? Spine. 2007;32(14):1555–60.

    Article  PubMed  Google Scholar 

  52. Hauge T, Magnaes B, Skullerud K. Rheumatoid arthritis of the lumbar spine leading to anterior vertebral subluxation and compression of the cauda equina. Scand J Rheumatol. 1980;9:241–4.

    Article  CAS  PubMed  Google Scholar 

  53. Kawaguchi Y, Matsuno H, Kanamori M, Ishihara H, Ohmori K, Kimura T. Radiologic findings of the lumbar spine in patients with rheumatoid arthritis and a review of pathologic mechanisms. J Spinal Disord Tech. 2003;16(1):38–43.

    PubMed  Google Scholar 

  54. Chan FL, Ho EK, Fang D, Hsu LC, Leong JC, Ngan H. Spinal pseudoarthrosis in ankylosing spondylitis. Acta Radiol. 1987;28(4):383–8.

    Article  CAS  PubMed  Google Scholar 

  55. Melhem ER, El-Khoury GY. Spinal infections. essentials of musculoskeletal imaging. Churchill Livingstone 2003.

  56. Michel-Batot C, Dintinger H, Blum A, Olivier P, Laborde F, et al. A particular form of septic arthritis: septic arthritis of facet joint. Jt Bone Spine. 2008;75(1):78–83.

    Article  Google Scholar 

  57. Ergan M, Macro M, Benhamou CL, Vandermarcq P, Colin T, L’Hirondel JL, et al. Septic arthritis of lumbar facet joints. A review of six cases. Rev Rhum Engl Ed. 1997;64(6):386–95.

    CAS  PubMed  Google Scholar 

  58. Park YH, Taylor JA, Szollar SM, Resnick D. Imaging findings in spinal neuroarthropathy. Spine. 1994;19(13):1499–504.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Todd R. Lefkowitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varlotta, G.P., Lefkowitz, T.R., Schweitzer, M. et al. The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol 40, 13–23 (2011). https://doi.org/10.1007/s00256-010-0983-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-010-0983-4

Keywords

Navigation