MRI Study of Degenerative Disc Disease in Lumbar Spine RUCHIRA SETHI, VISHRAM SINGH Santosh Medical College, Ghaziabad Delhi NCR

Degenerative disc disease (DDD) is a common cause of INTRODUCTION Degenerative disc disease (DDD) is a common cause of low back pain (LBP) leading to physical disability DDD is commonly used to define pathology occurring at the three joint complex Facet joint

ETIOLOGY OF DDD Genetic predisposition: collagen/ cytokines Deformation of endplate Environmental factors Water loss from nucleus pulposus Abnormal forces on Annulus fibrosis' Disc injury and degeneration

Effects of IVD degeneration causes The aim of present study is to assess prevalence of facet joint arthrosis in degenerative disc disease by MRI study of lumbar spine in lumbago patients IVD Degeneration stenosis herniation stress on Facet joints instability Facet Joint Arthrosis

MATERIALS & METHODS 39(male=18 ,female=21) lumbago patients with lumbar spinal stenosis (Selected by predefined questionnaire and imaging technique) Age group= 20-60 years MRI was done on 1.5 Tesla machine Observations taken on k-Pacs viewer for herniation /disc prolapse facet joint space, Hypersclerosis of joint margins and osteophyte formation at the joint

OBSERVATIONS L5-S1 39 18 27 L4-L5 21 L3-L4 15 VERTEBRAL LEVEL LUMBAR SPINAL STENOSIS IVD PROLAPSE FACET JOINT ARTHROSIS L5-S1 39 18 27 L4-L5 21 L3-L4 15

Fig 1: Disc prolapse between L3-L4 and L4-L5 (arrows)

Fig 2: Disc prolapse with bilateral facet joint arthrosis Prolapsed disc Facet Joint Arthrosis Spinous process Fig 2: Disc prolapse with bilateral facet joint arthrosis

Fig 3: (a) disc prolapse (b) FJA with hypersclerosis

Graphical representation for occurrence of DDD at three different levels

Pie chart representation to show % occurrence of LSS, DP, FJA

With the above results it is seen that there is DISCUSSION With the above results it is seen that there is Concomitant involvement of the disc and facet joints Derangement or injury to either of these articulations, leads to abnormal forces causing impairment of the above three elements , called as “tripod” effect. two facet joints intervertebral disc

The facet joints play an important role in load Degeneration of the disc is a common transmission ; clinical presentation 1.they stabilize the motion segment in even in younger age groups flexion and extension, 2. limit the axial rotation. DDD include not only herniation but also changes at diarthrodial synovial joints of the spine.

CONCLUSION The ongoing debate on choosing criteria for conservative and surgical treatment depends not only on the degeneration of IVD but also on the degenerative changes setting in at the facet joints. Hence the present study clearly demonstrates that facet joint criterias should be taken care of for conservative and surgical management in patients of low back pain

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QUESTIONNAIRE FOR SCREENING CASES OF LOW BACK PAIN based on SWISS SPINAL STENOSIS and OSWESTRY LBP DISABILITY QUESTIONNARE 1.Do you have any complaint of pain in lower back pain at present? a . yes b. No 2.Do you have any previous H/o pain in lower back region? a. yes b. No 3.If the ans. to above two questions is yes, how was the onset of pain? a. sudden b. gradually over few days/week/months 4.Is the pain constant or occurs and resolves on its own? Specify; 5.Does the pain worsens with sneezing, coughing or bending? 6.Is the pain distributed over legs and feet? a. yes b. No 7.Do you have any H/o trauma, fever, bladder or bowel disturbances? a . yes b. no 8.Do you have any H/o loss of appetite and weight? a. yes b . no 9.Do you have any H/o calf pain, specially during walking? a. yes b. no 10.Do you suffer from severe fatigue syndrome, any widespread pain? a. yes b. no 11.Do you suffer from any sleep disturbances associated with anxiety/depression? a. yes b. no  

GRADING OF FACET JOINT ARTHROSIS Grade 0 --Normal facet joint space (2±4 mm width) Grade 1 --Narrowing of the facet joint space (< 2 mm) and/or small osteophytes and/or mild hypertrophy of the articular process Grade 2-- Narrowing of the facet joint space and/or moderate osteophytes and/or moderate hypertrophy of the articular process and/or mild subarticular bone erosions Grade 3-- Narrowing of the facet joint space and/or large osteophytes and/or severe hypertrophy of the articular process and/or severe subarticular bone erosions and/or subchondral cysts