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

2. 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

3. 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

4. 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

5. MATERIALS & METHODS
39(male=18 ,female=21) lumbago patients with lumbar spinal stenosis
(Selected by predefined questionnaire and imaging technique)
Age group= 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

6. 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

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

8. 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

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

10. Graphical representation for occurrence of DDD at three different levels

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

12. 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

13. 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.

14. 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

15. THANK YOU

16. 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

17. 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