Traumatic degenerative arthritis of cervical facet joints
Introduction
Introduction to cervical facet joint traumatic degenerative arthritis The cervical facet joints are the synovial joints of the various large joints of the whole body, and are composed of upper and lower joints. The articular process and the plane of the vertebral body are about 40° to 45°, the articular surface is smooth, and the hyaline cartilage joint capsule is loose. The intervertebral facet joint has the effect of guiding and limiting the direction of motion of the segment of motion. For example, when the cervical vertebrae are flexed, the inferior articular process of the upper cervical vertebrae slides forward on the lower cervical superior articular process, but the joint capsule limits its excessive flexion. Although the cervical facet joint arrangement is beneficial to flexion and extension activities, it is unstable and vulnerable to injury. This anatomical feature of the facet joint is the anatomical basis of the lesion. Cervical facet joint traumatic degenerative arthritis refers to a disease in which a part of or all of the posterior facet joint of the cervical spine exhibits a damaging arthritis reaction and produces a series of clinical symptoms. basic knowledge The proportion of the disease: the incidence of this disease in the middle-aged and elderly people over 50 years old is about 0.005%-0.009% Susceptible people: no specific population Mode of infection: non-infectious Complications: headache, cervical spondylosis, dizziness
Cause
Causes of traumatic degenerative arthritis of the facet joint of the cervical spine
The specific pathogenesis and pathological changes of cervical facet joint traumatic degenerative arthritis are unclear due to lack of in-depth research, but trauma and degeneration are two affirmative factors that cause the disease.
1. Trauma:
In daily life, head and neck flexion and extension, rotation and other activities are more, mainly relying on intervertebral joints and bilateral joints on both sides to complete, poor working position, such as typists, houseworkers, long hours of work, in small joints Shear force causes the joint capsule to be in tension, while the overloaded tension causes the joint capsule to produce a traumatic inflammatory reaction and gradually thickens and hardens. In a car accident, the head and neck whiplashes suddenly add or subtract to the facet joints. The injury of the speed force causes the articular cartilage and subchondral fracture of the facet joint, the tear of the joint capsule and the blood in the joint capsule, the traumatic inflammatory changes of the joint capsule, the synovial cells are active, and the secretion of bone fluid is increased, which may be accompanied by The blood is accumulated, the joints are swollen, the pressure in the joint capsule is increased, and a series of symptoms such as neck pain caused by the C-type nerve fibers in the cyst wall are stimulated. Some people inject the physiological saline into the small joint capsule to induce pain in the neck, and the joint capsule The wound can also cause the microvessels to dilate, and the red blood cells, white blood cells and the like are formed to ooze into the joint fluid, and precipitate and mechanize, causing joint adhesion, and the joint cartilage damage makes the joint surface rough. Thereby increasing the chance of trauma, leading to the gradual shrinkage of cartilage, articular changes such as narrow joint space, and the trauma of bone and joint is an important factor for degeneration.
2. Degeneration:
With age, degeneration is an inevitable process. After the joints are strained or traumatized, joint capsule hypertrophy, scar formation, joint capsule damage, loss of synovial secretion and synovial secretion are reduced. Articular cartilage undergoes degenerative changes due to lack of nutrition, gradually thinning and rough, the surface of the cartilage is broken, can be extended into the cartilage, and even small fragments fall off into the synovial fluid. The small articular surface that is engaged with each other not only damages the articular surface due to wear. According to Wolf's law, the densification of the subchondral bone gradually occurs, and the surface of the joint becomes rougher and harder, resulting in hypertrophy of the facet joint, formation of osteophytes at the edge, change of mineral concentration in the soft tissue, and calcification of the joint capsule. The change causes the facet joint to be traumatized during exercise, thereby accelerating the occurrence of joint degeneration.
There is no clear boundary between trauma and degeneration. As a causative factor, the two have mutually reinforcing effects, and the wound accelerates the development of degeneration, which in turn increases the chance of trauma.
Prevention
Cervical facet joint traumatic degenerative arthritis prevention
First, prevention:
1. Pay attention to a good sleeping position and working position. People spend 6 to 9 hours a day in sleep. Therefore, it is important to prevent the head and neck from being placed in a proper position to prevent small joint diseases caused by strain. It is better to keep the position after the natural, and avoid "high sleep and worry". In the work, you should avoid the same position lasting for too long, pay attention to improve working conditions, adhere to work and rest, insist on work, and change the work if necessary.
2. Pay attention to self-protection and prevent trauma. Although it is said that there is no way to escape, using a seat belt while riding a plane can reduce the degree of trauma and slow down the development of the disease.
Second, other:
Since car accidents involve many social problems such as law and economic compensation, the chronic neck pain caused by this is caused by mental factors or small joint organic diseases, and special attention should be paid to identification.
Complication
Cervical facet joint traumatic degenerative arthritis complications Complications, headache, cervical spondylosis, vertigo
1. This disease is one of the important causes of chronic neck pain, cervical headache and cervical spondylotic radiculopathy.
2. Complications of small joint injection:
(1) The puncture needle will damage the vertebral artery if it is excessively forward.
(2) If the puncture needle is excessively inward, it may enter the epidural space or even enter the subarachnoid space, which may cause high epidural block and even total spinal anesthesia.
(3) may have a transient headache, dizziness or mild balance disorder symptoms, may be caused by local proprioceptor block, and will be able to recover later.
Symptom
Cervical facet joint traumatic degenerative arthritis symptoms Common symptoms Chest pain Shoulder pain Neck pain Head and neck activity restricted
Patients with history of neck trauma generally have a history of head and neck trauma or a long history of poor working position such as typing, car accidents, etc., especially in motorcycle accidents, car collisions and other whiplash damage history, after a whip-like injury caused by a car accident The incidence of chronic neck pain caused by small joints is quite high, and the Barnsley survey believes that it is as high as 54%.
Chronic neck pain Chronic neck pain is a characteristic manifestation of this disease, mostly persistent dull pain, can be induced or aggravated during activity, neck 2 ~ 3 or neck 5 ~ 6 small joints suffered from high incidence of trauma and strain, and the incidence is also high Small joint lesions of different segments can cause pain in different regions, and the distribution has certain characteristics.
1. Neck 2-3 small joints: The pain is located in the upper neck area and extends to the occipital area. The severe range can be extended to the ear, the top of the head, the forehead or the eye.
2. Neck 3-4 small joints: the posterior region of the neck, extending up to the underside of the pillow, but not exceeding the occipital region, not exceeding the scapula with a shape similar to that of the scapula.
3. Neck 4-5 small joints: similar to the triangular area distribution, the two sides are the posterior median line and the posterior border of the neck, the bottom is the transclavicular, the middle 1/3 intersection, parallel to the hypothetical dotted line of the scapula.
4. Neck 5-6 small joints: distributed in a triangular sleeve shape, pointed to the center of the neck, wrapped around the front, back and top of the scapula, and the baseline is the scapula.
5. Neck 6-7 facet joints: the distribution seems to cover the shape of the four sides of the upper scapula and the lower armpit.
6. Neck 7-thoracic 1 small joint: generally considered to focus on the lower part of the neck 6-7.
The above pain distribution law is the main area produced by small joint lesions in each segment. In severe cases, the distribution can spread to a wider range, but this area is often the most serious. The pain can be bilaterally distributed due to the involvement of bilateral small joints. The involvement of the facet joints causes the pain areas to overlap, which will make the diagnosis difficult.
The pain involved is due to the wide distribution of the cervical nerve roots in the head, neck, chest, upper limbs, etc. Therefore, in addition to local pain, it often causes painful performance. The headache is mainly caused by the involvement of the neck 2-3 small joints. Easy to be misdiagnosed, manifested as chronic persistent dull pain, can also be a typical migraine, or even forehead pain, shoulder pain, often caused by the involvement of the neck 5-6 small joints, easy to be confused with frozen shoulder, in addition to chest pain And the performance of upper limb pain.
Local signs of small joint traumatic degenerative arthritis often have obvious fixed tenderness, increased activity time, neck can reduce neck activity due to pain, and even the neck can be in a forced position, the local posterior medial branch of the spinal nerve corresponding to the small joint Blocking can relieve pain.
Examine
Examination of traumatic degenerative arthritis of the facet joint of the cervical spine
1. X-ray films need to take positive lateral slices and left and right oblique slices. There is no obvious change in the early stage. Later, the joint space is narrow and loose; gradually accumulate outside the joint protrusion to form a pointed bone spur; Sexual changes, the peripheral part is accompanied by obvious osteophyte formation, and the intervertebral foramen become smaller and deformed.
2. Tomography can clearly show the stenosis, osteophytes and deformation in the late stage of the joint.
3. CT scan can clearly show the degree of small joint lesions and its relationship with the spinal canal and root canal from the cross section. The common signs are:
1 small joint edge spur formation.
2 small joints are fat.
3 joint space is narrowed.
4 articular cartilage thinning.
5 "vacuum phenomenon" in the small joints.
6 joint capsule calcification.
7 articular subchondral bone sclerosis, etc., but in early CT scans are not as good as X-ray films, an advantage of CT scan is that the intervertebral disc can be observed while intervertebral disc disease.
4. SPECT conventional ECT image does not help much to observe this disease, but the high-spatial resolution ECT image can clearly show the increase in the intake of small joint nuclide. This method has the advantage of high sensitivity. As a screening method before the arthrodesis of small facet joints.
Small arthrography is of great help in the early diagnosis of traumatic degenerative arthritis of the facet joints. It must be performed under TV fluoroscopy. Side or posterior puncture can be used. The puncture method is the same as the small joint injection. After confirming that the puncture needle enters the joint space of the facet joint, the water-soluble contrast agent is injected. Generally, the joint capsule is relaxed or ruptured early, and the signs of small arthritis change can be seen. In the advanced stage, the difficulty of puncture and the change of imaging signs are obvious. If it is not performed, the local anesthetic and the hormone mixture can be injected after the end of the angiography, and the therapeutic effect can be simultaneously exerted.
Others to rule out possible intraspinal lesions, disc lesions and other lesions, conditional magnetic resonance imaging, myelography and discography to confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of traumatic degenerative arthritis of cervical facet joint
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Lateral cervical disc herniation
It is caused by sudden excessive movement of the neck or degeneration of the intervertebral disc. It is also one of the common causes of chronic neck pain. It can be acutely ill or chronically ill. The main symptoms are neck pain and limited activity, just like slipping the pillow. The pain can be radiated to the shoulders and the occipital region. The upper limbs often have pain and numbness. Few sides occur at the same time. The interspersed space can be asymptomatic. The head and neck are often in a stiff position, and the lower cervical spine and scapula are inferior. There is tenderness in the department, the head is backward and sideways to the patient side. The pressure on the head can cause pain and radiate to the hand. Pulling the upper limb of the affected side can cause pain. The X-ray plain film shows that the intervertebral space is narrow and degenerative. , myelography + CT scan and MRI can be seen in the prominent disc, simple disc herniation is easy to distinguish from small joint traumatic degeneration, but if both exist, it is easy to miss diagnosis and misdiagnosis, so effective treatment of disc disease If you can not alleviate chronic neck pain, you should consider the presence of traumatic degenerative arthritis of the facet joint.
2. Neck soft tissue strain
Mainly for simple neck muscle soreness and discomfort, no conduction or radiation to other places, mostly due to work fatigue reaction, if a little rest or confrontational reverse muscle activity (such as long-term bowing into the head activity), ie It can quickly restore fatigue and the symptoms disappear. The degree of pain and the effect of regulating muscle activity are often proportional to the length of the disease. Most of the symptoms of strain are from the muscles and ligaments of the back of the neck, sometimes mixed with bone and joint diseases. Distinguish, treatment should be corrected from work and life habits, posture and posture balance. Appropriate physical therapy, physical therapy, and massage are beneficial to patients. Patients with acute exacerbations should be neck braked, oral painkillers and sedatives, if necessary. Feasible 1% procaine pain point closure.
3. Tension headache
Headaches are generally bilateral, can affect the entire head, the nature of dull pain, typical contraction or pressure, to a mild or moderate degree, not aggravated by daily activities, repeated headaches, no more than monthly For 15 days, there may be one of the three major symptoms of nausea, photophobia or fear. The physical examination generally has no positive signs, and the third occipital nerve block test is ineffective.
4. Surgery around the shoulder joint
The disease is often between 50 and 60 years old, with slow onset, progressive shoulder pain and limited joint activity, often manifested as a special clinical process, that is, after the disease progresses to a certain extent, it no longer develops, and then The pain gradually relieves and even disappears, and the joint activity gradually recovers. The whole course is long, often takes several months or years. There are many tender points around the shoulder joints. There is no positive expression on the X-ray examination, and the pain points around the shoulder joints are blocked or paralyzed. The nerve block is effective.
5. Young women with neurofibrillary syndrome are more common, symptoms are exaggerated without positive signs, and the symptoms of diverting attention can be significantly alleviated when asked about medical history and physical examination. Suggestive therapy can be markedly effective. The use of posterior medial branch nerve block lag may be permanent. Sexual pain relief.
