2012年1月30日月曜日

What Causes Facet Joint Hypertrophy With Cyst

what causes facet joint hypertrophy with cyst

LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS Lower back and leg pain.


(Keywords: lumbar facet arthropathy spondylolysthesis, chiropractic, lumbar facet syndrome, spondylolysthesis arthritis, lower back and leg pain)

LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS is a not uncommon condition found at the Chiropractic Clinic. It's often associated with severe leg pain.

The lumbar facet joints are subject to wear-and-tear, particularly after a hyperextension injury that was not properly cared for. The ensuing chronic fixation leads invariably to Immobilisation Arthritis and Hyaline Cartilage degeneration. IMMOBILISATION ARTHRITIS ...

  • HYALINE CARTILAGE ...

  • LUMBAR FACET ARTHROPATHY ... what is it?

    • CASE FILE

    LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS

    Mrs G is a 75-year old woman who has had pain in her left buttock for five years. Four months ago she fell down five steps on her buttocks (the staircases in the Nederlands are very steep). A month later the pain started radiating down her the back of her thigh and calf, with tingling on top of her foot. She couldn't use any power with her left leg without severe pain in the leg. Turning her torso left and right, and straightening up after bending was very painful. The pain in her leg was constant, 24 hours per day. She could never escape it.


    CHIROPRACTIC HELP Safety on the Stairs ...


    EXAMINATION

    LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS


  • Looking for a Leg Length Inequality is always tricky. It can't be measured precisely without a special X-ray of the pelvis, which I didn't have, and sometimes it changes after adjusting the pelvis, or even adjusting the foot. However, by eye-balling her pelvis, there was no obvious low side. A mild scoliosis (curvature) however was clearly present.
    • LEG LENGTH INEQUALITY ...
  • There was a marked fixation in the opposite (right) sacroiliac joint, and at the L5-S1 joint (the lumbo-sacral joint). L4 was tender on palpation.
  • Forward bending caused moderate pain in her back and buttock but did not radiate to the leg. Sideways bending, right and left, were mildly uncomfortable.
  • The test of Lasegue for a pinched nerve was very mildly positive at 60 degrees, with pain in the buttock, but not the leg. The Slump test too was mildly positive.
    • SLUMP TEST ... for a pinched nerve.
  • There was no numbness, no muscle weakness and the reflexes were normal.
  • The piriformis muscle was very tender with active trigger points.
    • PIRIFORMIS SYNDROME ...
  • Her right hip shows signs of early hip arthritis. Limited flexion, adduction and internal rotation with pain in the groin.
    • HIP ARTHRITIS ...

    LUMBAR STENOSIS

    LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS

    The radiological report reads:

    "Forward slip of the body of L4 in relation to L5, spondylolisthesis, grade 1.

    At L4-5 a canal stenosis is seen with facet arthropathy and hypertrophy (thickening) of the Ligament Flavum. Reduced intervertebral foramena right more than links.

    At L5-S1 there is also relative canal stenosis, also on the basis of advanced facet arthropathy and hypertrophy of the Ligament Flavum. There is possibly a small synovial cyst at the left facet joint."


    Certainly there is a very small, tight spinal canal, consistent with our case history and findings. Chronic low back pain, buttock pain and radiating pain to the left foot.

    Can Chiropractic possibly help? Does chiropractic help have a spinal stenosis explanation and solution...?

    SPINAL STENOSIS EXPLANATION ...


    DISCUSSION

    LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS

    Something didn't quite fit. With such severe pain in the leg, I would in the first place have expected pain in the leg when she bent (either forwards, or sideways, backwards) and that the tests for a pinched nerve would be strongly positive. But no, this is not a "pinched" nerve in the normal sense, but irritated nerves, severely inflammed by the complex toxins exuded by fixated joints.

    We had to wait a week, before starting the treatment, for the X-rays and scan which brought forth the explanation. Extremely degenerate facet joints at L4-5 that had allowed the fourth lumbar vertebra to slide forwards: SPONDYLOLYSTHESIS.

    Interestingly her symptoms were partly from the S1 nerve root (from the L5 fixated joint) and partly from the L5 nerve root (tingling on top of her foot): from the Spondylolysthesis.

    The severe fixation in the right sacroiliac joint anatomy was central to the whole problem.


    SPONDYLOLYSTHESIS ...

    SACROILIAC JOINT ANATOMY ...

    TREATMENT

    The first three treatments involved the sacroiliac joints and L5 using the Thompson drop protocol, and gentle drop treatments on L5 with her in the side-lying posture. The pain increased after the first two treatments. She was dubious, but I assured her that was normal for a chronic condition.

    I modified the treatment to include the very degenerate L4-5 joint. From the case notes:

    "Flex iets Li bil. Kemp R en L > Links L5. L5R vast. ZSLR L licht in L bil. L4R, L5L roll drops. Steeds pijn, dus: Prone: R sac hard, L si AS hard. Supine R en L Si, ant bekken. Active release therapie aan de linker hamstring, piriformis en Iliotibial band."

    Within five treatment she had 50% less pain, and after seven the pain has completely gone.

    We are now busy with rehab, still concentrating on the right hip arthritis which is still tender, though also improving, and I'm pondering the need for a heel lift.

    Next week we start with a full examination of her neck, which is also stiff and painful.


    PROGRESS

    LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS

    Mrs G came in today for her seventh treatment. She's smiling, me too. She played tennis twice this week, with no ill effect. I'm no longer smiling! that wasn't allowed, but it seems with no negative results. She added a sentence about the loneliness of growing older. The tennis club is her solution. So be it, she's not just a back.

    The pain in her left leg has completely stopped and the Slump test is negative. She still has a little discomfort in the right sacroiliac joint, something she has had for years, which is connected to the arthritis in her right hip. The right groin is still a little painful when she rotates her hip. We're working on it, Rome wasn't built in a day. Nor were Aachen or Cologne as we say in Europe. (They are both worth a visit. Especially the Dom in Aachen which is where you'll see the remains of Charlemagne; and the Christmas fair in Cologne is generally acknowledged as the best in Europe. And the chocolate factory is to die for!)

    Managing these complex cases successfully means addressing each and every part of the syndrome. A mixture of symptoms and signs, in this case the

    1. Muscular condition in her left buttock, the Piriformis.
    2. The fixation at L5.
    3. The spondylolysthesis at L4.
    4. The hip arthritis on the other side.
    5. Thinking about the Leg Length Inequality, and would a heel lift help, or hinder.
    6. Convincing the patient of the need to do daily rehab exercises, to start walking more and sitting less. Tennis, mm???
    7. Persuading them to accept that some things belong to the past. Can they still garden, play tennis, golf, work in a bookshop where lifting boxes of books is required...

    LOWER BACK AND LEG PAIN

    LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS

    Lower back and leg pain is an every-day-event in chiropractic clinics. It's our bread and butter. Sometimes it's routine and straightforward, sometimes it can be extremely complex. Occasionally we have to refer patients for surgery. Occasionally!

    More often it's we who are trying to cope with very unhappy patients after Failed Back Surgery (FBS) as it's known in the literature, or the complications of surgery. LOWER BACK AND LEG PAIN ...


    COMPLICATIONS OF SURGERY

    Today I had a new patient in her upper fifties with a not dissimilar history, but she went for the surgery. Immediately after the operation she developed a severe foot drop, and could only move about with a walker for two months.

    And she still has disabling numbness and tingling in her lower leg. The X-ray reveals another LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS ... I wonder what we can do for her, if anything. COMPLICATIONS OF SURGERY ...

    IMPORTANT CONSIDERATIONS @ LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS

    Return from LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS to LUMBAR FACET SYNDROME … Go from LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS to CHIROPRACTIC HELP home page …

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