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Lumbar Facet Joint Arthrography with the Posterior Approach

¹ Department of Radiology, Hôpital Cochin, 27 rue du faubourg Saint-Jacques, 75679 Paris, France.

View larger version (139K): [in a new window]   Figure 1a.  (a) Axial computed tomographic (CT) scan obtained with soft-tissue windowing demonstrates severe facet osteoarthritis with a cyst (arrow). (b) Axial CT scan obtained with bone windowing depicts osteophytes (arrow), which make direct lateral access to the joint impossible.

View larger version (120K): [in a new window]   Figure 1b.  (a) Axial computed tomographic (CT) scan obtained with soft-tissue windowing demonstrates severe facet osteoarthritis with a cyst (arrow). (b) Axial CT scan obtained with bone windowing depicts osteophytes (arrow), which make direct lateral access to the joint impossible.

View larger version (112K): [in a new window]   Figure 2a.  Photographs show posteroanterior (a) and oblique (b) views of the L4-L5 facet of a skeleton. The articular cavity is materialized by plasticine. In LFJ arthrography, the needle is inserted into the inferior recess of the facet joint (arrow).

View larger version (133K): [in a new window]   Figure 2b.  Photographs show posteroanterior (a) and oblique (b) views of the L4-L5 facet of a skeleton. The articular cavity is materialized by plasticine. In LFJ arthrography, the needle is inserted into the inferior recess of the facet joint (arrow).

View larger version (16K): [in a new window]   Figure 3.  Diagrams illustrate innervation of a facet joint. Posterior rami may be affected by degenerative changes in the joint.

View larger version (15K): [in a new window]   Figure 4a.  (a, b) Diagrams illustrate impingement due to cysts and diverticula. When located in the superior recess, these lesions may impinge on the lumbar nerve root (arrow in a) or thecal sac (arrowhead in b). (c) Myelogram demonstrates nerve root impingement due to a cyst of the left L4-L5 articulation (arrow). (d) CT scan obtained after LFJ arthrography shows the nerve root impingement (arrow).

View larger version (118K): [in a new window]   Figure 4b.  (a, b) Diagrams illustrate impingement due to cysts and diverticula. When located in the superior recess, these lesions may impinge on the lumbar nerve root (arrow in a) or thecal sac (arrowhead in b). (c) Myelogram demonstrates nerve root impingement due to a cyst of the left L4-L5 articulation (arrow). (d) CT scan obtained after LFJ arthrography shows the nerve root impingement (arrow).

View larger version (118K): [in a new window]   Figure 4c.  (a, b) Diagrams illustrate impingement due to cysts and diverticula. When located in the superior recess, these lesions may impinge on the lumbar nerve root (arrow in a) or thecal sac (arrowhead in b). (c) Myelogram demonstrates nerve root impingement due to a cyst of the left L4-L5 articulation (arrow). (d) CT scan obtained after LFJ arthrography shows the nerve root impingement (arrow).

View larger version (123K): [in a new window]   Figure 4d.  (a, b) Diagrams illustrate impingement due to cysts and diverticula. When located in the superior recess, these lesions may impinge on the lumbar nerve root (arrow in a) or thecal sac (arrowhead in b). (c) Myelogram demonstrates nerve root impingement due to a cyst of the left L4-L5 articulation (arrow). (d) CT scan obtained after LFJ arthrography shows the nerve root impingement (arrow).

View larger version (17K): [in a new window]   Figure 5.  Diagrams of an LFJ (oblique view) illustrate how the size of the inferior articular recess varies depending on the degree of lordosis. Flexion resulting in kyphosis enlarges the inferior recess (arrow) and facilitates needle puncture. Extension or increased lordosis enlarges the superior recess (arrowhead).

View larger version (22K): [in a new window]   Figure 6a.  Diagram (a) and LFJ arthrogram (b) illustrate the location of the puncture site under the tip of the superior facet (arrow in a, arrowhead in b). Note that the site is located at the medial projection of the pedicle. At the L5-S1 level, the puncture site is just beneath the superior aspect of the sacrum (arrow in b).

View larger version (139K): [in a new window]   Figure 6b.  Diagram (a) and LFJ arthrogram (b) illustrate the location of the puncture site under the tip of the superior facet (arrow in a, arrowhead in b). Note that the site is located at the medial projection of the pedicle. At the L5-S1 level, the puncture site is just beneath the superior aspect of the sacrum (arrow in b).

View larger version (147K): [in a new window]   Figure 7a.  Posteroanterior (a) and lateral (b) LFJ arthrograms demonstrate normal anatomy. Note the ring appearance of the joint in a (arrowheads) and the S-shaped appearance in b (arrow).

View larger version (141K): [in a new window]   Figure 7b.  Posteroanterior (a) and lateral (b) LFJ arthrograms demonstrate normal anatomy. Note the ring appearance of the joint in a (arrowheads) and the S-shaped appearance in b (arrow).

View larger version (121K): [in a new window]   Figure 8.  LFJ arthrogram shows a degenerate facet joint. Note the heterogeneous contrast material filling and the irregular capsular margins.

View larger version (157K): [in a new window]   Figure 9a.  Axial CT scan (a) and LFJ arthrogram (b) show a cyst of the left L4-L5 articulation (arrowhead in a, arrow in b). The cyst is superior in location and was symptomatic.

View larger version (138K): [in a new window]   Figure 9b.  Axial CT scan (a) and LFJ arthrogram (b) show a cyst of the left L4-L5 articulation (arrowhead in a, arrow in b). The cyst is superior in location and was symptomatic.

View larger version (159K): [in a new window]   Figure 10a.  CT scan (a), axial T1-weighted MR image (b), and LFJ arthrogram (c) demonstrate a right LFJ cyst (arrows in a and c, arrowhead in b).

View larger version (155K): [in a new window]   Figure 10b.  CT scan (a), axial T1-weighted MR image (b), and LFJ arthrogram (c) demonstrate a right LFJ cyst (arrows in a and c, arrowhead in b).

View larger version (127K): [in a new window]   Figure 10c.  CT scan (a), axial T1-weighted MR image (b), and LFJ arthrogram (c) demonstrate a right LFJ cyst (arrows in a and c, arrowhead in b).

View larger version (28K): [in a new window]   Figure 11.  Diagrams illustrate abnormal communications between two ipsilateral facet joints (vertical communication) (left) and two contralateral facet joints (horizontal communication) (right).

View larger version (140K): [in a new window]   Figure 12a.  (a) Lateral LFJ arthrogram demonstrates a defect in the pars interarticularis (arrow). (b, c) Right (b) and left (c) LFJ arthrograms demonstrate a communication between the L5-S1 and L4-L5 joints (arrow in b, arrowhead in c). (d) Lateral LFJ arthrogram demonstrates contrast material within the pars interarticularis defect (arrow).

View larger version (144K): [in a new window]   Figure 12b.  (a) Lateral LFJ arthrogram demonstrates a defect in the pars interarticularis (arrow). (b, c) Right (b) and left (c) LFJ arthrograms demonstrate a communication between the L5-S1 and L4-L5 joints (arrow in b, arrowhead in c). (d) Lateral LFJ arthrogram demonstrates contrast material within the pars interarticularis defect (arrow).

View larger version (151K): [in a new window]   Figure 12c.  (a) Lateral LFJ arthrogram demonstrates a defect in the pars interarticularis (arrow). (b, c) Right (b) and left (c) LFJ arthrograms demonstrate a communication between the L5-S1 and L4-L5 joints (arrow in b, arrowhead in c). (d) Lateral LFJ arthrogram demonstrates contrast material within the pars interarticularis defect (arrow).

View larger version (132K): [in a new window]   Figure 12d.  (a) Lateral LFJ arthrogram demonstrates a defect in the pars interarticularis (arrow). (b, c) Right (b) and left (c) LFJ arthrograms demonstrate a communication between the L5-S1 and L4-L5 joints (arrow in b, arrowhead in c). (d) Lateral LFJ arthrogram demonstrates contrast material within the pars interarticularis defect (arrow).

View larger version (88K): [in a new window]   Figure 13a. Figures 13, 14. (13a) Sequential LFJ arthrograms obtained in a patient with advanced Baastrup disease demonstrate a horizontal communication. Note the progressive opacification of the interspinous process (arrow) followed by that of the contralateral facet joint (arrowhead). (13b) Lateral LFJ arthrogram clearly demonstrates opacification of the interspinous process (arrow). (14) LFJ arthrogram shows a horizontal communication with the classic butterfly appearance.

View larger version (118K): [in a new window]   Figure 13b. Figures 13, 14. (13a) Sequential LFJ arthrograms obtained in a patient with advanced Baastrup disease demonstrate a horizontal communication. Note the progressive opacification of the interspinous process (arrow) followed by that of the contralateral facet joint (arrowhead). (13b) Lateral LFJ arthrogram clearly demonstrates opacification of the interspinous process (arrow). (14) LFJ arthrogram shows a horizontal communication with the classic butterfly appearance.

View larger version (134K): [in a new window]   Figure 14. Figures 13, 14. (13a) Sequential LFJ arthrograms obtained in a patient with advanced Baastrup disease demonstrate a horizontal communication. Note the progressive opacification of the interspinous process (arrow) followed by that of the contralateral facet joint (arrowhead). (13b) Lateral LFJ arthrogram clearly demonstrates opacification of the interspinous process (arrow). (14) LFJ arthrogram shows a horizontal communication with the classic butterfly appearance.

View larger version (123K): [in a new window]   Figure 15.  LFJ arthrogram obtained in a patient with advanced facet osteoarthritis reveals a communication between the left L4-L5 and L3-L4 joints (straight arrow) and the interspinous process bursa (curved arrow).

View larger version (154K): [in a new window]   Figure 16a.  (a) LFJ arthrogram obtained at the beginning of opacification demonstrates a cyst located superiorly (arrow). (b) LFJ arthrogram obtained at the end of contrast material injection shows leakage with opacification of the soft tissues surrounding the facet joint (arrowhead). Such leakage has no adverse effects and may even result in complete resolution of the lesion if it occurs at the level of a cyst or diverticulum.

View larger version (153K): [in a new window]   Figure 16b.  (a) LFJ arthrogram obtained at the beginning of opacification demonstrates a cyst located superiorly (arrow). (b) LFJ arthrogram obtained at the end of contrast material injection shows leakage with opacification of the soft tissues surrounding the facet joint (arrowhead). Such leakage has no adverse effects and may even result in complete resolution of the lesion if it occurs at the level of a cyst or diverticulum.