Research Article

Magnetic Resonance Imaging Can Detect Symptomatic Patients with Facet Joint Pain. A Retrospective Analysis

Wolfgang Freund*, Frank Weber, Reinhard Meier and Stephan Klessinger

Published: 27 March, 2017 | Volume 1 - Issue 1 | Pages: 027-036

Background: Low back pain has recently been reported as the leading cause for disability worldwide. The diagnostic value of imaging has been estimated low. Led by own positive experience, however, we hypothesized that MRI can detect signs of facet joint pain.

Methods: 15 patients and 15 controls were retrospectively assessed by two readers. They compared de-identified T2 weighted lumbar spine MRI scans. Facet joint size, shape, angle, joint space signal and degeneration were rated. Pain aetiology was proven with the diagnostic gold standard of medial branch blocks.

Results: Facet joint angles and joint diameters were significantly larger in symptomatic patients, who also showed significantly higher grades of degeneration but no difference in joint space distances or shape or signal intensity.

The readers were able to correctly identify symptomatic patients with good interrater reliability (kappa 0.5, sensitivity and specificity 0.87-0.93), positive (LR+= 6.7-7.2) and negative likelihood ratios (LR-=0.15).

Conclusion: Contrary to recent publications, we could demonstrate differences between asymptomatic and symptomatic subjects showing the latter to have larger joints and more signs of degeneration.

One can conclude from the strong LR+ and LR- values that MRI is a useful investigation to rule in or rule out facet pain.

Read Full Article HTML DOI: 10.29328/journal.jcmei.1001006 Cite this Article Read Full Article PDF


Magnetic resonance imaging; Zygapophysial joint; Facet joint; Spine; Pain


  1. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 386: 743-800. Ref.: https://goo.gl/fiJsY9
  2. Suman A, Schaafsma FG, Elders PJ, van Tulder MW, Anema JR. Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial. BMC Public Health. 2015; 15: 522. Ref.: https://goo.gl/NKjhjz
  3. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976). 2004; 29: 79-86. Ref.: https://goo.gl/YLXzV6
  4. Kim KY, Wang MY. Magnetic resonance image-based morphological predictors of single photon emission computed tomography-positive facet arthropathy in patients with axial back pain. Neurosurgery. 2006; 59: 147-156. Ref.: https://goo.gl/8ziWYD
  5. Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J. 2007; 16: 1539-1550. Ref.: https://goo.gl/KXGUZq
  6. Chou R, Hufman LH. Guideline for the Evaluation and Management of Low Back Pain. Evidence Review. American Pain Society, 2015.
  7. Lakadamyali H, Tarhan NC, Ergun T, Cakir B, Agildere AM. STIR sequence for depiction of degenerative changes in posterior stabilizing elements in patients with lower back pain. AJR Am J Roentgenol. 2008; 191: 973-979. Ref.: https://goo.gl/jRXZzG
  8. Gao F, Hou D, Zhao B, Sun X, Sun H, et al. The pedicle-facet angle and tropism in the sagittal plane in degenerative spondylolisthesis: a computed tomography study using multiplanar reformations techniques. J Spinal Disord Tech. 2012; 25: 18-22. Ref.: https://goo.gl/2L6H63
  9. Van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, et al. Pain originating from the lumbar facet joints. Pain Pract. 2010; 10: 459-469. Ref.: https://goo.gl/LBDdIo
  10. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011; 12: 224-233. Ref.: https://goo.gl/G4bgoq
  11. Manchikanti L, Singh V. Review of chronic low back pain of facet joint origin. Pain Physician. 2002; 5: 83-101. Ref.: https://goo.gl/nFGKO3
  12. Bogduk N, Bogduk N. The zygapophysial joints-detailed structure. Clinical and radiological anatomy of the lumbar spine. Edinburgh; New York, Churchill Livingstone. 2012: 29-27.
  13. Bogduk N. Degenerative joint disease of the spine. Radiol Clin North Am. 2012; 50: 613-628. Ref.: https://goo.gl/KcV3qJ
  14. Lehman VT, Murthy NS, Diehn FE, Verdoorn JT, Maus TP. The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada. Clin Radiol. 2015; 70: 528-535. Ref.: https://goo.gl/jUD5tj
  15. Revel ME, Listrat VM, Chevalier XJ, Dougados M, N guyen MP, et al. Facet joint block for low back pain: identifying predictors of a good response. Arch Phys Med Rehabil. 1992; 73: 824-828. Ref.: https://goo.gl/KNbv5g
  16. Low back pain (early management): overwiev, Retrieved. 2015. Ref.: https://goo.gl/QgwJ0i
  17. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006; 15: 192-300. Ref.: https://goo.gl/2DiWBX
  18. Bundesärztekammer (BÄK), KBK, Arbeitsgemeinschaft der Wissenschaftlichen medizinischen Fachgesellschaften (AWMF): Nationale VersorgungsLeitlinie Kreuzschmerz-Langfassung, 1. Auflage. Version 5. 2010, zuletzt verändert, 2015.
  19. Maataoui A, Vogl TJ, Middendorp M, Kafchitsas K, Khan MF. Association between facet joint osteoarthritis and the Oswestry Disability Index. World J Radiol. 2014; 6: 881-885. Ref.: https://goo.gl/fub9VK
  20. Schinnerer KA, Katz LD, Grauer JN. MR findings of exaggerated fluid in facet joints predicts instability. J Spinal Disord Tech. 2008; 21: 468-472. Ref.: https://goo.gl/jM15Aw
  21. Cho BY, Murovic JA, Park J. Imaging correlation of the degree of degenerative L4-5 spondylolisthesis with the corresponding amount of facet fluid. J Neurosurg Spine. 2009; 11: 614-619. Ref.: https://goo.gl/FOvYN5
  22. Caterini R, Mancini F, Bisicchia S, Maglione P, Farsetti P. The correlation between exaggerated fluid in lumbar facet joints and degenerative spondylolisthesis: prospective study of 52 patients. J Orthop Traumatol. 2011; 12: 87-91. Ref.: https://goo.gl/srhYAF
  23. Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J. 2006; 15: 705-718. Ref.: https://goo.gl/1d4PfM
  24. Maataoui A, Vogl TJ, Khan MF. Magnetic resonance imaging-based interpretation of degenerative changes in the lower lumbar segments and therapeutic consequences. World J Radiol. 2015; 7: 194-197. Ref.: https://goo.gl/XkxO9z
  25. Lehman VT, Murphy RC, Kaufmann TJ, Diehn FE, Murthy NS, et al. Frequency of discordance between facet joint activity on technetium Tc99m methylene diphosphonate SPECT/CT and selection for percutaneous treatment at a large multispecialty institution. AJNR Am J Neuroradiol. 2014; 35: 609-614. Ref.: https://goo.gl/ncDqkC
  26. Freiermuth D, Kretzschmar M, Bilecen D, Schaeren S, Jacob AL, et al. Correlation of (99m) Tc-DPD SPECT/CT Scan Findings and Diagnostic Blockades of Lumbar Medial Branches in Patients with Unspecific Low Back Pain in a Randomized-Controlled Trial. Pain Med. 2015; 16: 1916-1922. Ref.: https://goo.gl/9ZmwCa
  27. Schwarzer AC, Wang SC, O’Driscoll D, Harrington T, Bogduk N, et al. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine (Phila Pa 1976). 1995; 20: 907-912. Ref.: https://goo.gl/Qff45d
  28. Kalichman L, Li L, Kim DH, Guermazi A, Berkin V, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila Pa 1976). 2008; 33: 2560-2565. Ref.: https://goo.gl/qRh9bL
  29. Stojanovic MP, Engel AJ. An Expedited Diagnostic Algorithm for Lumbosacral Pain: The Best Likelihood Scenario Approach. Pain Med. 2015; 16: 2271-2276. Ref.: https://goo.gl/OgdOs9
  30. Bogduk N, International Spine Intervention Society. Standards Committee. Practice guidelines for spinal diagnostic and treatment procedures. San Francisco, International Spine Intervention Society. 2013.
  31. Klessinger S, Halatsch M E, Freund W. Retrospective Magnetic Resonance Imaging Evaluation in Patients with Zygapophysial Joint Pain. J Spine Neurosurg. 2015; 4.
  32. R Development Core Team R. A language and environment for statistical computing. Vienna, R Foundation for Statistical Computing. 2015.
  33. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33: 159-174. Ref.: https://goo.gl/YeKm53
  34. Bogduk N, Dreyfuss P, Govind J. A narrative review of lumbar medial branch neurotomy for the treatment of back pain. Pain Med. 2009; 10: 1035-1045. Ref.: https://goo.gl/hpcx7Y
  35. Puig S, Felder-Puig R. [Evidence-based radiology: a new approach to evaluate the clinical practice of radiology]. Fortschr Roentgenstr. 2006; 178: 671-679. Ref.: https://goo.gl/P1CNeK
  36. Portney LG, Watkins MP. Chapter 27: Statistical Measures of Validity. Foundations of clinical research: Applications to practice. Upper Saddle River, Prentice Hall Health: 2009; 619-659.


Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?