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Cervical Facet Arthropathy


KEY FACTS

Terminology

  • Facet arthrosis, degenerative facet disease, degenerative joint disease

Imaging

  • Osseous facet overgrowth impinging on neural foramina in conjunction with articular joint space narrowing

  • Facet joint osteophytes producing foraminal narrowing

  • Mushroom-cap facet appearance

  • Joint space narrowing with sclerosis and bone eburnation

  • Intraarticular gas (“vacuum phenomenon”)

  • Enhancing inflammatory soft tissue changes surrounding facet joint are common

  • Joint space narrowing, thinning of articular cartilage

  • Facet effusions as linear hyperintensity

Top Differential Diagnoses

  • Septic facet

  • Healing facet fracture

  • Inflammatory arthritides

  • Paget disease

  • Myositis ossificans

  • Metastasis

Clinical Issues

  • Mechanical neck pain (facet arthrosis syndrome)

    • Related to irritation of innervation of joint from medial branch(es) of dorsal primary ramus

    • Capsular distension, inflammatory synovitis, entrapment of synovial villi between 2 articular processes, or nerve impingement by osteophytes

  • Pain aggravated by rest and alleviated by gentle movement

    • Worse in morning

  • Poor correlation between duration/severity of pain and extent of facet degeneration

Diagnostic Checklist

  • Best detail with thin-section CT

Lateral radiograph shows severe facet hypertrophic degenerative arthropathy at C2-C3
with marked hypertrophy of the facets.

Axial NECT shows severe, exuberant right facet degenerative arthropathy
. This has been described as a mushroom-cap appearance.

Sagittal NECT shows multilevel hypertrophic facet degenerative arthropathy with “vacuum phenomenon”
, bony eburnation, and osteophyte formation.

Axial T2* GRE MR shows severe right uncovertebral hypertrophic degenerative arthropathy with severe foraminal stenosis
with facet degenerative change.

TERMINOLOGY

Synonyms

  • Facet arthrosis, degenerative facet disease, degenerative joint disease

Definitions

  • Osteoarthritis of synovially lined apophyseal joints

IMAGING

General Features

  • Best diagnostic clue

    • Osseous facet overgrowth impinging on neural foramina in conjunction with articular joint space narrowing

  • Location

    • Normal anatomy

      • –

        C2 → C7 levels have 2 sets of paired joints

      • –

        Facet or zygapophyseal joints posteriorly, with oblique orientation

      • –

        Uncovertebral joints (joints of Luschka, neurocentral joints) formed by curved edges of vertebral bodies at lateral margins

    • Arthropathy most common in mid/lower cervical spine

  • Size

    • Facets may show minimal abnormality or large osteophytes approximating size of facet themselves

  • Morphology

    • Osseous facet overgrowth and cartilage erosion with joint space narrowing

Radiographic Findings

  • Radiography

    • Poor for demonstrating early facet degeneration

    • Later changes well demonstrated

    • Plain films demonstrate facet arthrosis well, not soft tissues

    • Oblique views demonstrate facet joints best

      • –

        Facet joint osteophytes producing foraminal narrowing

      • –

        Associated with degenerative disc disease

      • –

        “Mushroom cap” facet appearance

      • –

        Joint space narrowing with sclerosis and bone eburnation

      • –

        Intraarticular gas (“vacuum phenomenon”)

      • –

        Anterolisthesis, retrolisthesis not uncommon

Fluoroscopic Findings

  • Same as plain radiography; can observe motion abnormalities on flexion-extension

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