Chapter

Percutaneous lumbar facet augmentation in the treatment of lumbar facet arthropathy

September 2017

In book: Percutaneous lumbar facet augmentation in the treatment of lumbar facet arthropathy (pp.249 - 260)
Publisher: JP Medical Ltd, 2018

Authors:

Sergio Soriano-Solis

Javier Quillo-Olvera

The Brain and Spine Care Minimally Invasive Spine Surgery Group

José Antonio Soriano-Sánchez

Centro Médico ABC

Zygapophyseal or facet joints (Z-joints) are paired diarthrodial joints in the posterior aspect of the vertebral column and are the only true synovial joints between adjacent spinal levels in humans. As true synovial joints, each facet contains a joint space capable of accommodating 1–1.5 ml of fluid, a synovial membrane, hyaline cartilage surfaces and a fibrous capsule.1 The fibrous capsule of about 1 mm in thickness is composed mostly of collagen fibers arranged in a transverse fashion to resist flexion. The joint capsule is thick posteriorly, supported by fibers arising from the multifidus muscle. Superiorly and inferiorly, the capsule attaches further away, thereby forming subcapsular recesses with osteochondral margins that are filled with fibroadipose mesiaci. Anteriorly, the capsule is replaced by the ligamentum flavum.

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Article

[On the diagnostic value of capsule biopsy in various joint diseases]

March 1969 · Zeitschrift für Rheumaforschung

J Zeitlhofer

Article

The place of autologous platelet-rich plasma in the treatment of knee osteoarthritis

December 2016 · Rheumatology (Bulgaria)

Osteoarthritis is a degenerative joint disease characterized by loss of joint cartilage, projections along the bone edges (osteophytes) and changes in the underlying bone (subchondral osteosclerosis), and a number of biochemical and morphological changes, involving both the synovial membrane and joint capsule and periarticular structures. It is the most common clinical syndrome of joint pain, ... [Show full abstract] accompanied by varying degree of functional deficit and reduced quality of life. Although the loss of articular cartilage is not the only morphological substrate of osteoarthritis, it underlies the pathological process and accompanies clinical manifestations. Although the causes are still not fully understood, the associated biochemical, structural and metabolic changes are well documented. Morphological changes of hyaline cartilage in OA include the early formation of surface roughness and erosion, fibrillation and altered distribution of proteoglycans in the extracellular matrix. In later stages erosions deepen and further transforms into cartilage ulcerations. These are the result Of increased cetdbolism in combindtion with suboptimal reparative response of cartilage to biomechanical stimuli. Biological stimulus for repair processes in almost all tissues plays a number of growth factors. Hyaline cartilage is no exception. This is the principle of the therapy with autologous platelet- rich plasma, (PRP), which is the product of patient's own blood. It represents an attractive new alternative in the treatment of knee osteoarthritis due to the initial encouraging results and the minimal risk of intolerance and side effects. While there are still no universally accepted definition of PRP, the term most accurately can be defined as a blood derivative with a higher concentration of platelets compared to basal levels.

Article

Pre-Clinical Translation of Second Harmonic Microscopy of Meniscal and Articular Cartilage Using a P...

December 2018 · IEEE Journal of Translational Engineering in Health and Medicine

Previous studies using nonlinear microscopy have demonstrated that osteoarthritis (OA) is characterized by the gradual replacement of Type II collagen with Type I collagen. The objective of this study was to develop a prototype nonlinear laser scanning microendoscope capable of resolving the structural differences of collagen in various orthopaedically relevant cartilaginous surfaces. The current ... [Show full abstract] prototype developed a miniaturized femtosecond laser scanning instrument, mounted on an articulated positioning system, capable of both conventional arthroscopy and second-harmonic laser-scanning microscopy. Its optical system includes a multi-resolution optical system using a gradient index objective lens and a customized multi-purpose fiber optic sheath to maximize the collection of backscattered photons or provide joint capsule illumination. The stability and suitability of the prototype arthroscope to approach and image cartilage were evaluated through preliminary testing on fresh, minimally processed, and partially intact porcine knee joints. Image quality was sufficient to distinguish between hyaline cartilage and fibrocartilage through unique Type I and Type II collagen-specific characteristics. Imaging the meniscus revealed that the system was able to visualize differences in the collagen arrangement between the superficial and lamellar layers. Such detailed in vivo imaging of the cartilage surfaces could obviate the need to perform biopsies for ex vivo histological analysis in the future, and provide an alternative to conventional external imaging to characterize and diagnose progressive and degenerative cartilage diseases such as OA. Moreover, this system is readily customizable and may provide a suitable and modular platform for developing additional tools utilizing femtosecond lasers for tissue cutting within the familiar confines of two or three portal arthroscopy techniques.

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MR Imaging of Lipoma Arborescens and the Associated Lesions

October 2003 · Skeletal Radiology

To describe the typical features of lipoma arborescens on MR imaging with pathologic correlation and to evaluate the associated lesions within the joints. The MR imaging findings of 32 patients with the diagnosis of lipoma arborescens of the knee (n=32) and shoulder (n=1) were reviewed. The diagnosis of lipoma arborescens was confirmed by the histologic findings in 12 cases and the other 21 cases ... [Show full abstract] were diagnosed by the characteristic MR imaging features. One patient had bilateral lipoma arborescens of the knee joint. MR imaging showed a typical pattern of villous lipomatous proliferation of the synovium in all cases, as a diffuse pattern in 79% (26/33) of cases and as a dominant mass-like lesion in 21% (7/33) of cases. The associated MR pathology in the knee was (n=32): joint effusion (100%), degenerative changes (87%), meniscal tear (72%), synovial cysts (38%), bone erosions (25%), chondromatosis (13%), patellar subluxation (6%) and discoid meniscus (3%). In all cases except two there was associated pathology of the knee. MR imaging showed an associated rotator cuff tear in the lipoma arborescens of the shoulder. The characteristic MR features of lipoma arborescens allows an accurate diagnosis of this rare lesion, which is almost always associated with other chronic pathology of the joint in the elderly.

Chapter

Treatment of Facet Joints

January 2013

Lumbar zygapophysial joints are also called “facet joints”. They are often cause of chronic back pain because of rich innervation of the articular structures. In 1933, Ghormley named the spectrum of symptoms arising from its pathological involvement as “facet joint syndrome” (FCS). FCS represents ≤15% of chronic pain in the lower back. It is characterized by joint pain which is usually insidious ... [Show full abstract] in its onset and which may derive from almost any structure in the zygapophysial joints (fibrous capsule, synovial membrane, hyaline cartilage, tendons, bone) due to mechanical or inflammatory stimulation of nociceptors. Standard treatments for pain in lumbar facet joints are mainly intra-articular injections of corticosteroids and radiofrequency denervation (RFD) of the medial branches which innervate the zygapophysial joint. We review here the anatomy and physiology of the lumbar zygapophysial joints as well as diagnostic tools and treatments.

Chapter

The swollen joint

January 2014

C. Laversuch

Joints can be subdivided into fibrous, cartilaginous and synovial. The fibrous skull sutures and the fibro-cartilaginous symphysis pubis allow little or no movement. Synovial joints are complex and allow more movement. They have: a cavity, ends of adjacent bone covered in avascular hyaline cartilage and a lining of synovial membrane surrounded by a tough fibrous capsule. The synovial lined bursa ... [Show full abstract] reduces friction around the joint. There are six types of synovial joint each allowing different planes of movement. Patients present acutely to the acute physician with painful joints, loss of mobility or falls either as part of a local/systemic inflammatory process or due to osteoarthritis (or combination of both). Trauma, sepsis and fractures can complicate this further. Good history taking can distinguish degenerative from inflammatory joint disease, optimizing management.

Article

Meniscal nodule

February 1993 · Knee Surgery Sports Traumatology Arthroscopy

We report a case of solitary synovial chondroma arising from the lateral meniscus in the knee.

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Arthroscopic anatomy of the equine cervical articular process joints

June 2013 · Equine Veterinary Journal

Reason for performing study: Although arthropathy of the cervical articular process joints (APJs) is common, descriptions of the arthroscopic technique of the cervical APJ have not been reported previously. Objectives: To develop an arthroscopic approach to the APJ and to describe the arthroscopic anatomy of the APJ. Study design: Descriptive cadaver study and clinical case report. Methods: ... [Show full abstract] The regional anatomy was reviewed and the technique developed on fresh cadaver necks. A series of cadaveric APJ arthroscopies from C2-C3 to C6-C7 were performed to evaluate the procedure, which was then used in 3 clinical cases. A description of the procedure and the potential complications encountered were recorded. Results: The equine APJ consists of cranioventral and caudodorsal recesses; a single entry point at one of these recesses enables almost complete evaluation of cartilage surfaces and the synovial membrane and its villi. Successful entry into both APJ recesses was achieved in 22 cadaveric APJs and 5 APJs in the 3 clinical cases operated upon. An instrument portal was created to assess the feasibility of surgical arthroscopy. Complications were minor, and dissection of the APJs following the arthroscopic exploration revealed that the cartilage and periarticular neurovascular structures were not damaged during the procedure. Conclusions: This study shows that arthroscopic examination of the APJs of equine cervical vertebra is feasible and can be performed in mature horses. Arthroscopy of the APJs may provide additional diagnostic information compared to conventional diagnostic techniques.

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Hemangioma mimicking meniscal injury: A report on 10 years of knee pain

May 1989 · Acta Orthopaedica Scandinavica

Article

The extrasynovial and capsular fat pads on the posterior aspect of the knee joint

May 1971 · The British journal of radiology

W J Weston

The detailed anatomical description of the extrasynovial fat pads on the posterior aspect of the knee joint is given. They have a ‘3’ shape to conform with the outline of the femoral and lateral tibial condyles. The fatty layers about the posterior joint capsule and on the cephalic and dorsal aspect of the posterior cruciate ligament are also described. These extrasynovial fat pads can be ... [Show full abstract] displaced posteriorly by an effusion in the knee joint, when the pattern of the fat is still maintained. In rheumatoid arthritis, where a synovial mass is produced by oedema, effusion, and synovial hypertrophy, the ‘3’ pattern may be replaced by an irregular margin. In the case presented, the calcified popliteal artery was displaced posteriorly. The fabella, when present and ossified, may be displaced posteriorly to provide an indirect sign of joint effusion or a synovial mass.

Article

Full-text available

Characterization of the Responses of Human Synovial Fibroblasts In Vitro

Albert Agro

The synovial membrane (SM) is a specialized tissue which lines the joint capsule surrounding the interface between bone and cartilage. The intimal layer of the SM, a 1 to 2 cell thick layer of myeloid and mesenchymally-derived cells, has generally been characterized as the population of cells responsible for the secretion of synovial fluid (SF) and with maintaining structural stability within the ... [Show full abstract] capsule of diarthrodial joints. In pathological states, the SM is transformed into an aggressive tissue inundated by inflammatory cells and their soluble mediators. The intimal layer of the SM and its resident cells, Type A and Type B synoviocytes, undergo an alteration in phenotype during disease, particularly chronic joint inflammation. These synoviocytes expand in number and activity and have been demonstrated to be involved in part with the arthritic lesions associated with inflammatory joint disease. The purpose of this thesis is to illustrate that the human synovial fibroblast (HSF or Type B synoviocyte) is a dynamic cell both responding to and influencing its local environment. More specifically, it is documented that HSF activity is significantly affected by a host of locally produced soluble mediators released during arthritic diseases. In addition, HSF are shown to respond to their environment by possessing the capability to alter the activity of other inflammatory cells which are present in the joint milieu. We also show that the pathological state of the originating SM is significant in determining the response and activity of HSF. That is, HSF-derived from normal SM respond to some stimuli differently than do HSF derived from SM originating from diseased joints.

Article

Canine synovial osteochondromatosis

May 2002 · Kleintierpraxis

Canine synovial osteochondromatosis (SOC) is a rarely diagnosed joint disease. Metaplastic proliferations of fibroblasts within the synovial membrane into chore droblasts cause multiple tumor-like cartilaginous nodules, which undergo varying degrees of calcification and enchondral ossification. These nodules may detach from the synovial membrane and become loose bodies. The intra-articular ... [Show full abstract] proliferations and loose bodies cause degenerative joint disease and elicit chronic progressive lameness. Osteochondroma formation can be idiopathic (primary SOC) or stimulated by traumatic, degenerative or inflammatory conditions (secondary SOC). Differentiation of primary and secondary SOC is difficult. Histopathologic criteria are conflicting. The diagnosis of SOC is made by radiography and histological examination of the joint capsule Multiple round masses of varying sizes and stages of calcification within the joint capsule seen radiographically, as well as osteochondral nodular formations in the synovial membrane seen histologically, are diagnostic of this condition. Upon joint exploration, synovial biopsies should be performed when the synovial membrane appears nodular. Surgical removal of loose bodies and synovectomy have resulted in marked long term improvement. Three cases of canine synovial osteochondromatosis (SOC), one affecting the ellbow joint two affecting the hip joint are presented.