Facet Distention Sign in Spinal StenosisLow back pain with symptoms down the leg(s) is a common symptom of spinal stenosis in older adults. Spinal stenosis is a narrowing of the space available for the nerve roots and their blood vessels in the spine.
Standing up straight or extending the spine closes these spaces even more causing increased symptoms. This is called positional dependent spinal stenosis. Bending forward has the opposite effect and often reduces painful symptoms. The usual way to diagnose this problem is based on the patient's report of symptoms and a standard supine (lying down) MRI.
However, a dynamic slip from spondylolisthesis won't show up in a standard MRI. Spondylolisthesis describes a spinal condition where the body of one vertebra slips forward over the vertebra below it. The traction from this movement pulls on the neural tissue causing worse symptoms.
Patients with spinal stenosis and spondylolisthesis may need surgery to take the pressure off the spinal nerves and spinal fusion to stop the slip. In this study, orthopedic surgeons at Baylor College of Medicine showed that changes in the shape and position of the facet joints of the spine can help show when there is positional dependent spinal stenosis with spondylolisthesis. The surgeon needs this information before planning surgery.
The authors call these facet joint changesthe facet distention sign. Once the physician knows what to look for, this sign can be seen on standard supine CT or MRI images. The presence of the facet distention sign predicts that when the patient is standing upright, the vertebra will slip forward making the stenosis worse. Standing X-rays or a myelogram can then be done to determine the degree of slippage.
Peleg Ben-Galim, MD, and Charles A. Reitman, MD. The Distended Facet Sign: An Indicator of Position-Dependent Spinal Stenosis and Degenerative Spondylolisthesis. In The Spine Journal. March 2007. Vol. 7. No. 2. Pp. 245-248.
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