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Acquired central canal spinal stenosis of the lumbar spine is commonly secondary to a combination of disc bulge, facet joint hypertrophic changes and ligamentum flavum thickening. Additional contributing factors include degenerative spondylolisthesis and synovial cysts.
Degenerative spondylolisthesis is a disorder that involves an anterior and/or lateral slippage of the vertebral body over the one below due to degenerative changes.
Benign appearing x-rays of the lumbar spine do not rule out the presence of spinal stenosis. In fact, x-ray findings of degenerative spondylolisthesis with facet arthrosis warrant further evaluation with lumbar MRI.
Facet joint effusion has been well reported in literature as highly predictive for instability associated with degenerative spondylolisthesis.
j Ortho Traumatol 2011 observed a correlation between increased facet fluid detected on MRI and lumbar instability on dynamic x-rays.
Eur Spine J 2012 titled "Lumbar facet joint effusion the MRI: a sign of instability in degenerative spondylolisthesis?" concludes "Facet joint effusion is clearly correlated with spontaneous reduction of the extent of slippage in the supine position compared to the upright position."
Spine 2013 titled Diagnostic advancement of axial loaded lumbar spine MRI in patients with clinically suspected central spinal canal stenosis reports additional diagnosis of central spinal canal stenosis and significant decrease of dural sac cross-sectional area using an axial loading device. The significant decrease was related to facet joint effusion. They also concluded that patients with facet joint instability had a tendency to show significant changes in the central spinal canal area.
In Vivo 2003 titled Axial loading MRI of the lumbar spine concludes that axial loading MRI provides valuable information for specific non-invasive or operative management of low back pain.
Recognizing facet joint effusion on MRI is important in the assessment, management and prognosis of lumbar degenerative spondylolisthesis.
