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Review Article - (2023) Volume 10, Issue 2

Patients who experience excruciating facet joint distress

Shyam Meheta*
Department of Rheumatology, University of Osmania, India
*Correspondence: Shyam Meheta, Department of Rheumatology, University of Osmania, India, Email:

Received: 25-Mar-2023, Manuscript No. ipar-23-13613; Editor assigned: 27-Mar-2023, Pre QC No. ipar-23-13613(PQ); Reviewed: 10-Apr-2023, QC No. ipar-23-13613; Revised: 14-Apr-2023, Manuscript No. ipar-23-13613(R); Published: 21-Apr-2023, DOI: 10.36648/ipar.


Description of human facet joint capsular tissues and degenerative facet joints. Lumbar facet joint degeneration may be a major cause of sciatica and low back pain. Neovascularization and cellular alterations in inflammatory factor expression in human degenerative facet joint capsular tissue were the focus of this study. The effects of pain stimulation on these changes in FJC tissues were also evaluated.


Capsular tissues; Neovascularization; Degeneration; Pain stimulation


Back pain is one of the most prevalent medical conditions affecting adults in the United States. The lifetime prevalence is between 70 and 85 percent, with 10 to 20 percent suffering from chronic low back pain. Facet joint degeneration is frequently referred to as "facet joint syndrome" as a cause of LBP. Recent articles have conducted extensive reviews of FJD caused by osteoarthritic changes, which is a common cause of LBP, affecting 15–45% of patients with chronic LBP [1].

The paired zygophyseal joints that connect two adjacent vertebrae are known as facet joints. A "spinal motion segment" is made up of the paired FJs and their corresponding intervertebral disc, which are a "three-joint complex." At the spinal motion segment, FJs are subjected to compressive, shear, and axial loading. The FJ comprises of hyaline ligament, menisci, synovium, and joint case. Sensory innervation is distributed by the medial branch of the dorsal primary ramus, which runs through the FJ. Nociceptive, autonomic, and mechanoreceptor nerve fibres abound in the human facet joint capsular tissue, which is the fibrous connective tissue lined with synovium surrounding the joint. Additionally, the dorsal root ganglion is in close proximity to the FJ. Joint degeneration has been linked to cytokine mediators of inflammation, angiogenesis, sensory neuron ingrowth, and pain. FJD has been linked to pathologic loading, which has been linked to the production of cytokines linked to inflammation, angiogenesis, the growth of sensory neurons, and pain in joint tissues. LBP may be the result of facet hypertrophy, inflammation, or degradation, according to studies; however, the precise connection between LBP and FJC tissues is still poorly understood [2].

Cytokine release from degenerative FJs has been shown in previous research to be inversely correlated with patients' LBP symptoms. Neovascularization and degeneration have been linked to other joints, including the knee. Joint pain and degeneration are linked to angiogenesis and nerve growth. Its underlying mechanisms that cause FJD require more research. The mechanisms by which FJD progresses to pain formation remain a mystery, and research into these mechanisms is on-going. The objective of this study is to explore the aggravation, angiogenesis, neuronal ingrowth and agony middle people that happen in FJC tissues got from subjects with persistent LBP with degenerative FJs. An ex vivo organ co-culture system utilizing degenerative FJC tissues and rat lumbar DRGs was also developed to study functional mechanisms and potential cellular communication between sensory neurons and peripheral tissues [3].


Tissue donors: Within 24 hours of death, consented asymptomatic organ donor tissue samples were obtained from the Gift of Hope Tissue Network. From hospital records and personal information provided by next of kin, the Gift of Hope Tissue Network provided clinical information about the organ donors. For the purposes of our experiments, lumbar spine segments were extracted from donors whose clinical back pain symptoms were unreported. Following the manufacturer's instructions, total protein was extracted from human FJC tissues using cell lysis buffer. The bicinchoninic acid protein assay was used to determine the protein concentrations of human FJC tissues. For western blot analyses, equal amounts of protein were separated by 10% SDS-PAGE and electro blotted onto nitrocellulose membranes. The ECL system was utilized to visualize immunoreactivity [4].

The manufacturer's instructions were followed when isolating total RNA with Trizol reagent. cDNA was amplified with the MyiQ Real-Time PCR Detection System for real-time PCR. Using the manufacturer's iQ5 Optical System Software, each amplification curve yielded a threshold cycle. According to the manufacturer's instructions, the CT method was used to measure relative mRNA expression. On request, the primer sequences and their conditions will be made available. Carbon dioxide was used to kill adult Sprague-Dawley rats without causing any symptoms of pain. Under stereoscopic microscopy, bilateral lumbar DRGs from L1 to L5 were carefully removed by aseptic dissection, particularly to avoid physical damage. There were three wells in each experimental group, each containing either unique normal or degenerative FJC tissues or the media control. As previously mentioned, each well's three DRGs were harvested for RNA extraction and PCR [5].

Descriptive statistics were calculated, group differences were tested, and multiple testing error inflation was corrected using statistical analysis software like SAS and SPSS for Windows. A two-sided t-test was used to compare groups for variables with similar variances and distributions close to normal. Benjamini and Hochberg's adjustment method for controlling the rate of false discovery was used to account for the issue of error inflation brought on by multiple hypothesis testing. By grouping the P-values by analytical section, linear step-up adjustments were used to control the FDR and reduce the risk of error inflation. All statistical tests had a significance level of P 0.05 after error inflation was taken into account. The figures display distinct P-values. Mean data are presented. The 95% confidence interval is used to represent error bars.


The inferior facet's gross appearance of human FJs was evaluated and given a representative grade. Edge osteophytes, reactive bone, and cartilage erosion grew in size in samples of higher grades. It was evident that the surgical samples with symptoms had the most degenerative changes in their morphology. Histological comparison of normal and degenerated facets with various degrees of pathological conditions was used to further examine the gross appearance of human FJs for proteoglycan content. When advanced degeneration FJs was compared to healthy joints, Safranin O staining showed that proteoglycan levels were significantly decreased. The FJs' Alcian Blue Hematoxylin/Orange G and H&E staining results backed up the structural and morphological changes that were linked to grade [6].

Staining for the immune cell marker CD11b revealed the presence of inflammatory cells in degenerative FJC tissues. We compared the expression of cytokines in healthy and degenerative FJC tissues. Multiple pro-inflammatory cytokines had significantly increased in levels as a result of cytokine antibody array analyses.


Our findings showed that FJC tissues taken from patients with LBP who had degenerative FJs had higher levels of angiogenesis, inflammation, and neurogenesis than FJC tissues taken from healthy donors who had no symptoms. Additionally, the overexpression of pain-related molecules by degenerated FJC tissues may cause DRG neurons to become more sensitive to pain. When compared to normal FJs, the elevated levels of pro-inflammatory cytokines and cartilage-degrading enzymes found in degenerative FJs strongly support the hypothesis that these molecules contribute to structural and molecular changes in FJC tissues and adjacent FJs. However, it is important to note that, concurrently, both pro-inflammatory cytokines and enzymes that degrade cartilage and there is an increase in anti-inflammatory cytokines and cartilage-degrading enzyme inhibitors such IL-10, IL-13, TIMP-2, and TIMP- 3. Similar findings have been made in other structural tissues of human joints, indicating that the reparative response may have failed to reverse the degenerative process [7].

Through stimulation of inflammation and innervation, recent studies have shown that angiogenesis is a major contributor to joint degenerative disease and pain. According to a theory, angiogenesis-induced infiltration of inflammatory cells into the joint may make LBP worse. Angiogenesis is thought to be a factor in enhanced pain perception because it encourages the growth of new sensory nerve fibres. In the FJC of symptomatic patients, an upregulation of angiogenic factors, inflammatory cytokines, immune cell infiltration, and newly formed sensory nerve fiber ingrowth may be indicative of a progressive pattern that begins with FJ degeneration and progresses to pain production [8].

In degenerative FJs, newly formed sensory nerve fibres respond to inflammation and release vasoactive substances into the joint to initiate or facilitate inflammation. The nearness of the FJ to the DRG might upgrade these "crosstalk" capacities. Sensory neurons in the DRGs release inflammatory cytokines and pain-mediators when the FJ is damaged. As a result, the nocioceptive changes in degenerative FJs are significantly exacerbated by these released molecules. The overproduction of essential pain mediators substance P and NGF in our DRG co-culture model demonstrates that degenerative FJC tissues alter the functional properties of sensory neurons in the DRG. According to our findings, symptomatic LBP patients experience an increase in pain production as a result of increased inflammatory neuropeptides, receptors, and ion channels, as well as “crosstalk” between the degenerated FJ and DRG. When compared to normal knee cartilage, osteoarthritic knee cartilage contains significantly less TIMP-3, the most potent chondroprotective molecule of the four TIMP family members49. TIMP-3, on the other hand, was found to be significantly higher than normal in degenerative FJC tissues in the current study. Likewise, we likewise tracked down a huge decrease in prostaglandin E2 receptor EP2 in degenerative FJC tissues. It is known that the pathophysiology of cartilage is connected to the elevated expression of the EP2 receptor in degenerative knee joint cartilage. These results suggest that these molecules may be expressed differently in different tissues [9].

Despite the fact that this study yielded significant outcomes, it is important to keep in mind its limitations. First, the small sample size may have limitations, particularly for normal tissues. Getting an enormous example populace demonstrated troublesome in light of the fact that examples were obtained carefully from assented patients or from cadaveric organ benefactors. Second, the lack of pain scores directly related to LBP limited the personal information that could be gleaned from the cadaveric donors. Thirdly, the use of human FJC tissues and rat DRGs in the DRG coculture model may result in inconsistencies. Understanding "crosstalk" between peripheral tissues and the sensory nerve system should be improved by continuing research on additional targets using the DRG co-culture system [10].


The findings suggest that neuronal stimulation of afferent pain fibres and increased inflammatory and angiogenic characteristics in degenerative FJC tissues are linked to joint degeneration and the progression of FJD. Our comprehension of translational or pre-clinical information that cannot be answered by human clinical studies will be greatly improved by replicating symptomatic FJD that results in FJ pain in animal models.




  1. Vallat-Decouvelaere AV, Dry SM, Fletcher CD. Atypical and malignant solitary fibrous tumors in extrathoracic locations: evidence of their comparability to intra-thoracic tumors. Am J Surg Pathol. 1998; 22(12): 1501-1511.
  2. Indexed at, Google Scholar, Crossref

  3. Gold JS, Antonescu CR, Hajdu C. Clinicopathologic correlates of solitary fibrous tumors. Cancer. 2002; 94(4): 1057-1068.
  4. Indexed at, Google Scholar, Crossref

  5. Cranshaw I, Gikas P, Fisher C. Clinical outcomes of extra- thoracic solitary fibrous tumours. Eur J Surg Oncol. 2009; 35(9): 994-998.
  6. Indexed at, Google Scholar, Crossref

  7. Kayani B, Sharma A, Sewell MD, et al. A Review of the Surgical Management of Extrathoracic Solitary Fibrous Tumors. Am J Clin Oncol. 2018; 41(7): 687-694.
  8. Indexed at, Google Scholar, Crossref

  9. Demicco EG, Park MS, Araujo DM. Solitary fibrous tumor: a clinic pathological study of 110 cases and proposed risk assessment model. Mod Pathol. 2012; 25(9): 1298-1306.
  10. Indexed at, Google Scholar, Crossref

  11. Baldi GG, Stacchiotti S, Mauro V. Solitary fibrous tumor of all sites: outcome of late recurrences in 14 patients. Clin Sarcoma Res. 2013; 3: 4.
  12. Indexed at, Google Scholar, Crossref

  13. Park MS, Patel SR, Ludwig JA. Activity of temozolomide and bevacizumab in the treatment of locally advanced, recurrent, and metastatic hemangiopericytoma and malignant solitary fibrous tumor. Cancer. 2011; 117(21): 4939-4947.
  14. Indexed at, Google Scholar, Crossref

  15. Choi H, Charnsangavej C, Faria SC. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol. 2007; 25(13): 1753-1759.
  16. Indexed at, Google Scholar, Crossref

  17. Roughley PJ, Mort JS. The role of aggrecan in normal and osteoarthritic cartilage. J Exp Orthop. 2014; 1(1): 8.
  18. Indexed at, Google Scholar, Crossref

  19. Chiusaroli R, Piepoli T, Zanelli T, et al. Experimental pharmacology of glucosamine sulfate. Int J Rheumatol. 2011; 2011: 939265.
  20. Indexed at, Google Scholar, Crossref