Advertisement

Zygapophyseal Joint Adhesions After Induced Hypomobility

      Abstract

      Objective

      Adhesions (ADH) have been previously identified in many hypomobile joints, but not in the zygapophyseal (Z) joints of the spine. The objective of this study was to determine if connective tissue ADH developed in lumbar Z joints after induced intervertebral hypomobility (segmental fixation).

      Methods

      Using an established rat model, 3 contiguous segments (L4, L5, L6) were fixed with specially engineered, surgically implanted, vertebral fixation devices. Z joints of experimental rats (17 rats, 64 Z joints) with 4, 8, 12, or 16 weeks of induced hypomobility were compared with Z joints of age-matched control rats (23 rats, 86 Z joints). Tissue was prepared for brightfield microscopy, examined, and photomicrographed. A standardized grading system identified small, medium, and large ADH and the average numbers of each per joint were calculated.

      Results

      Connective tissue ADH were characterized and their location within Z joints described. Small and medium ADH were found in rats from all study groups. However, large ADH were found only in rats with 8, 12, or 16 weeks of experimentally induced intervertebral hypomobility. Significant differences among study groups were found for small (P < .003), medium (P < .000), and large (P < .000) ADH. The average number of medium and large ADH per joint increased with the length of experimentally induced hypomobility in rats with 8 and 16 weeks of induced hypomobility.

      Conclusions

      We conclude that hypomobility results in time-dependent ADH development within the Z joints. Such ADH development may have relevance to spinal manipulation, which could theoretically break up Z joint intra-articular ADHs.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Janse J.
        Hildebrandt RW Principles and practice of chiropractic: an anthology. Kjellberg & Sons, Wheaton1976: 326
        • Triano JJ
        Interaction of spinal biomechanics and physiology.
        in: Haldeman S Principles and practice of chiropractic. 2nd ed. Appleton & Lange, East Norwalk, Conn1992: 225-257
        • Cramer GD
        • Fournier JT
        • Henderson CN
        • Wolcott CC
        Degenerative changes following spinal fixation in a small animal model.
        J Manipulative Physiol Ther. 2004; 27: 141-154
        • Cramer GD
        • Tuck NR
        • Knudsen JT
        • Fonda SD
        • Schliesser JS
        • Fournier JT
        • et al.
        Effects of side-posture positioning and side-posture adjusting on the lumbar zygapophysial joints as evaluated by magnetic resonance imaging: a before and after study with randomization.
        J Manipulative Physiol Ther. 2000; 23: 380-394
        • Cramer GD
        • Gregerson DM
        • Knudsen JT
        • Hubbard BB
        • Ustas LM
        • Cantu JA
        The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects.
        Spine. 2002; 27: 2459-2466
        • Cramer GD
        • Fournier JT
        • Henderson C
        Zygapophysial joint changes following spinal fixation.
        in: International Conference on Spinal Manipulation; 2000 September 21-23; Minneapolis. Brookline: Foundation for Chiropractic Education and Research. 2000: 85-87
        • Pickar JG
        • Wheeler JD
        Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat.
        J Manipulative and Physiol Ther. 2001; 24: 2-11
        • Ianuzzi A
        • Khalsa PS
        Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions.
        Spine J. 2005; 5: 277-290
        • Bakkum BW
        • Henderson CN
        • Hong SP
        • Cramer GD
        Preliminary morphological evidence that vertebral hypomobility induces synaptic plasticity in the spinal cord.
        J Manipulative Physiol Ther. 2007; 30: 336-342
        • Cramer GD
        • Cantu JA
        • Pocius JD
        • Balester F
        • Simpson DRJ
        • Horner TB
        • et al.
        Reliability of zygapophysial (Z) joint measurements taken from MRIs of subjects with acute low back pain.
        FASEB J. 2009; 23: 649
        • Enneking WF
        • Horowitz M
        The intra-articular effects of immobilization on the human knee.
        J Bone Joint Surg Am. 1972; 54: 973-985
        • Trudel G
        • Seki M
        • Uhthoff HK
        Synovial adhesions are more important than pannus proliferation in the pathogenesis of knee joint contracture after immobilization: an experimental investigation in the rat.
        J Rheumatol. 2000; 27: 351-357
        • Hannafin JA
        • Chiaia TA
        Adhesive capsulitis. A treatment approach.
        Clin Orthop Relat Res. 2000; : 95-109
        • Hase M
        Adhesions in the temporomandibular joint: formation and significance.
        Aust Dent J. 2002; 47: 163-169
        • Laroche M
        • Ighilahriz O
        • Moulinier L
        • Constantin A
        • Cantagrel A
        • Mazieres B
        Adhesive capsulitis of the shoulder: an open study of 40 cases treated by joint distention during arthrography followed by an intraarticular corticosteroid injection and immediate physical therapy.
        Rev Rhum Engl Ed. 1998; 65: 313-319
        • Henderson CN
        • Cramer GD
        • Zhang Q
        • DeVocht JW
        • Fournier JT
        Introducing the external link model for studying spine fixation and misalignment: part 1—need, rationale, and applications.
        J Manipulative Physiol Ther. 2007; 30: 239-245
        • Henderson CN
        • Cramer GD
        • Zhang Q
        • DeVocht JW
        • Fournier JT
        Introducing the external link model for studying spine fixation and misalignment: part 2, biomechanical features.
        J Manipulative Physiol Ther. 2007; 30: 279-294
        • Henderson CN
        • Cramer GD
        • Zhang Q
        • DeVocht JW
        • Sozio RS
        • Fournier JT
        Introducing the external link model for studying spine fixation and misalignment: current procedures, costs, and failure rates.
        J Manipulative Physiol Ther. 2009; 32: 294-302
        • Landis J
        • Koch G
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 174
        • Giles LG
        Human zygapophyseal joint inferior recess synovial folds: A light microscopic examination.
        Anat Rec. 1988; 220: 117-124
        • Giles LG
        The pathophysiology of the zygapophysial joints.
        in: Haldeman S Principles and practice of chiropractic. 2nd ed. Appleton & Lange, East Norwalk, Conn1992: 197-210