Stages Of Degeneration In The Threejoint Complex

Degenerative changes in the three-joint complex progress through three clinical stages. The stage of dysfunction is characterized by very minimal damage to joints

Neural Exit Foramen Cyst
Fig. 5. Synovial cyst. Sagittal T2-weighted image demonstrates a synovial cyst (white arrowhead) extending into the L5-S1 neural foramen from the adjacent fluid filled (black arrow) facet. The cyst abuts the exiting L5 nerve root. Incidentally noted is an L5 vertebral body hemangioma.

that is difficult to detect objectively. Similarly, the patient's symptoms are not yet severe. The stage of instability is defined by the presence of abnormal movement of the vertebrae. Clinical symptomatology and radiologic findings are apparent, which may include spondylolisthesis and position-dependent lateral stenosis. Eventually, with the progression of osteophytosis and degenerative changes, movement of the vertebrae is limited, resulting in the stage of stabilization. Dynamic stenosis encountered before give way to fixed lesions, and patients may report some degree of improvement as a result of the stability (20). Thus, the finding of spondylolisthesis on imaging may not necessarily indicate instability, as stabilization may have already taken place (24).

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