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Chiropractic Research Review

Naked Facet Sign "Does Not Consistently Imply" Vertebral Instability

Flexion injuries due to axial loads or distractive forces are common to the spine. The naked facet sign (NFS), which can be identified on computed tomographic (CT) scans, has been suggested to be one sign of significant injury to ligaments in the thoracolumbar spinal region.

NFS is evident when "the inferior articular facets of the cephalad vertebra do not appear adjacent to the superior facets of the subjacent caudal vertebra."

The objective of this research was to discover the angles of rotation needed for NFS to occur in the thoracolumbar region. Visualization software and a spinal model were used to replicate certain flexion injuries. To simulate CT images, crossways planes were made so that they were parallel to the end plates of the vertebra. Rotation was then measured at the point the NFS was visible.

It was observed that the replication of the NFS occurred between five and 16.5 degrees of rotation. "These results suggest that the naked facet sign does not consistently imply the presence of posterior column vertebral instability," the authors conclude. These findings could help physicians relate NFS and injury pattern to decisions on stability and options for treating the injury.

Harris MB, Stelly MV, Villarraga ML, et al. Modeling of the naked facet sign in the thoracolumbar spine. Journal of Spinal Disorders 2001:14(3), pp. 252-258.

Chiropractic Research Review

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