[2cool4U]

Harrison,

Thanks for the literature confirmation. 42 different systems-Yikes! As you noted, imaging assessment for facet disease isn't part of the routine clinical picture. This won't change until only one or a few classification schemes are developed, but even then, a system would only be useful if each different level of disease reliably corresponds to symptom severity. IMHO, this may never happen.

Annapurna,

I was speaking of primarily bone changes of the facets, as you mentioned because the earlier changes are not easily assessable by MRI due to the sizes of the structures involved. Shoulders and knees are good examples where cartilaginous disease or joint fluid can be readily evaluated.

One of the best ways to improve both of these areas would be, as Harrison mentioned, pathological and histological evaluation, ideally correlated with pre-op imaging findings, which could eventually lead to a classification system. However, I don't think there's a way to get tissue samples from facet joints during surgery or by biopsy. Autopsy studies probably have been done somewhere along the line, but patients would have to be carefully followed while alive and back pain records kept along with imaging records. Something akin to the landmark Framingham heart disease studies, for example. Animal histology studies have likely been done, but clinical correlation to pain levels can't be performed.

I guess these are some of the reasons that medicine remains part art and part science.