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Intra-Articular Meniscoid Folds in Thoracic Zygapophysial Joints

Schulte, Tobias L. MD*; Filler, Timm J. MD, PhD†; Struwe, Patrick MD‡; Liem, Dennis MD*; Bullmann, Viola MD, PhD*

doi: 10.1097/BRS.0b013e3181c9b053

Study Design. A descriptive morphologic anatomic study was performed.

Objective. The study aimed to investigate intra-articular meniscoids (folds) and cartilage quality in the thoracic zygapophysial joints (ZAJs), and to discuss them in the context of possible causes of thoracic back pain.

Summary of Background Data. The clinical relevance of the intra-articular meniscoid structures described in the cervical and lumbar spine is unclear, particularly in relation to ZAJ blockades. Corresponding data for the thoracic joints are not available.

Methods. A total of 297 ZAJs between C7 and L1, obtained from 12 human cadavers (7 female, 5 male; mean age 81 years), were studied. The intra-articular folds were described and classified morphologically. The characteristics of the folds and their association with zygapophysial cartilage quality were investigated. Thirteen example folds were studied histologically.

Results. In all, 268 intra-articular meniscoid folds were found in 183 joints. Three types were identified: type 1 (90%; mean length 3.1 mm) were thin, solid folds originating from a connective-tissue base, with multiple vessels at the joint capsule, extending between the joint surfaces. Type 2 folds (6%) were soft structures of fat and loose connective tissue including multiple vessels, located in the joint recess and not extending between the joint surfaces. The remaining folds (type 3, 4%) were circumscribed thickenings of the joint capsule. Three folds showed chronic hemorrhage, with dilated vessels at the base, and this was associated with severe cartilage lesions. In 16 folds, the base had direct tissue connection to the fat tissue of the epidural space.

Conclusion. This study for the first time systematically classifies intra-articular meniscoid folds in human thoracic ZAJs. These folds may represent an anatomic correlate for thoracic back pain. The chronic hemorrhage observed may be an important factor leading to arthritis.

This descriptive morphologic anatomic study of 297 thoracic zygapophysial joints identified and classified 3 types of intra-articular meniscoid folds, correlating them with the joints' cartilage quality. These folds may help explain thoracic back pain due to joint blockades. Hemorrhage in these folds may contribute to the development of arthritis.

From the *Department of Orthopedics, Münster University Hospital, Münster, Germany; †Institute of Anatomy, University of Münster, Germany; and ‡Department of Medicine, St. Franziskus Hospital, Münster, Germany.

Acknowledgment date: March 11, 2009. Revision date: July 11, 2009. Acceptance date: August 17, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The investigations comply with the current laws of Germany. Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Address correspondence and reprint requests to Tobias L. Schulte, MD, Department of Orthopedics, Münster University Hospital, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.