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CERVICAL CT: UNCOVERTEBRAL JOINT DEGENERATION — HOW TO DIAGNOSE

The Dx

/ Spine Degeneration

CERVICAL CT: UNCOVERTEBRAL JOINT DEGENERATION

How do you diagnose uncovertebral joint degeneration on CT?

The best way to see uncovertebral joint degeneration is on CT, starting with the normal appearance of the joint before looking for degenerative change.
The coronal CT is the best plane to assess for uncovertebral degeneration.
In this video we go through normal uncovertebral joint anatomy, the CT appearance of degeneration, and why identifying it matters clinically.

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▾ The uncinate process and articular margin

The uncinate process arises from the vertebral body and articulates with the inferolateral aspect of the vertebral body above.
The inferior margin of the vertebral body above has a beveled or angled appearance — generally referred to as the articular margin of the uncovertebral joint.
There has been debate over whether this is a true joint, but it is now considered a proper joint, with some fibrocartilage present.

▾ Function and joint type

It is a synovial joint, so it is prone to inflammatory change.
Its main purpose is to restrict lateral flexion of the neck.
The joint forms the anterior margin of the intervertebral foramen, which is why degeneration here has downstream effects on the exiting nerve root.

▾ Normal appearance on coronal CT

On the normal side, there is a nice, well-preserved space between the uncinate process and the inferior articular margin, with no degenerative change.

▾ Degenerative findings on the contralateral side

Narrowing of the joint space.
Significant sclerosis at either side of the articular margin.
Hypertrophic change involving the whole region, including the uncinate process, best appreciated by comparison with the contralateral, normal side.

▾ Checking for foraminal narrowing

Coronal reformats are used first to identify the degeneration itself, and sagittal reformats are then used to assess for foraminal narrowing from osteophyte formation arising from the degenerated joint.

Osteophytes arising from uncovertebral joint degeneration extend into the intervertebral foramen and can compress the exiting nerve root.
The degenerated joint can also be a pain generator in its own right, independent of any nerve root compression.

Uncovertebral joint degeneration is best seen on CT, predominantly on coronal reformats.
Degenerative findings include joint space narrowing, sclerosis at the articular margin, and hypertrophic change of the uncinate process, best appreciated against the contralateral normal side.
Osteophytes from this joint extend into the intervertebral foramen and can compress the exiting nerve root — check sagittal reformats for foraminal narrowing.
The uncovertebral joint itself can also be a pain generator, independent of any nerve root compression.

▾ What is the best imaging plane for assessing uncovertebral joint degeneration?

Coronal CT reformats. Start there to identify the degeneration, then check sagittal reformats for any resulting foraminal narrowing.

▾ What CT findings indicate uncovertebral joint degeneration?

Narrowing of the joint space, significant sclerosis at either side of the articular margin, and hypertrophic change of the uncinate process, compared against the normal contralateral side.

▾ Why does uncovertebral joint degeneration matter clinically?

Two reasons: osteophytes arising from the degenerated joint can extend into the intervertebral foramen and compress the exiting nerve root, and the degenerated joint itself can be a pain generator on its own.