CERVICAL CT: UNCOVERTEBRAL JOINT DEGENERATION — HOW TO DIAGNOSE

• 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.

• 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.

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

• 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.

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.

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

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.

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.