ABCs of the degenerative spine

Abstract

Degenerative changes in the spine have high medical and socioeconomic significance. Imaging of the degenerative spine is a frequent challenge in radiology. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. The aim of this article is to review radiological findings involving the intervertebral discs, end plates, bone marrow changes, facet joints and the spinal canal in relation to the pathogenesis of degenerative changes in the spine. Findings are described in association with the clinical symptoms they may cause, with a brief review of the possible treatment options. The article provides an illustrated review on the topic for radiology residents.Teaching Points • The adjacent vertebrae, intervertebral disc, ligaments and facet joints constitute a spinal unit. • Degenerative change is a response to insults, such as mechanical or metabolic injury.• Spine degeneration is a biomechanically related continuum of alterations evolving over time.

A pilot investigation of chemonucleolysis-induced intervertebral disc degeneration in the ovine lumbar spine

“…[40–43] Together, these alterations diminish the ability of the tissue to effectively support compressive loading leading to a reduction in IVD height and overall mechanical dysfunction. [6,11,44] Similarly, imaging of degenerate human IVDs often display progressive darkening of the IVDs and loss of height with increasing grade of degeneration.…”

“…Modic changes), and osteophyte formation. [6] These changes are associated with IVDD, an aberrant, cell-mediated process originating in the NP due in part to genetic predispositions, mechanical overload, and limited nutrient supply. [7] Once initiated, IVDD is marked by elevated concentrations of pro-inflammatory mediators that promote the production of matrix-degrading enzymes by resident cells.…”

Signos radiológicos más frecuentes relacionados con dolor lumbar y su aplicabilidad en valoración pre-ocupacional

“…Los hallazgos característicos de la degeneración del disco en las radiografías convencionales incluyen formación de osteofitos a lo largo de los bordes de las placas terminales, estrechamiento de la altura del espacio discal, esclerosis aumentada a lo largo de las placas terminales y posibles osteofitos o esclerosis de las facetas articulares. 21,22 En las primeras etapas de la enfermedad del disco lumbar, la altura de los discos puede no variar. Algunos pacientes pueden tener inestabilidad relacionada con la insuficiencia del disco lumbar.…”

“…La articulación facetaría se ha visto cada vez más implicada como una fuente potencial de DL. 21,22,24 Los hallazgos radiográficos típicos en la enfermedad de esta articulación incluyen el estrechamiento del espacio articular, la esclerosis subcondral, el gas intraarticular y la formación de osteofitos. Un estudio informó que las radiografías oblicuas tenían un 55% de sensibilidad y un 69% de especificidad para identificar la presencia de cambios degenerativos en las articulaciones facetarías.…”

Characterization of chondroitinase-induced lumbar intervertebral disc degeneration in a sheep model intended for assessing biomaterials

“…(6),(11),(57) Semi-quantitative and qualitative histological evaluations of Degen IVDs demonstratedsignificant alterations in the NP, AF, and CEP disruptions as compared to Vehicle and Uninjured IVDs. This was demonstrated by decreases in proteoglycan staining intensity and disorganization of the NP, alterations in the lamellar architecture of the AF, and the formation of Schmorl's nodes (breaches of the NP into adjacent vertebral bodies), respectively.…”