Osteoarthrosis & Disc Degeneration Flashcards
What is the most common joint problem?
degeneration
What is the difference between primary and secondary osteoarthrosis?
- primary = no known/proven factors
- secondary = known precipitating factors (trauma/biomechanics, congenital anomalies, inflam./metabolic)
What is the relationship between radiologic findings of joint degeneration and signs & symptoms?
poor correlation
When does osteoarthrosis tend to manifest?
> 45 yrs
What are the typical clinical manifestations of joint degeneration?
insidious onset:
- aching (dull)
- pain
- stiffness
What are the radiographic characteristics of osteoarthosis?
- osteophytes/spondylophytes
- non-uniform jt space loss
- subchondral sclerosis
- subchondral cysts
- joint mouse
- subluxation
- unilateral or bilateral
What are subchondral cysts?
cracks/fissures filled with synovial fluid
Spondylosis deformans is degeneration of the ____
annulus
Intervertebral osteochondrosis is degeneration of the ____
nucleus pulposis
What are the radiographic characteristics of spondylosis deformans?
- minimal disc space loss
- prominent osteophytes
- annular vacuum clefts
What are the radiographic characteristics of intervertebral osteochondrosis?
- prominent loss of disc space
- minimal osteophytes
- nuclear vacuum phenomenon
Where are annular vacuum clefts found?
at corners of endplates where annulus attaches
Where is nuclear vacuum phenomenon found?
dark space in middle of disc space
What question should you ask a patient who shows signs of spondylosis deformans?
any problems swallowing?
(spondylophytes can cause mechanical dysphagia)
Annulus fibrosus is called ____
intercalary bones
(can also be an anomaly)
What are 3 differential diagnoses for intercalary bones?
- limbus bone
- teardrop Fx
- normal secondary oss. center of vertebral endplate
What may generate pain with disc degeneration?
- outer 1/3 annular fibers (where nn travel)
- vertebral endplates
What are the clinical concerns of disc degeneration?
- pain
- altered biomechanics (modic changes)
- disc herniations
- neuro. implications (radiculopathy, myelopathy)
What are modic changes?
changes in marrow of endplate in response to degenerative changes in adjacent discs
An endplate appears dark on both T1 and T2 MRI. What type of modic change is this?
type 3
An endplate appears bright on T1 and dark on T2 MRI. What type of modic change is this?
type 2
An endplate appears dark on T1 and bright on T2 MRI. What type of modic change is this?
type 1
An endplate appears bright on both T1 and T2 MRI. What type of modic change is this?
type 2
What is the only type of modic change that is clinically significant?
type 1
(associated with discogenic Sx)
Type 1 modic change represents replacement with ____
fibrovascular tissue
Type 2 modic change represents replacement with ____
fatty tissue
Type 3 modic change represents replacement with ____
bony sclerosis
What radiographic sign is associated with type 3 modic change?
hemispheric spondylosclerosis
What type of modic change is considered acute?
type 1
What type of modic change is considered chronic?
type 2
Annular fissures are also called ____ or ____
- annular tears
- high intensity zones (HIZ)
Where in the disc are annular fissures most commonly found?
posterior disc
What are the 3 types of annular tears?
- transverse
- concentric
- radial
What is the most common type of annular tear?
concentric
What is the only type of annular tear that is important?
radial
What part of the annulus is involved with a transverse tear?
peripheral annulus
What is a transverse annular fissure?
represents a separation of disc insertion fibers (Sharpey’s fibers) at the cartilaginous endplate
How do transverse annular fissures appear radiographically?
seen as vacuum cleft
(rarely seen on MRI)
What is a concentric annular fissure?
vertically oriented separation between annular layers
What is the clinical significance of a transverse annular tear?
none
What is the clinical significance of a concentric annular tear?
none (no evidence of Sx)
What is a radial annular fissure?
longitudinal fissuring extending from the nucleus through multiple layers of annulus
What can happen to the nucleus with a radial annular fissure?
significant nuclear migration
What is the clinical significance of radial annular fissures?
associated with symptoms of discogenic pain
- growth of vascularized granulation tissue in tear
- chemical and mechanical irritation to outer (innervated) portion of annulus
What is the diagnosis? What are the radiographic findings associated with this condition?
Spondylosis deformans
- prominent osteophytes
- preserved disc space
- annular vacuum clefts
What is the diagnosis? What are the radiographic findings associated with this condition?
Intervertebral osteochondrosis (IVOC)
- minimal osteophytes
- loss of disc space
- nuclear vacuum phenomenon
What type of modic change is seen, and what does it represent?
Type 1 modic change
= fibrovascular tissue
What type of modic change is seen, and what does it represent?
Type 3 modic change
= bony sclerosis
What type of modic change is seen, and what does it represent?
Type 2 modic change
= fatty tissue
