Degenerative and dystrophic diseases of the spine and back pain

Despite the etiological differences in the genesis of degenerative (involutive, associated with aging) and dystrophic (metabolic) lesions of the musculoskeletal system, the features characteristic of each of these processes have not been clearly distinguished in the clinical and radiological picture of the disease.

The historically word combination "degenerative-dystrophic lesions" is widely used in medical literature, although for most of the diseases considered in this section the term "dystrophic" is more justified. In this case, depending on the severity of metabolic disturbances and their prevalence, clinical symptoms and radiographic changes from the musculoskeletal system may have different expression.

[1], [2], [3], [4]

Sheyerman's disease

In modern vertebrology, Scheiermann's disease (juvenile kyphosis) is regarded as a private form of Sheyerman dysplasia (juvenile osteochondrosis), the severity of which is very individual and depends on hereditary factors, the patient's age and the level of lesion (thoracic or lumbar). On the basis of Sheyermann's dysplasia, the development of degenerative osteochondrosis and back pain, characteristic of older patients, is possible . Dynamics of X-ray changes in this pathology allows us to introduce the concept of Scheiermann's dysplasia scale, which can be designated by a scheme on which the horizontal axis corresponds to the increasing age of patients.

Typical radiographic signs of Sheyermann's dysplasia are: widespread wedge shape of the vertebral bodies, presence of Schmorl's hernias, a decrease in the height of intervertebral discs and gently sloping kyphosis (typical for the thoracic region). It is important to emphasize. That for the diagnosis of simultaneous presence of all the listed characteristics is not necessary. The maximum severity of Sheyerman's dysplasia corresponds to the Sorenson x-ray criterion typical for the thoracic spine and includes two features: the wedge of vertebral bodies exceeding 5 ° and the lesion of at least three adjacent vertebrae.

Two separate diseases - the juvenile Gyuntza kyphosis and the fixed round spin of Lindemann are accompanied by a gentle kyphosis and back pain, i.e. Clinical manifestations, which most resemble the juvenile kyphosis of Sheyermann. However, typical radiographic signs allow us to differentiate these states.

Klingo-x-ray features of the juvenile kyphosis Gyntsch and the fixed round back Lindemash

	Clinical signs	X-ray signs
Juvenile kyphosis of Gyuntza	Suture or a round back, Pain syndrome - in 50% of patients.	The wedge shape of the discs, the wedge base is reversed Correct rectangular shape of vertebral bodies The absence of Schmorl hernias and defects of the closure plates
The fixed round spin of Lindemann	Pronounced stoopness The stiffness of the spine in the zone of deformation.	Cuneiformity of vertebral bodies The wedge shape of the discs, the wedge base faces anteriorly Absence of Schmorl hernias and defects of the closure plates.

Spondylosis

Spondylosis, or limited calcification of the anterior longitudinal ligament, has traditionally been considered in the literature as a variant of degenerative-dystrophic spine lesion, although there is an opinion about the traumatic nature of this pathology.

Distinguishing clinical and radiological signs of spondylosis are:

• absence of pain in the back (in the vast majority of observations) in the presence of pronounced radiologic signs of local ossification of the anterior longitudinal ligament;
• defeat 1-2, rarely - 3 segments, more often - in the lumbar region;
• absence of decrease in the height of intervertebral discs. The presence of a decrease in disc height indicates a combination of chondrosis and spondylosis;
• the formation of osteophytes does not have strict symmetry, and they themselves differ in irregular shape, fringing;
• osteophytes have a typical orientation and localization: they usually start outside the epiphyseal plate area from the level of attachment of the anterior longitudinal ligament to the vertebral bodies, go up and down with respect to the intervertebral disc, skirting it. Less often ossification of the anterior longitudinal ligament detached as a result of trauma begins at the level of the middle of the disc, or a "counter" ossification is observed, proceeding from cranial and caudal directions located in relation to the adjacent disk of vertebral bodies (the parrot's beak symptom), until the apophyses completely fuse. In osteochondrosis, the localization and direction of the Yongkhans spines are horizontal. The appearance of coracoid bone growths is possible not only with spondylosis, but also with Forestier's disease (synovial fixing hyperostosis, fixing ligamentosis).

Differential diagnostic signs of spondylosis and Forestier disease

Symptom	Spondylosis	Forestier's disease
Localization of the beginning of the process	More often lumbar vertebrae	Usually the central thoracic segments (usually on the right). Less common lumbar (more often left).
Prevalence of the process	1-2, rarely 3 segments	A large number of segments, often inflicted whole parts of the spine
Disk Status	Not changed	Not changed
Joints of axial skeleton	Not amazed	Not amazed
Presence of a trauma in the anamnesis	There is	No
Rigidity of the spine	In a restricted area	Common

Spondylarthrosis

Spondyloarthrosis is a degenerative lesion of the articular cartilage of arcuate joints, accompanied by stretching and infringement of their capsules, dystrophy and subsequent ossification of the ligamentous apparatus of the spine. Symptoms of spondylarthrosis include back pain more often somitic, less often - radicular; X-ray - subchondral sclerosis of articular surfaces, narrowing of the joint gap until its complete disappearance, bone growths in the joint zone and deformations of the articular processes.

As in the clinical examination, and when carrying out functional radiographs of the spine, the limitation of the volume of movements due to the block of the vertebral-motor segment is revealed. As its integral part, the arcuate joint with any pathology of the vertebral-motor segment undergoes functional overload. That is why the dystrophic process in the disc usually occurs with the phenomena of spondyloarthrosis. In the absence of dystrophic changes in the discs, the isolated lesion of one or more joints may be due to deformities of the spine in any plane, trauma or dysplasia that disrupt the normal function of the joint. The formation of spondylarthrosis can contribute to:

• anomalies of tropism - spatial orientation of arcuate joints. The asymmetry of paired arcuate joints, in which arthrosis does not develop, usually does not exceed 20 °;
• anomalies in the size and structure of the arcuate joints: different size, wedge-shaped and saddle joints, aplasia of the articular process, additional ossification nuclei;
• the presence of transient vertebrae and their anomalies;
• violations of the fusion of the bodies and arches of the vertebrae;
• violation of the formation of arches of vertebrae.