(2,3) Osteoarthrosis & Disc Degeneration

Question 1

What is the most common joint problem?

Answer 1

degeneration

Question 2

What is the difference between primary and secondary osteoarthrosis?

Answer 2

• primary = no known/proven factors
• secondary = known precipitating factors (trauma/biomechanics, congenital anomalies, inflam./metabolic)

Question 3

What is the relationship between radiologic findings of joint degeneration and signs & symptoms?

Answer 3

poor correlation

Question 4

When does osteoarthrosis tend to manifest?

Answer 4

> 45 yrs

Question 5

What are the typical clinical manifestations of joint degeneration?

Answer 5

insidious onset:
- aching (dull)
- pain
- stiffness

Question 6

What are the radiographic characteristics of osteoarthosis?

Answer 6

• osteophytes/spondylophytes
• non-uniform jt space loss
• subchondral sclerosis
• subchondral cysts
• joint mouse
• subluxation
• unilateral or bilateral

Question 7

What are subchondral cysts?

Answer 7

cracks/fissures filled with synovial fluid

Question 8

Spondylosis deformans is degeneration of the ____

Answer 8

annulus

Question 9

Intervertebral osteochondrosis is degeneration of the ____

Answer 9

nucleus pulposis

Question 10

What are the radiographic characteristics of spondylosis deformans?

Answer 10

• minimal disc space loss
• prominent osteophytes
• annular vacuum clefts

Question 11

What are the radiographic characteristics of intervertebral osteochondrosis?

Answer 11

• prominent loss of disc space
• minimal osteophytes
• nuclear vacuum phenomenon

Question 12

Where are annular vacuum clefts found?

Answer 12

at corners of endplates where annulus attaches

Question 13

Where is nuclear vacuum phenomenon found?

Answer 13

dark space in middle of disc space

Question 14

What question should you ask a patient who shows signs of spondylosis deformans?

Answer 14

any problems swallowing?
(spondylophytes can cause mechanical dysphagia)

Question 15

Annulus fibrosus is called ____

Answer 15

intercalary bones
(can also be an anomaly)

Question 16

What are 3 differential diagnoses for intercalary bones?

Answer 16

• limbus bone
• teardrop Fx
• normal secondary oss. center of vertebral endplate

Question 17

What may generate pain with disc degeneration?

Answer 17

• outer 1/3 annular fibers (where nn travel)
• vertebral endplates

Question 18

What are the clinical concerns of disc degeneration?

Answer 18

• pain
• altered biomechanics (modic changes)
• disc herniations
• neuro. implications (radiculopathy, myelopathy)

Question 19

What are modic changes?

Answer 19

changes in marrow of endplate in response to degenerative changes in adjacent discs

Question 20

An endplate appears dark on both T1 and T2 MRI. What type of modic change is this?

Answer 20

type 3

Question 21

An endplate appears bright on T1 and dark on T2 MRI. What type of modic change is this?

Answer 21

type 2

Question 22

An endplate appears dark on T1 and bright on T2 MRI. What type of modic change is this?

Answer 22

type 1

Question 23

An endplate appears bright on both T1 and T2 MRI. What type of modic change is this?

Answer 23

type 2

Question 24

What is the only type of modic change that is clinically significant?

Answer 24

type 1
(associated with discogenic Sx)

Question 25

Type 1 modic change represents replacement with ____

Answer 25

fibrovascular tissue

Question 26

Type 2 modic change represents replacement with ____

Answer 26

fatty tissue

Question 27

Type 3 modic change represents replacement with ____

Answer 27

bony sclerosis

Question 28

What radiographic sign is associated with type 3 modic change?

Answer 28

hemispheric spondylosclerosis

Question 29

What type of modic change is considered acute?

Answer 29

type 1

Question 30

What type of modic change is considered chronic?

Answer 30

type 2

Question 31

Annular fissures are also called ____ or ____

Answer 31

- annular tears - high intensity zones (HIZ)

Question 32

Where in the disc are annular fissures most commonly found?

Answer 32

posterior disc

Question 33

What are the 3 types of annular tears?

Answer 33

- transverse - concentric - radial

Question 34

What is the most common type of annular tear?

Answer 34

concentric

Question 35

What is the only type of annular tear that is important?

Answer 35

radial

Question 36

What part of the annulus is involved with a transverse tear?

Answer 36

peripheral annulus

Question 37

What is a transverse annular fissure?

Answer 37

represents a separation of disc insertion fibers (Sharpey's fibers) at the cartilaginous endplate

Question 38

How do transverse annular fissures appear radiographically?

Answer 38

seen as vacuum cleft (rarely seen on MRI)

Question 39

What is a concentric annular fissure?

Answer 39

vertically oriented separation between annular layers

Question 40

What is the clinical significance of a transverse annular tear?

Answer 40

none

Question 41

What is the clinical significance of a concentric annular tear?

Answer 41

none (no evidence of Sx)

Question 42

What is a radial annular fissure?

Answer 42

longitudinal fissuring extending from the nucleus through multiple layers of annulus

Question 43

What can happen to the nucleus with a radial annular fissure?

Answer 43

significant nuclear migration

Question 44

What is the clinical significance of radial annular fissures?

Answer 44

associated with symptoms of discogenic pain - growth of vascularized granulation tissue in tear - chemical and mechanical irritation to outer (innervated) portion of annulus

Question 45

What is the diagnosis? What are the radiographic findings associated with this condition?

Answer 45

Spondylosis deformans - prominent osteophytes - preserved disc space - annular vacuum clefts

Question 46

What is the diagnosis? What are the radiographic findings associated with this condition?

Answer 46

Intervertebral osteochondrosis (IVOC) - minimal osteophytes - loss of disc space - nuclear vacuum phenomenon

Question 47

What type of modic change is seen, and what does it represent?

Answer 47

Type 1 modic change = fibrovascular tissue

Question 48

What type of modic change is seen, and what does it represent?

Answer 48

Type 3 modic change = bony sclerosis

Question 49

What type of modic change is seen, and what does it represent?

Answer 49

Type 2 modic change = fatty tissue