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Atlas of Back Pain Editor by Ismail Jatoi, Manfred Kaufmann, Jean-Yves Petit

By Ismail Jatoi, Manfred Kaufmann, Jean-Yves Petit

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2002 CRC Press LLC Scheuermann’s disease is a condition of unknown etiology whereby there is progressive wedging of vertebrae with the appearance of endplate defects. Material from the intervertebral disc can herniate into the vertebral body, causing multiple level Schmorl’s nodes. As this progresses, there is an increase in the normal thoracic kyphosis. In a percentage of patients, this is asymmetric, causing a low degree of lateral scoliosis. Neurologic deficits, however, are unusual in this condition.

These changes are more clearly seen on post-discography CT scanning. Electrodiagnostic evaluation is often used to document injury or encroachment on the nerve roots or the spinal cord which occurs as a result of disc COMPRESSION FRACTURE A direct axial force applied to the spine, especially in flexion, can result in a collapse of the vertebral body. There is a disruption of the intrinsic bone structure, followed by edema and healing of the bone. If severe, these compression fractures can force spicules of bone or the entire vertebral body to move posteriorly, encroaching on the central canal or laterally encroaching on the neuroforamen.

Courtesy ChurchillLivingstone (Saunders) Press ©2002 CRC Press LLC T2 weighted MR sagittal image of the lumbar spine (a), demonstrating high-grade spinal stenosis at L2–L3, L3–L4 and L4–L5. The spinal fluid has a bright signal intensity and the compression of the intrathecal rootlets is apparent. On the axial T2 MR image (b), the central canal stenosis is caused by thickening of the posterior neural arch and ligamentum flavum, and overgrowth of the posterior facet joints. 5 Multiple-level degenerative lumbar spondylosis and spinal stenosis a b These images are from the same patient.

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