Degenerative Spinal Disease (EDE). It includes a group of pathologies whose main symptom is chronic cervical, dorsal or lumbar pain. It is considered the leading cause of sick leave in industrialized countries and the second leading cause of consultation in primary care, only behind the common cold.
Summary
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- 1 Vertebral Joints
- 2 Main types of diseases
- 1 Cartilaginous joints (discovertebral junction)
- 2 Synovial joint
- 3 Fibrous joint and enthesis
- 3 Sources
Vertebral Joints
- Cartilaginous: intervertebral discs.
- Synovials: joints of the articular processes.
- Ligaments: Anterior Longitudinal Ligament, Posterior LL, L Yellow, L InterSpinous, L Supra Spinous, L Inter Transverse.
- Intervertebral Disc: The central portion of the intervertebral disc is called the nucleus pulposus, made up of fibrocartilage, and surrounded by a fibrous ring made of collagen and fibercartilage.
Towards the anterior, the fibrous ring joins a cartilaginous plate and the periosteum of the vertebral body through collagen fibers, the latter being thicker, called Sharpey fibers. The nutrition of the intervertebral discs depends on the diffusion of fluids from the vertebral bone marrow, or through the fibrous ring from the surrounding blood vessels.
- Of the Apophysis Art.:They have a synovial membrane, meniscus-like structures and a thin joint capsule.
- Ligaments: ALL: adherent to the anterior aspect of the vertebral bodies. It goes from the basilar process of the occipital to the sacrum.
LLP: adherent to the posterior aspect of the intervertebral discs and vertebral bodies. It runs from the anterior edge of the occipital foramen to the sacrum. LA: goes from the front and bottom edge of each sheet.
Main types of diseases
Cartilaginous joints (discovertebral junction)
- OsteochondrosisIntervertebral: It results from dehydration and decreased tissue resistance of the intervertebral disc, particularly in the nucleus pulposus. Unknown cause. Changes are seen in the nucleus pulposus, fibrous ring, and hyaline cartilage plate. The initial alteration consists of a lengthening of the nucleus pulposus, degeneration of the cartilaginous plate and a decrease in the density of the intervertebral disc, then a decrease in the disc space and bone sclerosis of the adjacent vertebral bodies (with the formation of small triangular osteophytes), which They may also contain radiolucent lesions of different sizes called Schmorl’s cartilaginous nodules. Inside the intervertebral disc, the vacuum phenomenon can be seen, a non-pathognomonic sign of IV osteochondrosis, but a sign of disc degeneration.
- Spondylosis Deformans: Characteristically form osteophytes , especially in the lateral and anterior sides of the vertebral body. More frequent in older adult men. Pathogenesis: alteration of the peripheral fibers of the fibrous ring as an initial factor, allowing anterior and anterolateral displacement of the disc that can lead to traction at the site of bone union of the fibers of the fibrous ring. Osteophytes develop a few mm from the discovertebral junction. Symptoms: Unclear, dysphagia, stiffness, decreased mobility, pain. The neurological deficit caused by this pathology is very rare.
- Axial Uncovertebral or Neurocentral Osteoarthritis: Pathology observed in the last five vertebral bodies (C3 to C7), where the uncovertebral joints are observed. When the disc degenerates, a progressive decrease of the intervertebral space occurs, causing the degeneration of the uncovertebral joints. Osteophytes are seen projecting from the posterior aspect of the vertebral body to the disc space and intervertebral foramen and later the nerve roots can be compromised.
Synovial joint
- Osteoarthritis of apophyseal joints: Pathology most frequently observed in the middle and lower cervical spine, upper and medial dorsal spine, and lower lumbar. Erosion of the articular cartilage, narrowing of the articular space, sclerosis and osteophytosis are observed. Capsular laxity leads to ligament alteration and subluxation of one vertebra over another, a phenomenon called pseudospondylolisthesis. Occasionally, joint ankylosis may also be seen. The rich innervation of the capsule and synovial membrane could explain the pain in some of these patients. In addition, spinal stenosis can be seen with compression of the spinal cord and its nerve roots resulting in pain, paresthesias, and paresis of the affected segments.
- Costovertebral osteoarthrosis: Pathology observed in the joints of the ribs with the vertebrae. More frequent in the 11 and 12 ribs.
- Osteoarthrosis of the lumbosacral joint: Congenital disorders of the lumbosacral joint are frequent. A neoarticulation can be observed between the transverse processes of the altered vertebra and the wings of the sacrum, or rarer with the iliac bone and which can be uni or bilateral. Joint space narrowing, sclerosis and osteophytosis, and occasionally bone ankylosis may be seen.
Fibrous joint and entheses
- Ligamentous degeneration: Ossification and calcification of almost all ligaments of the spinal column can be observed. Because ligaments are rich in nerve fibers, they are associated with pain and tenderness.
Excessive lordosis or decreased disc space leads to contact of the spinous processes and degeneration of the affected ligaments, with sclerosis and pain of the affected segment; phenomenon called Baastrup .
