Destructive discovertebral degenerative disease of the lumbar spine

Charran, A.; Tony, G.; Lalam, Radhesh; Tyrrell, P. N. M.; Tins, Bernhard; Singh, Jaspreet; Eisenstein, S. M.; Balain, Birender; Trivedi, Jayesh; Cassar‐Pullicino, Victor N.

doi:10.1007/s00256-012-1446-x

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…While this pathologic condition was first described for the hip joint already in 1959 [ 5 ], very little research has been done around the topic, and even less so in spine setting, with the present case being the first one of spinal RDOA reported in the literature. While eight cases of “destructive discovertebral disc disease” have been observed in a previously published paper, the lack of rapid destruction and the presence of comorbidities such as advanced osteoporosis, rheumatoid arthritis or breast cancer in this patient cohort suggest that this case represents a different pathologic entity from the ones already reported [ 6 ].…”

Section: Discussionmentioning

confidence: 71%

Rapidly destructive osteoarthritis of the spine: lessons learned from the first reported case

Baroncini

Berjano

Migliorini

et al. 2022

BMC Musculoskelet Disord

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Background Rapidly Destructive Osteoarthritis (RDOA) has been described for the hip and shoulder joints and is characterized by a quickly developing bone edema followed by extensive remodeling and joint destruction. Confronted with a similarly evolving case of endplate edema and destruction of the disk space, we offer the first described case of spinal RDOA and illustrate the challenges it presented, along with the strategies we put in place to overcome them. Case presentation We present a case of spinal RDOA that, also due to the delay in the diagnoses, underwent multiple revisions for implant failure with consequent coronal and sagittal imbalance. A 37-years-old, otherwise healthy female presented with atraumatic low back pain: after initial conservative treatment, subsequent imaging showed rapidly progressive endplate erosion and a scoliotic deformity. After surgical treatment, the patient underwent numerous revisions for pseudoarthrosis, coronal and sagittal imbalance and junctional failure despite initially showing a correct alignement after each surgery. As a mechanic overload from insufficient correction of the alignement of the spine was ruled out, we believe that the multiple complications were caused by an impairment in the bone structure and thus, reviewing old imaging, diagnosed the patient with spinal RDOA. In case of spinal RDOA, particular care should be placed in the choice of extent and type of instrumentation in order to prevent re-intervention. Conclusion Spinal RDOA is characterized by a quickly developing edema of the vertebral endplates followed by a destruction of the disk space within months from the first diagnosis. The disease progresses in the involved segment and to the adjacent disks despite surgical therapy. The surgical planning should take the impaired bone structure account and the use of large interbody cages or 4-rod constructs should be considered to obtain a stable construct.

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Section: Discussionmentioning

confidence: 71%

Rapidly destructive osteoarthritis of the spine: lessons learned from the first reported case

Baroncini

Berjano

Migliorini

et al. 2022

BMC Musculoskelet Disord

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“…A diffuse pattern of disc calcification must raise suspicion for a systemic disorder causing metabolic calcifications (calcinosis) or very rarely ochronosis. A destructive spondyloarthropathy caused by crystals will typically lack osteopenia and rather show dense sclerosis and eburnation with disc space narrowing [ 31 ]. It can be associated with malalignment, subchondral fracture and “bone sand” as described by Charran et al [ 31 ].…”

Section: Second Step: What Is the Exact Location?mentioning

confidence: 99%

“…A destructive spondyloarthropathy caused by crystals will typically lack osteopenia and rather show dense sclerosis and eburnation with disc space narrowing [ 31 ]. It can be associated with malalignment, subchondral fracture and “bone sand” as described by Charran et al [ 31 ]. It can mimic infectious discitis, neuroarthropathic change, gout-related and haemodialysis-related spondyloarthropathy.…”

Section: Second Step: What Is the Exact Location?mentioning

confidence: 99%

Radiological identification and analysis of soft tissue musculoskeletal calcifications

2018

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Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith).Teaching Points• Calcifications have to be differentiated form ossification and foreign body.• A musculoskeletal MRI study must always be correlated with a radiograph.• The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma.• HADD and CPPD crystal deposition have a distinct appearance on radiograph.• Calcinosis is more frequently caused by chronic renal failure and scleroderma.

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“…Similar rapidly destructive arthropathies have been described in the knee, [19][20][21] shoulder (Milwaukee shoulder syndrome) 22,23 and lumbar spine. 24 Their association with subchondral insufficiency fractures have been well described. 20,[25][26][27][28] In our clinical experience, overlapping features of Charcot arthropathy and RPOA were observed, including key pathologic features.…”

Section: Introductionmentioning

confidence: 99%

Overlapping features of rapidly progressive osteoarthrosis and Charcot arthropathy

Sono

Meyers

Miller

et al. 2019

Journal of Orthopaedics

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Nerve growth factor (NGF) is the primary neurotrophin in the skeleton and a central mediator of skeletal pain. Recent trials of anti-NGF neutralizing antibodies have resulted in infrequent but well-described incidence of rapidly progressive osteoarthrosis (RPOA). Neuropathy, whether from syphilis or diabetes, is also associated with severe joint destruction, known as neuroarthropathy or Charcot joint. These commonalities of severe joint destruction with either loss of a neurotrophin (anti-NGF) or a deficit of functional skeletal innervation led us to examine our institutional case files for potential radio-pathologic overlap between RPOA and Charcot joint.

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Destructive discovertebral degenerative disease of the lumbar spine

Cited by 10 publications

References 16 publications

Rapidly destructive osteoarthritis of the spine: lessons learned from the first reported case

Rapidly destructive osteoarthritis of the spine: lessons learned from the first reported case

Radiological identification and analysis of soft tissue musculoskeletal calcifications

Overlapping features of rapidly progressive osteoarthrosis and Charcot arthropathy

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