X-Ray: Osteosclerotic spine

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X-Ray: Osteosclerotic spine

  1. 1. Prof. P.Vijayaraghavan’s unit Dr. Karthikeyan.S
  2. 6. X-RAY Findings <ul><li>Multiple osteophytes seen. </li></ul><ul><li>Subchondral sclerosis. </li></ul><ul><li>Intervertebral disc calcification. </li></ul><ul><li>Gas noted in the intervertebral space.(vacuum phenomena). </li></ul><ul><li>Diffuse narrowing of disc space. </li></ul>
  3. 8. <ul><li>Vacuum sign of knuttsen . </li></ul><ul><li>Early radiologic finding. </li></ul><ul><li>Collection of N2 in nuclear and annular fissures. </li></ul><ul><li>Present as a area of linear lucency. </li></ul><ul><li>Sign of disc aging /degeneration. </li></ul>
  4. 9. <ul><li>IMPRESSION: </li></ul><ul><li>Secondary Degenerative Joint Disease. </li></ul>
  5. 10. <ul><li>Differential Diagnosis : </li></ul><ul><li>Ochronosis </li></ul><ul><li>Gout </li></ul><ul><li>Calcium Pyro Phosphate Disease </li></ul><ul><li>Hyperparathyroidism </li></ul><ul><li>Ankylosing Spondylitis </li></ul><ul><li>DISH </li></ul><ul><li>Fluorosis </li></ul>
  6. 11. DIFFERENTIAL DIAGNOSIS <ul><li>Ochronosis </li></ul><ul><li>Radiological Finding- </li></ul><ul><li>Universal disc calcification and subchondral sclerosis </li></ul><ul><li>Universal disc thinning/degenerative changes. </li></ul><ul><li>Increased kyphosis and lordosis. </li></ul><ul><li>Small osteophytes. </li></ul><ul><li>Calcification of interspinous ligament </li></ul><ul><li>Vertebral fusion. </li></ul>
  7. 12. <ul><li>Gout </li></ul><ul><li>75% of patients c/o back pain. </li></ul><ul><li>Spine involvement - less common .Cervical spine involvement more. </li></ul><ul><li>End plate erosion/ osteophytes. </li></ul><ul><li>Annular calcification/posterior apophyseal degeneration. </li></ul>
  8. 13. <ul><li>CPPD </li></ul><ul><li>Haemochromatosis / Wilsons disease. </li></ul><ul><li>Spine involvement relatively infrequent. </li></ul><ul><li>Calcification of annulus. </li></ul><ul><li>Vertebral body sclerosis. </li></ul><ul><li>Osteophytes. </li></ul><ul><li>Loss of disc space/ vaccum phenomena. </li></ul>
  9. 14. <ul><li>Hyperparathyroidism. </li></ul><ul><li>Nuclear pulposus, annular fibrous calcification. </li></ul><ul><li>Rugger jersy spine. </li></ul><ul><li>Trabecular pattern accentuated. </li></ul>
  10. 15. <ul><li>Ankylosing spondylitis- </li></ul><ul><li>Sacro iliac involvement is the hallmark. </li></ul><ul><li>Thoroco lumbar spine is the earliest involved. </li></ul><ul><li>Disc changes include annular ossification. </li></ul><ul><li>Romanas lesion -Discrete radiolucent Vertebral body corner erosion is earliest. </li></ul><ul><li>Vertebral body contour lost square shaped Bamboo spine. </li></ul><ul><li>Ossification of interspinous/supraspinous ligament- Dagger sign. </li></ul>
  11. 16. <ul><li>DISH- Diffuse Idiopathic Skeletal Hyperostosis </li></ul><ul><li>Calcification and later ossification of ALL of four or more vertebrae. </li></ul><ul><li>Flowing wax sign. </li></ul><ul><li>Disc space is preserved </li></ul>
  12. 17. <ul><li>Fluorosis </li></ul><ul><li>Spine involvement common. </li></ul><ul><li>Osteopenia followed by hyperostosis . ligament calcification present. </li></ul><ul><li>No disc calcification ,space is maintained. </li></ul>
  13. 18. Thank you Thank you

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