Therefore, I suggest using the term “degenerative disk disease” in one’s dictations to refer to these entities. It usually doesn’t make a lot of difference to the referring clinician which component of the disk has degenerated. In practice, one often sees evidence of degeneration of both the annulus and the nucleus.

With increasing age (arrow), progressive degeneration of the annulus leads to increasing osteophytosis at the disk space margins - the height of the disk space is largely preserved

The clinicians know what I’m describing and they and their patients are not unduly frightened by the unfamiliar terminology used for this very familiar process. Therefore, I prefer to state “marginal osteophytes are noted at multiple disc spaces in the spine” in my dictations. Using these terms in a film report can lead to calls from clinicians wondering just what horrible disease their patients have. However, both of these terms tend to make the disease sound a lot worse than it really is. In the literature, this entity has been termed “spondylosis deformans” or “senile ankylosis”. This leads to marginal osteophytosis at the endplates, especially in the thoracolumbar spine in many persons over 50 years of age. Yet another extremely common degenerative disorder involves degeneration of the annulus fibrosus. With increasing age (arrow), progressive degeneration of the nucleus leads to decreasing disk space height As the disc space decreases in height, increased stress is also placed on the facet joints, leading to the frequent association of osteoarthritis of the facets at the same level. When this happens, the altered pattern of stresses may lead to marginal osteophytosis adjacent to the affected endplates. As this happens, the intervertebral disc height begins to decrease. With age, the nucleus tends to become more and more dehydrated, and gradually begins to degenerate. Marked osteophytosis and joint space narrowing is noted in the facet joints in this patient with severe osteoarthritis of the lumbar spine - the osteophytosis is causing significant encroachment on the lateral recesses bilaterallyĪnother very common disorder is degeneration of the nucleus pulposus. Osteoarthritis may be primary or secondary. In the spine, therefore, osteoarthritis occurs in the apophyseal (facet) joints, the uncovertebral joints (cervical spine), the costovertebral joints, and the sacroiliac joints. By definition, osteoarthritis occurs in a synovial joint.

This is, by far, the most common type of arthritis seen in humans.

However, the same basic logical principles mentioned in the last chapter also apply here. The different anatomy and physiology of these joints means that we will see different disorders affecting this part of the skeleton. The cartilaginous endplate, the annulus fibrosus, and the nucleus pulposus are analogous to the articular cartilage, the joint capsule and the synovial fluid of the synovial joint. However, there are several structures in the intervertebral disc joint which are analogous to structures found in a true synovial joint. aphophyseal) joints and portions of the sacroiliac joints), there are also many amphiarthrodial joints which are not synovial (the intervertebral disc joints). While this type of joint is also found in the axial skeleton (the facet (a.k.a. In the appendicular skeleton, one is mostly concerned with the diarthrodial synovial joints.

Degenerative osseous changes