Skeletal Radiol (1990) 19:203-205
Skeletal Radiology
Spinal stenosis subsequent to juvenile lumbar osteochondrosis Kaj Tallroth, M.D., F.I.C.A. 1,, and Dietrich Schlenzka, M.D. 2 1 Department of Radiology and 2 Department of Orthopaedic Surgery, Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland
Abstract. This p a p e r describes eight p a t i e n t s w i t h spinal stenosis a s s o c i a t e d w i t h m a r k e d osteochondrous changes in the v e r t e b r a l b o d i e s d u e to j u v e n i l e l u m b a r o s t e o c h o n d r o s i s ( S c h e u e r m a n n ' s disease). In no case was the m i d s a g i t t a l o r i n t e r p e d i c u l a r d i a m e t e r o f the spinal c a n a l indicative o f b o n y stcnosis. O n the o t h e r h a n d , in the m y e l o g r a m s the sagittal d i a m e t e r o f the d u r a l sac was in all cases significantly n a r r o w e d , a d i a g n o s t i c sign o f c e n t r a l spinal stenosis. T h e r e f o r e , m y e l o g r a p h y s h o u l d a l w a y s be c o n t e m p l a t e d w h e n o s t e o c h o n d r o u s c h a n g e s are p r e s e n t a n d spinal stenosis is s u s p e c t e d clinically regardless o f w h e t h e r the spinal c a n a l d i a m e t e r s are n o r m a l in p l a i n films. K e y words: L u m b a r o s t e o c h o n d r o s i s M y e l o g r a p h y - S p i n a l stenosis
Radiology -
N a r r o w i n g o f the l u m b a r spinal c a n a l c a n be classified by the c o n s t i t u e n t s o f the wall ( b o n e o r soft tissue), the l o c a l i z a t i o n o f the stenosis (central o r lateral), o r the etiology. T h e m o s t c o m m o n etiologic t y p e is a c q u i r e d spinal stenosis w h i c h includes such c o n d i t i o n s as t r a u m a , severe k y p h o s i s o r scoliosis, s p o n d y l o l i s t h e s i s , P a g e t ' s disease, tabetic o s t e o a r t h r o p a t h y a n d a c r o m e g a l y as well as d e g e n e r a t i v e s p o n d y l o s i s a n d o s t e o a r t h r i t i s with ost e o p h y t e s a n d h y p e r o s t o s i s [2, 10, 11, 15, 19]. As far as we h a v e l e a r n e d f r o m l i t e r a t u r e surveys, j u v e n i l e lumb a r o s t e o c h o n d r o s i s has n o t b e e n d o c u m e n t e d as a cause o f o r p r e d i s p o s i n g f a c t o r in d e v e l o p m e n t a l spinal stenosis. In this p a p e r we p r e s e n t eight p a t i e n t s with a n a r r o w e d spinal c a n a l s u b s e q u e n t to j u v e n i l e l u m b a r osteoc h o n d r o s i s . F u r t h e r , we discuss the difficulties a s s o c i a t e d with p l a i n film d i a g n o s i s a n d the v a l u a b l e role o f m y e lography.
Material and methods From April 1985 to April 1989 we performed lumbar myelography on eight patients (all male, mean age 43.4 years, range 2%51 years) in whom the diagnosis was registered as spinal stenosis due to vertebral changes typical of juvenile lumbar osteochondrosis. The indications for myelography were sciatic syndrome in two patients and chronic lumbar pain in six. Spinal stenosis was suspected in five patients as a result of clinical examination and a history of bilateral, intermittent pain and claudication without signs of arterial insufficiency. After retrospective review of the plain radiographs and myelograms, the findings were classified and recorded. We assessed the number of vertebrae affected by osteochondrosis and showing elongated and wedge*shaped bodies and endplate depressions (Schmorl's nodes) as well as signs of central spinal stenosis. This assessment included measurement of the midsagittal diameter using the method originally described by Eisenstein [7, 8]. According to his experimental work, the posterior limit of the spinal canal from the first to the fourth lumbar vertebrae is located at the level of the cephalad half of the vertebral body on a line joining the apices of the superior and inferior articular facets. For the fifth lumbar vertebra, the posterior limit of the spinal canal is located just anterior to a well-demarcated radiolucent area in the spinous process. The interpedicular diameter is measured as the distance between the oval pedicles in the frontal radiograph. In this study, we noted common features of spinal stenosis: high, narrowed intervertebral windows; sagittally oriented, long intervertebral joints; and thickened, enlarged laminae. The diameters were measured in millimeters and adjusted by a geometrical magnification factor of 0.82. A midsagittal diameter __
Skeletal Radiology
Spinal stenosis subsequent to juvenile lumbar osteochondrosis Kaj Tallroth, M.D., F.I.C.A. 1,, and Dietrich Schlenzka, M.D. 2 1 Department of Radiology and 2 Department of Orthopaedic Surgery, Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland
Abstract. This p a p e r describes eight p a t i e n t s w i t h spinal stenosis a s s o c i a t e d w i t h m a r k e d osteochondrous changes in the v e r t e b r a l b o d i e s d u e to j u v e n i l e l u m b a r o s t e o c h o n d r o s i s ( S c h e u e r m a n n ' s disease). In no case was the m i d s a g i t t a l o r i n t e r p e d i c u l a r d i a m e t e r o f the spinal c a n a l indicative o f b o n y stcnosis. O n the o t h e r h a n d , in the m y e l o g r a m s the sagittal d i a m e t e r o f the d u r a l sac was in all cases significantly n a r r o w e d , a d i a g n o s t i c sign o f c e n t r a l spinal stenosis. T h e r e f o r e , m y e l o g r a p h y s h o u l d a l w a y s be c o n t e m p l a t e d w h e n o s t e o c h o n d r o u s c h a n g e s are p r e s e n t a n d spinal stenosis is s u s p e c t e d clinically regardless o f w h e t h e r the spinal c a n a l d i a m e t e r s are n o r m a l in p l a i n films. K e y words: L u m b a r o s t e o c h o n d r o s i s M y e l o g r a p h y - S p i n a l stenosis
Radiology -
N a r r o w i n g o f the l u m b a r spinal c a n a l c a n be classified by the c o n s t i t u e n t s o f the wall ( b o n e o r soft tissue), the l o c a l i z a t i o n o f the stenosis (central o r lateral), o r the etiology. T h e m o s t c o m m o n etiologic t y p e is a c q u i r e d spinal stenosis w h i c h includes such c o n d i t i o n s as t r a u m a , severe k y p h o s i s o r scoliosis, s p o n d y l o l i s t h e s i s , P a g e t ' s disease, tabetic o s t e o a r t h r o p a t h y a n d a c r o m e g a l y as well as d e g e n e r a t i v e s p o n d y l o s i s a n d o s t e o a r t h r i t i s with ost e o p h y t e s a n d h y p e r o s t o s i s [2, 10, 11, 15, 19]. As far as we h a v e l e a r n e d f r o m l i t e r a t u r e surveys, j u v e n i l e lumb a r o s t e o c h o n d r o s i s has n o t b e e n d o c u m e n t e d as a cause o f o r p r e d i s p o s i n g f a c t o r in d e v e l o p m e n t a l spinal stenosis. In this p a p e r we p r e s e n t eight p a t i e n t s with a n a r r o w e d spinal c a n a l s u b s e q u e n t to j u v e n i l e l u m b a r osteoc h o n d r o s i s . F u r t h e r , we discuss the difficulties a s s o c i a t e d with p l a i n film d i a g n o s i s a n d the v a l u a b l e role o f m y e lography.
Material and methods From April 1985 to April 1989 we performed lumbar myelography on eight patients (all male, mean age 43.4 years, range 2%51 years) in whom the diagnosis was registered as spinal stenosis due to vertebral changes typical of juvenile lumbar osteochondrosis. The indications for myelography were sciatic syndrome in two patients and chronic lumbar pain in six. Spinal stenosis was suspected in five patients as a result of clinical examination and a history of bilateral, intermittent pain and claudication without signs of arterial insufficiency. After retrospective review of the plain radiographs and myelograms, the findings were classified and recorded. We assessed the number of vertebrae affected by osteochondrosis and showing elongated and wedge*shaped bodies and endplate depressions (Schmorl's nodes) as well as signs of central spinal stenosis. This assessment included measurement of the midsagittal diameter using the method originally described by Eisenstein [7, 8]. According to his experimental work, the posterior limit of the spinal canal from the first to the fourth lumbar vertebrae is located at the level of the cephalad half of the vertebral body on a line joining the apices of the superior and inferior articular facets. For the fifth lumbar vertebra, the posterior limit of the spinal canal is located just anterior to a well-demarcated radiolucent area in the spinous process. The interpedicular diameter is measured as the distance between the oval pedicles in the frontal radiograph. In this study, we noted common features of spinal stenosis: high, narrowed intervertebral windows; sagittally oriented, long intervertebral joints; and thickened, enlarged laminae. The diameters were measured in millimeters and adjusted by a geometrical magnification factor of 0.82. A midsagittal diameter __
