Coloana vertebralaPatologie degenerativa2013Patologie discala degenerativaDiscul intervertebral alcatuit din: Nucleu pulpos, moale (masa centrala moale semigelatinoasa,) inconjurat de nelul !bros consistenta "erma (lamele concentrice !brocartilaginoase)Patologie discala degenerativa #"ectea$a discul intervertebral Disculintervertebral"unctionea$acaostucturaantioc %amorti$ea$asolicitarilemecaniceproduseasupracoloanei vertebrale in timpulmiscarilor comple&e ale corpului, mentinand stabilitatea acesteia 'data cu inaintarea in varsta % discul se des(idratea$a progresiv si se subtia$a, isi pierde elasticitatea si implicit % )e&ibilitatea*devenind o masa rigida, care restrictionea$a miscarile% durere + ntimpulproceselordedegenerare,disculintervertebralpoate su"erimaimultetipuridemodi!cari%poatebombaina"ara (bulging), (ernia sau se subtia$a ,odi!carilordiscalesitotodataalespatiuluiintervertebral,care se reduce:potconducelade$voltareaosteoftozei,inscopulcresterii stabilitatii coloanei vertebrale la acel nivel, sipotprovocastenozadecanalspinal,compresiemedularasi radiculara,spondilolisteza(aluneareaant-).retroliste$adisculuisicorpului vertebralPentru e&empli!care:Patologie discala degenerativaPierdereainaltimiidisculuiintervertebralseasociazacumodificaride osteoartrita, dintrecare,de$voltareaosteo!telorosteo!telorcurolinmentinereastabilitatii coloanei vertebrale la acel nivelPatologie discala degenerativa /egenerarea discului intervertebral poate !:consecinta !$iologica a inaintarii in varsta sausecundaraunorprocesepatologicediscale(traumatisme acute.cronice, in"ectii) ,odi!cariledegenerativediscalepotinteresaunul.maimulte discuri intervertebrale si pot ! intalnite la orice nivel al coloanei vertebrale, dar mai "recvent lombar inferior si cervical Peste 001 din procesele degenerative discale apar la nivel 2345 sau 25461 si debutea$a in general in decada a 34a sau a 34a de varsta 2adebut,seproduceomicaruptura.!suraininelul!brosal discului intervertebral %ceea ce poate produce durere +7uptura inel !bros 8(ttp:..999-spine4(ealt(-com.video.degenerative4disc4disease4interactive4videoPatologie discala degenerativa:indecarearupturiidiscale% tesutcicatricial,darnula"elde puterniccomparativcutesutul !brocartilaginosoriginaln timp, va ! le$at si nucleul pulpos central,caresevades(idratala randul sau si va deveni insu!cient, se vade"ormaprabusindu4sediminuarea spatiuluiintervetrebralintrecele2vertebre supra-sisubiacenta,sidezalinierea suprafetelor articulare intervertebralePatologie discala degenerativa /e$aliniereasupra"etelorarticulare intervertebraleCutimpul,aceasta po$itiene!reascaa vertebrelor%va determinaaparitia osteo!telor(pinteni ososi)care,dacase de$voltasprecanalul spinal%vorproduce steno$adecanalspinal si,inconsecinta, compresieconsecutiva medulara si radiculara#plati$area ()attening) disculuiPatologie discala degenerativa6imptomatologie: /urerelocalarecurenta,rigiditate,miscarilimitatemaiales inregiuneain"erioaraacoloaneivertebrale,"esierasauin membrelein"erioare,accentuatedeanumitemiscaricum sunt )e&ia brusca, rasucirea saupo$itia se$anda indelungata n pre$enta herniei de disc intervertebral pacientul acuza dureri in picior, abdomen sau genunchi, corespondente radacinii nervoase afectate po$itia culcata diminuea$a durereaPatologie discala degenerativanvestigatiaimagisticadeelectie(goldstandard),care evidentia$amodi!cariledegenerativeincipiente(e&- des(idratarea discala) %IRM maginea radiografca: ingustarea spatiului articular intervertebralosteo!to$a 7adiogra!ilee"ectuateinpo$itiede)e&ie4e&tensie,pot! utilepentruevidentiereainstabilitatiicoloaneivertebrale% arata, de obicei,modi!cari survenite la varste mai inaintate;des(idratareadiscalava!urmatade:ingustareaspatiului articular intervertebral;c(iardacasimptomatologianuestepre$enta,persoanele tinere cu varsta de 20430 ani pot pre$enta modi!carile discale pre$entate mai susPatologie discala degenerativaRTG % degenerare discala severa 25461, cu: ingustarea accentuata a spatiului intervertebral condensarea platourilor vertebralesi osteo!to$a anterioara pronunSectiunesagitala IRM T2W arata aspectul normal al semnalului corpului vertebral si al discului intervertebralmagine =1> cusaturatie de grasime: aspect normal al disculuiPatologie discala degenerativa /egenerearea discalaincipienta incipienta, corespun$atoare proceselor de des(idratare se traduce 7, prin % diminuarea, urmata de pierderea (in "a$ele avansate avansate)semnalului normal (iperintens in secventele =2 poderate % discul apare in (iposemnal =2> (? blac@ discA) BisurileradiareBisurileradiaredelanivelulinelului!brosproducsemnaleliniare (iperintense=2,binevi$ibileinsectiunilesagitaleCsemnalul (iperintenssedatorea$aaparitieitesutuluidegranulatielanivelul rupturii /atoritale$ariiinelului!brosseconstata%reducereainaltimii inaltimiisi protru$ie protru$iediscalaposterioara,maialeslapacientiicuvarstaD50 ani (2, 3 /isculdegeneratpoatecontineacumulariga$oase(a$ot)inariile !surate,cuapectde?viddiscalAsau?vacuump(enomenonA ?vacuump(enomenonA, semnpatognomonicpentrudegenerareadiscala,mai"recvent lombarsicervical,cu(iposemnal7,accentuatCga$ulpoate! intalnitsiintr4un"ragmentdiscal(erniarsauintr4o(erniediscala intraspongioasaPatologie discala degenerativa#)-7, plan sagitalSTIR (s(ort =1 inversion recoverF),(3): linieori$ontalain(iposemnal%!suri!suriininteriorulnucleului pulpossageataalbagroasa(modi!caridegenerative incipiente) 'datacuevolutiaprocesuluidegenerativ%distinctiaintre nucleulpulpossiinelul!brosestemaievidenta(capde sageata)Procesul degenerativ mai avansat % disc complet (ipointens (sageata alba subtire)G)-7,plansagitalpeliniamediana=2>cusaturatiede grasime:/egenerarediscalaavansatavi$ibilalanivelemultiple% (iposemnaluni"ormaldiscurilorsireducereainaltimii acestora (sageti albe subtiri)C osteo!te osteo!te semnal similar cu al osului spongios vertebralPatologie discala degenerativa(3) 7uptura 7upturaineluluiinelului !bros:(#)6ectiunesagitala7,T1>49eig(ted(ponderate) "atsat, postcontrast i-v-(gadolinium subs-c- paramagnetica) %pri$adecontrast4(ipersemnal(sageataalba)a traiectului de ruptura (peri"eric 4 inelulinelul !bros)(G)6ectiunesagitalaT2>"atsat("atsaturation)altca$ rupturaposterioara a fibrelor externe ale inelului fibros (sageata rosie) hipersemnal (tesutul de granulatie )Patologie discala degenerativa7,: Protru$ii Protru$ii discale (sageti)7, 4degenerarediscala lombara cu: protru$ie consecutiva si steno$a usoarasteno$a usoara de canal spinalPatologie discala degenerativaPatologie discala degenerativaCT6agital:spondilo$alombarain"- cu reducerea spatiului intervertebral si ?vacuump(enomenonA(2345si25461)modi!caridegenerativeavansate ale"aetelorarticulare;erosiunesi osteosclero$a "aetei articulare dr (25461) 4 sageataIRM: ?vacuum?vacuum p(enomenonA p(enomenonA si ero$iuni marginale ale platourilor vertebralePatologie degenerativa vertebrala: modi!carile 7, ale intensitatii semnalului la nivelul platourilorplatourilor vertebralevertebrale adiacente degenerarii discale'datacualterareadisculuiintervertebral%seproducmodi!cari distructivesiintesutulcartilagionssituatintrediscsiplatoul vertebral adiacent-,odi!carileosoasedegenerative osoasedegenerativeasociateproceselordegenerative discale, respectiv aletesutului spongios subcondral invecinat au "ost clasi!cate de Modic in 3 tipuri:tipulI:edemulosossiprocesulreactivin)amatorgranulomatos acut.subacut delanivelul platourilor vertebrale %(iposemnal =1 si (ipersemnal=2Cpoatepre$entapri$adecontrastin=1>-Procesul poate ! reversibil.evoluea$a spre tipul 4deasemenea,pot!pre$ente(erniidiscalemiciintraspongioase (protru$ii)inplatourilevertebraleadiacenteosteoporo$ate,uneori multiple% nodulii 6c(morlnodulii 6c(morl tipulII:proli"eraregrsoasamedularaosoasa,ireversibila% (ipersemnal =1 si =2tipulIII:distrugereamaduveiosoaseadiacentdegenerescentei discale,modi!carilefbroase,scleroticeosoasedeterminand %(iposemnal =1 si =2Patologie discala degenerativa: nodulii 6c(morlRtg imagine radiogra!ca a nodulilor 6c(morl la nivel lombarNodulii6c(morlNodulii6c(morl%mici(erniidiscaleverticalein$oneledere$istenta sca$uta ale platourilor vertebrale pot ! decelatiodata cu inaintarea in varsta, dar pot apare si latineri! in cadrul osteonecro$ei aspetice 6c(euermann (osteocondrita juvenila)pot!vi$ibiliperadiogra!i,darmaialesC=sau7,%hiposemnal!2; determinareactiein)amatorieosoasa,cupri$adecontrasti-v-in secventele 7, =1 ponderate Pot ! sau nu simptomatici, provocand durere localaPatologie degenerativa vertebrala: ca$uri diverseca$uri diverse,odi!cari degenerative ale platourilor vertebrale platourilor vertebrale: #)47,sagital =2> "atsat si G) 4 sagital =1> : Modic tip II (proli"erare grasoasa) % (ipersemnal =2 (#) si =1(G)la nivel 2345 (sageti subtiri) Modic tip I % (ipersemnal =2 (#) si (iposemnal =1(G) la nivelul platoului in"erior 25 si platoului superior 61(sageti groase)Patologie degenerativa vertebrala: ca$uri diverse ca$uri diverse Modic III (7,, =1 si 6=7): reducerea intensitatii semnalului la nivelul platourilor vertebraleplatourilor vertebrale adiacente degenerarii discale (iposemnal 23425Patologie discala degenerativa: calci!cari disc intervertebralcalci!cari disc intervertebral/egenerareadisculuiintervertebral,pelanga modi!carileamintiteanterior,presupunesi calci!cari calci!cariintradiscale,deobiceilanivelulinelului !brossimairaralenucleuluipulpos-/iagnosticul di"erential%bolimetabolice(guta,diabet, (iperparatiroidism)Patologie discala degenerativa: ca$uri diverseca$uri diverseCalci!care discalaCalci!care discala(3)4 bibliogra!eRtg "": usoara rectitudine a coloanei cervicale usoara reducere a inaltimii corpilor vert- C5 si CH C54CH% densitate calcara central sila marginea posterioara a spatiului intervertebralCT sectiune a#iala:con!rma calci!care nucleului pulpos (erniat post4lat dr-IRM: reducerea semnalului *discului intervertebral C54CH in =1 si =2- sectiuni a&iale si sagitale % contactcu radacina nervoasa CH dr- ingustare canal spinal pe dreapta si compresia dureisi maduvei spinariiPatologie discala degenerativa : ca$uri ca$uri diversediverse(3) Ci"o$aCi"o$a degenerativa 4 7, sagital =14 la nivel toracic mijlociu:reducereaanterioaraininaltimeadisculuiintervertebral, determinand % ci"o$acrestereaanterioaraaIant4postvertebrallaacestnivel%este sec- modi!carilor cronice de remodelare vertebralaPatologie discala degenerativa6colio$a degenerativa: 6colio$a degenerativa: estesec-proceselordegenerativediscale,caredetermina dezaliniereacorpilorvertebralisiproducedurerilocale"membreinf provocate de contracturile muscularePatologie discala degenerativa6colio$a degenerativa:6colio$a degenerativa: (#)7econstructieCTinplan coronal:scolio$asinistro4conve&alombar in"erior (sageti albe)asimetriediscaladegenerativa(sageti negre) osteofitozalateralamarcata(capsageata neagra)spondiloliste$alateraladreapta 2343 (parante$a alba)(B)7econstructieCTinplan sagital:pierderealordo$eilombare (sageti albe)degenerarediscalaseverala nivele multiple (sageti negre)'steo!to$aanterioara proeminenta (cap sageata)Patologie discala degenerativa 6pondiloliste$a:6pondiloliste$a:de$aliniereprinalunecarea.deplasareaunuicorp vertebral"aadecelimediatsubiacentdeterminandinstabilitatesicompresie radiculara (impingement oc, izbire)6pondiloliste$aJtiologie: congenitala (6pina Gi!da 'culta), traumatica, degenerativa, neopla$ica(metasta$e), in"ectioasa 6unt descrise mai multe stadii evolutive: 0 Normal6tadiul 1: sub 2516tadiul 2: 2545016tadiul 3: 6tage 51 to K516tadiul 3: 6tage KH to 1001 Patologie degenerativa vertebrala: Procese degenerative ale "a "aeiping 7ong, GNC aianming Pan, ,/C 2in bu, ,/- Single2level Calcifed Cervical Dis7 +erniation in a 1829ear2old Girl'rt(opedics2012 4 :olume 35 c ssue Q: e120K4e1301- /': 10-302Q.013KK33K420120K254305- 'steoart(ritis- /iagnosis and ,edical- 6urgical ,anagement- #ut(ors: ,os@o9it$ 7->-, Loldberg :-,-, Uoc(berg ,-C- Publis(ed Fear: 200KPages: 1541H.10H- C(en CZ, be( 2, 7esnic@ / et4al- ntraspinal posterior epidural cFsts associated 9it( Gaastrupds disease: report o" 10 patients- #[7 #m [ 7oentgenol- 2003C1Q2 (1): 10143- #[7 #m [ 7oentgenolK- Carlens C, Uergens ,P, Lrune9ald [, J@bom #, J@lund #, Uoglund C', et al- 6mo@ing, use o" moist snu^, and ris@ o" c(ronic in)ammatorF diseases- m ! "espir #rit #are $ed- [un 1 2010C1Q1(11):121K422- e,edlinef- Q- Garton #, >ort(ington [- Lenetic susceptibilitF to r(eumatoid art(ritis: an emerging picture- rthritis "heum- 'ct 15 2000CH1(10):13314H- e,edlinef0- Pra@@en G, #lbani 6, ,artini #- [uvenile idiopat(ic art(ritis- %ancet- [un 2011C3KK(0KQ3):213Q430- e,edlinef- 10- Uin@s #, Ze a, Garton #, JFre 6, Go9es [, >ort(ington [- #ssociation o" t(e 227#.C/25 gene 9it( juvenile idiopat(ic art(ritis- rthritis "heum- [an 2000CH0(1):2514K- e,edline11- van der Ueijde /,- 7adiograp(ic imaging: t(e ggold standardd "or assessment o" disease progression in r(eumatoid art(ritis- "heumatolog& ('xford)- [un 2000C30 suppl 1:041H- e,edlinef- 12- =an bZ, Conag(an PL- maging in r(eumatoid art(ritis- Best Pract "es #lin "heumatol- #ug 2011C25(3):5H04Q3- e,edlinef-13- >ells #B, Uaddad 7U- Jmerging role o" ultrasonograp(F in r(eumatoid art(ritis: optimi$ing diagnosis, measuring disease activitF and identi"Fing prognostic "actors- (ltrasound $ed Biol- #ug 2011C3K(Q):11K34Q3- e,edlinef- 13- Gruno ,#, >a@e!eld 7[- #rt(ritis in Color: #dvanced maging o" #rt(ritis- n: #hapter )* (ltrasound of rheumatoid arthritis+ ,n* Bruno $, $osher -!, .old ./, eds- P(iladelp(ia, P#: 6aunders4JlsevierC 2000:0H4122- 15- C(eung PP, /ougados ,, Lossec 2- 7eliabilitF o" ultrasonograp(F to detect sFnovitis in r(eumatoid art(ritis: a sFstematic literature revie9 o" 35 studies (1,315 patients)- rthritis #are "es (0obo1en)- ,ar 2010CH2(3):323433- e,edlinef-1H- Garlo9 /P- Lenomic imprinting: a mammalian epigenetic discoverF model- nnu "ev .enet- 2011C35:3K04303- 1K- Uitc(on C#, C(andad B, Berucci J/, et al- #ntibodies to porp(Fromonas gingivalis are associated 9it( anticitrullinated protein antibodies in patients 9it( r(eumatoid art(ritis and t(eir relatives- ! "heumatol- [un 2010C3K(H):1105412- e,edlinef- 1Q- 7outsias [L, Loules [/, Loules #, C(aralampa@is L, Pi@a$is /- #utopat(ogenic correlation o" periodontitis and r(eumatoid art(ritis- "heumatolog& ('xford)- [ul 2011C50(K):11Q0403- e,edlinef- 10- Lremese J, 6alah B, Gosello 62, et al- :erF earlF r(eumatoid art(ritis as a predictor o" remission: a multicentre real li"e prospective studF- nn "heum 2is- [ul 13 2012Ce,edlinef-20- Pra@@en G, #lbani 6, ,artini #- [uvenile idiopat(ic art(ritis- %ancet- [un 2011C3KK(0KQ3):213Q430- e,edlinef- 21- #(lmin ,, 6vensson G, #lbertsson Z, Borslind Z, Ua"strjm - n)uence o" gender on assessments o" disease activitF and "unction in earlF r(eumatoid art(ritis in relation to radiograp(ic joint damage- nn "heum 2is- [an 2010CH0(1):23043- e,edlinef- 22- Z(an ,#- Spdate on spondFloart(ropat(ies- nn ,ntern $ed- [un 1Q 2002C13H(12):Q0H400K- e,edlinef- Gibliogra!e 4continuare23- ,cLonagle /, Libbon >, JmerF P- Classi!cation o" in)ammatorF art(ritis bF ent(esitis- %ancet- 'ct 3 100QC352(0133):113K430- e,edlinef- 23- ndra ,i(aita, 2igia 'pris- Patologie degenerativa discala si vertebrala-in 7, vertebro4medular-#rta Lra!ca,Gucuresti- 2001:5Q4H025- /e #ngelis 7, 6alah B, Lrassi >- Prevalence o" spondFloart(ropat(ies in an talian population sample: a regional communitF4based studF- 3cand ! 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"heumatol- [ul 200KC33(K):15H145- e,edlinef- 3H- ,a@sFmo9Fc( >P, C(io9c(an9isa9a@it P, Clare =, Pedersen 6[, Istergaard ,, 2ambert 7L- n)ammatorF lesions o" t(e spine on magnetic resonance imaging predict t(e development o" ne9 sFndesmop(Ftes in an@Flosing spondFlitis: evidence o" a relations(ip bet9een in)ammation and ne9 bone "ormation- rthritis "heum- [an 2000CH0(1):034102- e,edlinef-