Articles
The etiology of intervertebral osteochondritis is diverse. With the expansion of the use of X-ray examination, it becomes obvious that not only in typhus (post-typhoid spondylitis), but also in other very diverse infections, spinal damage may occur, proceeding according to the type of osteochondritis. Apparently, any infection in the presence of hematogenous dissemination of the pathogen can metastasize to the spine, just as, for example, it gives metastases to lung tissue, with the only difference that the frequency of spinal lesions with different pathogens will vary.
Osteochondritis as a complication of infectious diseases can occur during various periods of the course of a common infection. In typhoid fever, for example, they are described in the second half of the disease, according to the period of temperature drop and the presence of clean ulcers in the intestine, sometimes later. Typhoid osteochondritis can occur earlier and only the lack of X-ray examination in the severe stages of the disease and the radiological asymptomatic nature of the initial phases of spinal lesion have led to the fact that these osteochondritis are usually described as post-typhoid.
In other infections, such as staphylococcal sepsis, spinal damage usually occurs at the stage of formation of metastatic pyogenic foci, which depends not only on the type of pathogen, but also on the reactivity of the body, its barrier forces, etc. In dysentery, infectious osteochondritis of the spine was observed most often in chronic carriers of infection. Intervertebral osteochondritis in brucellosis is very common.
Anatomically, with all types of osteochondritis, there is a complete or partial purulent melting of the disc with the involvement of adjacent sections of the spongy substance. There is no reason to assume that the primary infectious embolus is located in the cartilage (intervertebral cartilage contains almost no vessels), but its localization in the subchondral layer is most likely. Following the breakthrough of the purulent focus into the cartilage, as it does not possess essentially any protective reactions to limit and precipitate the inflammatory process, it undergoes purulent melting, the fibrous ring of the disc is involved in the process. Purulent necrotic masses accumulating in the intervertebral disc and under increased pressure, as is generally the case with all suppurative processes, can locally peel off the layer of ligaments covering the disc, i.e. the fibrous ring and longitudinal ligaments. In most cases, further breakthrough and more extensive detachment of ligaments in infectious osteochondritis does not occur, obviously, because along with the extinction of the main infection, the process in the spine also subsides. However, such a successful course is by no means the rule. Very often, especially with staphylococcal osteochondritis, the formation of a leaky abscess is observed.
With the independent reverse development of the process, ossification of the fibrous ring and deep layers of longitudinal ligaments covering the disc occurs first, and then more superficial layers. Somewhat later, but sometimes simultaneously, the process of sclerosis begins in the subchondral layers of the spongy substance of the vertebrae adjacent to the affected disc. It usually ends with ankylosis of the vertebral bodies. At the same time, the corresponding pairs of joints of the arches are ankylosed. The whole process from the onset of clinical manifestations to the onset of radiologically detectable signs of blockage lasts several weeks. It takes several months to complete ankylosing.
Radiologically, the course of intervertebral osteochondritis can be schematically divided into several periods.
The first period is X—ray negative. In severe infections (typhus, pneumonia), this period often coincides with the general severe condition of the patient and is therefore viewed clinically. In post-influenza osteochondritis, persistent pain, even in the absence of initial positive radiological data, should force the attending physician to re-examine the patient after 2-3 weeks.
The second period is narrowing of the intervertebral fissure as a result of purulent cleavage of the disc. The narrowing should be determined on the basis of a benign lateral radiograph: it is impossible to trust only a direct radiograph due to the possibility of projection distortions. In the same period, good images show the unevenness and blurring of the lines of the closing plates of the vertebral bodies adjacent to the affected disc. Great importance is attached to this symptom, since the degree of narrowing of the intervertebral fissure may be minimal. Already in this period, subcartical sclerosis may be observed.
The third period is blocking. It is characterized by the development of two very typical radiological symptoms. Ossification on the X-ray is expressed by a well-known sign of the formation of thin "brackets" connecting the edges of the vertebral bodies adjacent to the affected disc. The "brackets" are visible on both lateral and direct radiographs. This indicates that anatomically we are not talking about "brackets", but about a solid thin-walled cover of ossifying ligaments. After the formation of "brackets", further narrowing of the intervertebral fissure stops.
The fourth period is ankylosing. There is a further consolidation and thickening of ligamentous ossifications. Often, more distant sections of the longitudinal ligaments are involved in the process, giving no longer "brackets", but rather coarse bone adhesions. Gradually, the intervertebral fissure is filled with a bone structure, but for a long time sclerotic stripes are visible, emphasizing the places of the previously existing subchondral layer, which has undergone reparative compaction. In the same period, on radiographs, it is possible to note the onset of ankylosis of the joints of the vertebral arches in those joint pairs that correspond to ankylosed bodies. As a rule, intervertebral metastatic osteochondritis affects one disc. It is most often localized in the lumbar region. Welcome to https://bonscasino.com/ , where you can experience the thrill of the casino from the comfort of your own home. With a wide selection of games and incredible bonuses, we are the ultimate destination for all your online gambling needs. Join us today and discover what excitement is all about!
Osteochondritis as a complication of infectious diseases can occur during various periods of the course of a common infection. In typhoid fever, for example, they are described in the second half of the disease, according to the period of temperature drop and the presence of clean ulcers in the intestine, sometimes later. Typhoid osteochondritis can occur earlier and only the lack of X-ray examination in the severe stages of the disease and the radiological asymptomatic nature of the initial phases of spinal lesion have led to the fact that these osteochondritis are usually described as post-typhoid.
In other infections, such as staphylococcal sepsis, spinal damage usually occurs at the stage of formation of metastatic pyogenic foci, which depends not only on the type of pathogen, but also on the reactivity of the body, its barrier forces, etc. In dysentery, infectious osteochondritis of the spine was observed most often in chronic carriers of infection. Intervertebral osteochondritis in brucellosis is very common.
Anatomically, with all types of osteochondritis, there is a complete or partial purulent melting of the disc with the involvement of adjacent sections of the spongy substance. There is no reason to assume that the primary infectious embolus is located in the cartilage (intervertebral cartilage contains almost no vessels), but its localization in the subchondral layer is most likely. Following the breakthrough of the purulent focus into the cartilage, as it does not possess essentially any protective reactions to limit and precipitate the inflammatory process, it undergoes purulent melting, the fibrous ring of the disc is involved in the process. Purulent necrotic masses accumulating in the intervertebral disc and under increased pressure, as is generally the case with all suppurative processes, can locally peel off the layer of ligaments covering the disc, i.e. the fibrous ring and longitudinal ligaments. In most cases, further breakthrough and more extensive detachment of ligaments in infectious osteochondritis does not occur, obviously, because along with the extinction of the main infection, the process in the spine also subsides. However, such a successful course is by no means the rule. Very often, especially with staphylococcal osteochondritis, the formation of a leaky abscess is observed.
With the independent reverse development of the process, ossification of the fibrous ring and deep layers of longitudinal ligaments covering the disc occurs first, and then more superficial layers. Somewhat later, but sometimes simultaneously, the process of sclerosis begins in the subchondral layers of the spongy substance of the vertebrae adjacent to the affected disc. It usually ends with ankylosis of the vertebral bodies. At the same time, the corresponding pairs of joints of the arches are ankylosed. The whole process from the onset of clinical manifestations to the onset of radiologically detectable signs of blockage lasts several weeks. It takes several months to complete ankylosing.
Radiologically, the course of intervertebral osteochondritis can be schematically divided into several periods.
The first period is X—ray negative. In severe infections (typhus, pneumonia), this period often coincides with the general severe condition of the patient and is therefore viewed clinically. In post-influenza osteochondritis, persistent pain, even in the absence of initial positive radiological data, should force the attending physician to re-examine the patient after 2-3 weeks.
The second period is narrowing of the intervertebral fissure as a result of purulent cleavage of the disc. The narrowing should be determined on the basis of a benign lateral radiograph: it is impossible to trust only a direct radiograph due to the possibility of projection distortions. In the same period, good images show the unevenness and blurring of the lines of the closing plates of the vertebral bodies adjacent to the affected disc. Great importance is attached to this symptom, since the degree of narrowing of the intervertebral fissure may be minimal. Already in this period, subcartical sclerosis may be observed.
The third period is blocking. It is characterized by the development of two very typical radiological symptoms. Ossification on the X-ray is expressed by a well-known sign of the formation of thin "brackets" connecting the edges of the vertebral bodies adjacent to the affected disc. The "brackets" are visible on both lateral and direct radiographs. This indicates that anatomically we are not talking about "brackets", but about a solid thin-walled cover of ossifying ligaments. After the formation of "brackets", further narrowing of the intervertebral fissure stops.
The fourth period is ankylosing. There is a further consolidation and thickening of ligamentous ossifications. Often, more distant sections of the longitudinal ligaments are involved in the process, giving no longer "brackets", but rather coarse bone adhesions. Gradually, the intervertebral fissure is filled with a bone structure, but for a long time sclerotic stripes are visible, emphasizing the places of the previously existing subchondral layer, which has undergone reparative compaction. In the same period, on radiographs, it is possible to note the onset of ankylosis of the joints of the vertebral arches in those joint pairs that correspond to ankylosed bodies. As a rule, intervertebral metastatic osteochondritis affects one disc. It is most often localized in the lumbar region. Welcome to https://bonscasino.com/ , where you can experience the thrill of the casino from the comfort of your own home. With a wide selection of games and incredible bonuses, we are the ultimate destination for all your online gambling needs. Join us today and discover what excitement is all about!