Spine DJD Nomenclature Sonia K Ghei, MD
Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology http://www.asnr.org/spine_nomenclature/ David F. Fardon, MD, Chairperson, Clinical Task Force Pierre C. Milette, MD, Chairperson, Imaging Task Force Since its initial publication in March 2001, the terminology proposed in this work has been endorsed by other societies. It is now officially supported, recommended or web-linked by the following American and European professional organizations and scientific societies: American Academy of Orthopaedic Surgeons (AAOS) American Academy of Physical Medicine and Rehabilitation (AAPM&R) American College of Radiology (ACR) American Society of Neuroradiology (ASNR) American Society of Spine Radiology (ASSR) Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) European Society of Neuroradiology (ESNR) North American Spine Society (NASS) Physiatric Association of Spine, Sports and Occupational Rehabilitation (PASSOR)
Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology http://www.asnr.org/spine_nomenclature/ David F. Fardon, MD, Chairperson, Clinical Task Force Pierre C. Milette, MD, Chairperson, Imaging Task Force Since its initial publication in March 2001, the terminology proposed in this work has been endorsed by other societies. It is now officially supported, recommended or web-linked by the following American and European professional organizations and scientific societies: American Academy of Orthopaedic Surgeons (AAOS) American Academy of Physical Medicine and Rehabilitation (AAPM&R) American College of Radiology (ACR) American Society of Neuroradiology (ASNR) American Society of Spine Radiology (ASSR) Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) European Society of Neuroradiology (ESNR) North American Spine Society (NASS) Physiatric Association of Spine, Sports and Occupational Rehabilitation (PASSOR) MULTIDISCIPLINARY CONSENSUS
Definitions based on morphology and pathology -Do not imply any particular etiology -Do not suggest any particular treatment -Do not make a distinction between symptomatic and asymptomatic disease
DISC DISEASE
The bilocular appearance of the adult nucleus resulting from the development of a central horizontal band of fibrous tissue is considered a sign of normal maturation. Includes discs that are congenitally abnormal or that have undergone changes in their morphology as an adaptation to abnormal growth of the spine (eg scoliosis or spondylolisthesis). http://www.asnr.org/spine_nomenclature/recommendations.shtml Adapted from Milette PC. Classification, diagnostic imaging and imaging characterization of a lumbar herniated disc. Radiol Clin North Am 2000; 38:1267-1292
Degenerative/Traumatic Lesion Annular tear/fissure Herniation Protrusion/Extrusion Intravertebral Degeneration Spondylosis deformans Intervertebral osteochondrosis
Degenerative/Traumatic Lesion Annular tear/fissure Herniation Protrusion/Extrusion Intravertebral Degeneration Spondylosis deformans Intervertebral osteochondrosis
Deteriorated disc
Degenerative/Traumatic Lesion Annular tear/fissure Herniation Protrusion/Extrusion Intravertebral Degeneration
Annular tear Also appropriately termed annular fissure. Separations between annular fibers or avulsion of fibers from their vertebral body insertions. The term fissure" is used to refer to a localized radial, concentric, or horizontal disruption of the annulus without associated displacement of disc material beyond the limits of the intervertebral disc space. Does not imply that the lesion is secondary to trauma. http://www.asnr.org/spine_nomenclature/slide2.shtml
Degenerative/Traumatic Lesion Annular tear/fissure Herniation Protrusion/Extrusion Intravertebral Degeneration
Disc herniation Localized displacement of disc material beyond the limits of the intervertebral disc space. The disc space is defined, craniad and caudad, by the vertebral body end-plates and, peripherally, by the outer edges of the vertebral ring apophyses, exclusive of osteophytic formations. Note about the term disc-osteophyte complex
OLD! In 2011 revision, a broad-based herniation, involving >90 of the disc circumference, is now considered an asymmetric bulge Bulging disc <50% (180 degrees) >50% (180 degrees) <25% 25-50%
In 2011 revision, a broadbased herniation, involving >90 of the disc circumference, is now considered an asymmetric bulge Bulging disc <25% (90 degrees) >25% (90 degrees) = <25% >25%
Bulging disc <25% (90 degrees) >25% (90 degrees) <25% (90 degrees) >25% (90 degrees)
VOLUME AVERAGING (PSEUDOBULGE)
Disc herniation Herniated discs can be described as protrusion or extrusion, based on the shape (not size) of the displaced material. Protrusion is present, if the greatest distance, in any plane, between the edges of the disc material beyond the disc space is less than the distance between the edges of the base in the same plane. Extrusion is present when, in at least one plane, any one distance between the edges of the disc material beyond the disc space is greater than the distance between the edges of the base in the same plane, or when no continuity exists between the disc material beyond the disc space and that within the disc space. Sequestered disc is included in this category.
Protrusion Migration Sequestration
Schmorl s node = Intravertebral disc herniation
Description of a disc herniation: Morphology Protrusion Extrusion Intravertebral Location
STENOSIS
Boundaries of central canal Vertebral body and disc Facet joint, Ligamentum flavum Facet joint, Ligamentum flavum
Boundaries of neural foramen Cranial pedicle Vertebral body, Disc Facet joint, Ligamentum flavum Caudal pedicle
DEGENERATIVE ENDPLATE CHANGES Modic Type: I Edema II Fat III - Fibrosis
The postoperative spine: Granulation tissue/scar
Arachnoiditis Clumped roots Empty sac Pseudocord Enhancing roots
The End