[Degenerative diseases of the spine: Rare and often unrecognized causes of pain syndromes].
OBJECTIVE
The aim of this article is to describe rare and often unrecognized causes of spinal pain syndromes.


METHODS
Intervertebral disc degeneration frequently appears in early adulthood and can have a symptomatic or asymptomatic course. This article discusses incidence, pathophysiology, imaging, and pain symptomatology involved in the origin of back pain.


RESULTS
Anulus tears are often found in asymptomatic individuals but could be implicated in lumbar pain symptomatology in correlation with the provocative discography. Transient disorders can lead to pseudarthrosis of the iliac bone and to degeneration or to a reactive hypermobility with intervertebral disc degeneration in the level above. Modic type 1 erosive osteochondrosis is characterized by bone marrow edema near the hyaline cartilage end plate, which mostly elicits severe pain and results in serious limitations in everyday activities. The most important differential diagnosis is spondylodiscitis. Schmorl's nodes can exhibit considerable surrounding bone marrow edema that can be mistaken for metastases. A combination of MRI and CT should be employed for the diagnostic work-up of fatigue fracture of the interarticular portion, which is often overlooked due to its location. Synovial cysts of the facet joints can lead to radicular symptoms. Insufficiency fracture of the sacrum is frequently mistaken for metastasis due to intense scintigraphic enhancement and its signal behavior in MRI. CT provides instructive information.


CONCLUSIONS
Differential diagnosis should include less common causes such as anulus tears, transient disorders, activated Schmorl's nodes, synovial cysts of the facet joints, fatigue fractures of the interarticular portion of the spine and the sacrum and distinguish from metastases in particular.
Baur-Melnyk
A
A
Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München. Andrea.Baur@med.uni-muenchen.de
Triantafyllou
M
M
Birkenmaier
C
C
Reiser
M
M
D001416:Back Pain / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000175:diagnosis*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D035583:Rare Diseases / Q000175:diagnosis; D013577:Syndrome; D014057:Tomography, X-Ray Computed / Q000379:methods*