Osteocondrosi vertebrale

Per osteocondrosi  si intende un processo degenerativo che coinvolge primariamente il disco intersomatico e  successivamente le vertebre con alterazione distrofica  della limitante somatica e osteofitosi somato-marginale. Con la diagnostica per immagini possiamo riconoscere gran parte di tali alterazioni si guisa né l’evoluzione.

La radiologia convenzionale (figura 1) permette di valutare il restringimento dello spazio intersomatico, che deve essere di almeno 2 mm rispetto all’altezza del disco intervertebrale adiacente, visualizzabile nella proiezione LL i quantificato a livello della parte centrale dei piatti vertebrali, la sclerosi ossea subcondrale i irregolarità delle limitanti somatiche, l’ampliamento osteofitario delle superfici somatiche  espressione generalmente di vie equilibrio strategie con su pregresse condizione di instabilità e/o sovraccarico compartimentale.  Rappresentazione strategia di tale reazione osteofitaria avviene su un piano parallelo alle limitanti somatiche. L’alterazione osteofitaria  longitudinale risulta altresì espressione di parziale calcificazione del legamento longitudinale anteriore. In alcuni casi sono evidenti, nella proiezione latero-laterale, calcificazioni o raccolte gassose all’interno dello spazio intervertebrale espressione di degenerazione del disco.

La Risonanza Magnetica (RM) consente di valutare le varie fasi di degenerazione del l’unità disco vertebrale.

Inizialmente sono evidenti segni di alterata intensità di segnale del disco intersomatico espressione di perdita della normale idratazione del disco, che generalmente si accompagna ad una dilatazione del rispettivo l’anulus fibroso: a questa può sovrapporsi la fuoriuscita del nucleo polposo all’esterno dell’anulus (ernia discale), agomento che verrà  trattato in altro  paragrafo.

Successivamente  si possono delineare sulle contrapposte limitanti somatiche alterazioni dell’intensità di segnale a carico di corrispondenti strati basali subcondrali, in una prima fase a carattere infiammatorio  ed espressione di sofferenza da aumentato carico compressivo.  La risonanza magnetica   mostra elevato sensibilità nella caratterizzazione di queste alterazioni degenerative, in fase infiammatoria, che appaiono ipointense nelle sequenze T1 pesate ed iperintense nelle sequenze T2 pesate e  con soppressione del grasso (figura 2).   Tale riconoscimento riveste un ruolo diagnostico significativo in quanto consente di definire  quali compartimenti articolari del rachide risentano di  errati carichi biomeccanici  al fine di ottenere il miglior   inquadramento posturale.

 Nelle  successive fasi di stabilizzazione, con la scomparsa dei processi infiammatori,  la risonanza magnetica evidenzia l’alterazione distrofica  e morfologica dei piatti vertebrali, che appare   iperintensa sia nelle sequenze T1 che nelle sequenze T2,  scarsamente identificabile nelle sequenze con soppressione del grasso (figura 3), dovuta  alla  conversione in tessuto adiposo del midollo osseo.

Esiste  un terzo  tipo di alterazione distrofica del limitanti somatiche, meno frequente, espressione   di stabilizzazione dei  processi degenerativi,  caratterizzata da formazione di tessuto sclerotico in sede subcondrale,   che appare in RM  ipointensa sia nelle sequenze T1, sia nelle sequenze T2 pesate.


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