Skip to main content
SpringerLink
Log in

Bildgebende Verfahren in der Rheumatologie: Bildgebung bei degenerativen Erkrankungen der Wirbelsäule

Imaging in rheumatology: degenarative diseases of the spine

  • Qualitätssicherung
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Degenerative Veränderungen der Wirbelsäule gehören zu den häufigsten Ursachen für Beschwerden im Bereich des Bewegungsapparates. Für die Diagnostik und Differenzialdiagnostik hat das konventionelle Röntgenbild unverändert seinen festen Platz. Zu den wesentlichen Vorteilen zählen der geringe Zeitaufwand und die geringen Kosten. Eine Höhenminderung des Intervertebralraums und Sklerosierungen der Grund- und Deckplatten gehören zu den ersten radiologischen Veränderungen und können im weiteren Verlauf von Spondylophytenbildungen, Arthrosen der Intervertebralgelenke und einem degenerativem Wirbelgleiten begleitet werden. Frühveränderungen der Bewegungssegmente sind jedoch mit dem Röntgenbild nicht zu erfassen. Zudem fehlt die räumliche Abbildungsmöglichkeit. Durch die Computertomographie (CT) und Magnetresonanztomographie (MRT) sind die diagnostischen Möglichkeiten wesentlich verbessert worden. Mit der MRT können die Wirbelsäule und die beteiligten Weichteile dreidimensional dargestellt werden. Eine differenzialdiagnostische Abgrenzung zu inflammatorischen, traumatischen oder neoplastischen Prozessen ist möglich. Unverändert problematisch ist die mangelnde Korrelation zwischen den bildgebenden Befunden mit der klinischen Symptomatik. Röntgenbild und MRT können somit nur bei entsprechender Kenntnis über die Symptome und möglichen Krankheitsbilder sinnvoll interpretiert werden.

Abstract

Degeneration of the spine is a common reason for pain in the musculoskeletal system. Radiography is an important tool for diagnosis and differential diagnosis. Cost efficacy and economy of time are advantages in using conventional x-rays. Although narrowing of intervertebral disc spaces, irregular ossification of the vertebral end-plate as well as osteophytes, facet joint osteoarthritis and spondylolisthesis can be observed, early changes in the discs or the subdiscal bone can not be detected by x-rays. Moreover, 3-dimensional imaging is not possible. Computer tomography (CT) and magnetic resonance imaging (MRI) are reliable for identifying disorders of the spine and soft-tissue. Differentiation between inflammation, trauma and tumor is possible. There is still a problem with the relationship between the information obtained by x-rays or MRI and clinical symptoms. Therefore, interpretation of radiological examinations assumes a knowledge of clinical symptoms and the different kinds of diseases which are possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9

Literatur

  1. Ackermann WE, Ahmad M (2000) Lumbar spine pain originating from vertebral osteophytes. Reg Anesth Pain Med 25: 324

    Article  PubMed  Google Scholar 

  2. Agency for Health Care Policy and Research/AHCPR (1994) Acute low back problems in adults. Clinical practice guideline number 14, AHCPR publication No. 95-0642. Department of Health and Human Services, Public Health Service, Rockville/MD

  3. Aroua A, Decka I, Robert J et al. (2003) Chiropractor’s use of radiography in Switzerland. J Manipulative Physiol Ther 26: 9–16

    Article  PubMed  Google Scholar 

  4. Benini A (1997) Stenosis of the lumbar spinal canal. Pathophysiology, clinical aspects and therapy. Orthopade 26: 503–514

    Article  PubMed  Google Scholar 

  5. Berlemann U, Laubli R, Moore RJ (2002) Degeneration of the atlanto-axial joints: a histological study of 9 cases. Acta Orthop Scand 73: 130–133

    Article  PubMed  Google Scholar 

  6. Biering-Sorensen F (1983) A prospective study of low back pain in a general population. II. Location, character, aggravating and relieving factors. Scand J Rehabil Med 15: 81–88

    PubMed  Google Scholar 

  7. Bigos SJ, Battie MC, Spengler DM (1992) A longitudinal, prospective study of industrial back injury reporting. Clin Orthop Relat Res 279: 21–34

    PubMed  Google Scholar 

  8. Bigos SJ, McKee JE, Holland JP et al. (2001) Back pain, the uncomfortable truth – assurance and activity problem. Schmerz 15: 430–434

    Article  PubMed  Google Scholar 

  9. Borenstein DG, O’Mara J W Jr, Boden SD et al. (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study. J Bone Joint Surg Am 83: 1306–1311

    PubMed  Google Scholar 

  10. Carey TS, Evans AT, Hadler NM et al. (1996) Acute severe low back pain. A population-based study of prevalence and care-seeking. Spine 21: 339–344

    Article  PubMed  Google Scholar 

  11. Cavagna F (2004) Technological advances and clinical trends in MRI. Eur Radiol 14 Suppl 7: O1–O2

    Article  Google Scholar 

  12. Chung CB, Vande Berg BC, Tavernier T et al. (2004) End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skeletal Radiol 33: 399–404

    Article  PubMed  Google Scholar 

  13. Coste J, Paolaggi JB, Spira A (1991) Reliability of interpretation of plain lumbar spine radiographs in benign, mechanical low-back pain. Spine 16: 426–428

    PubMed  Google Scholar 

  14. Dai L (1998) The relationship between vertebral body deformity and disc degeneration in lumbar spine of the senile. Eur Spine J 7: 40–44

    Article  PubMed  Google Scholar 

  15. Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie und Berufsverband der Ärzte für Orthopädie (Hrsg) (2002) Leitlinien der Orthopädie: Bandscheibenbedingte Ischialgie, 2. Aufl. Deutscher Ärzteverlag, Köln

  16. De vos Meiring P, Wells IP (1990) The effect of radiology guidelines for general practitioners in Plymouth. Clin Radiol 42: 327–329

    Article  PubMed  Google Scholar 

  17. Dorenbeck U, Schreyer AG, Grunwald IQ et al. (2004) Degenerative diseases of the lumbar spine. Comparison of the multiecho data image combination sequence with magnetization transfer saturation pulse versus lumbar myelography/postmyelographic computed tomography. Acta Radiol 45: 866–873

    Article  PubMed  Google Scholar 

  18. Ebraheim NA, Lu J, Biyani A et al. (1997) Anatomic considerations for uncovertebral involvement in cervical spondylosis. Clin Orthop Relat Res 334: 200–206

    PubMed  Google Scholar 

  19. Epstein NE, Epstein JA, Carras R, Hyman RA (1990) Far lateral lumbar disc herniations and associated structural abnormalities. An evaluation in 60 patients of the comparative value of CT, MRI, and myelo-CT in diagnosis and management. Spine 15: 534–539

    PubMed  Google Scholar 

  20. Fletcher J, Clark MD, Sutton FA et al. (1999) The cost of MRI: changes in costs 1989–1996. Br J Radiol 72: 432–437

    PubMed  Google Scholar 

  21. Ford LT, GilulaLA, Murphy WA, Gado M (1977) Analysis of gas in vacuum lumbar disc. AJR Am J Roentgenol 128: 1056–1057

    PubMed  Google Scholar 

  22. Fujiwara A, Tamai K, Yamato M et al. (1999) The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 8: 396–401

    Article  PubMed  Google Scholar 

  23. Glaves J (2005) The use of radiological guidelines to achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knees performed for GPs. Clin Radiol 60: 914–920

    Article  PubMed  Google Scholar 

  24. Glover GH (2000) MRI: basic principles and future potential. Comput Aided Surg 5: 132 (abstract)

    Article  PubMed  Google Scholar 

  25. Gupta MC (2003) Degenerative scoliosis. Options for surgical management. Orthop Clin North Am 34: 269–279

    Article  PubMed  Google Scholar 

  26. Hassett G, Hart DJ, Manek NJ et al. (2003) Risk factors for progression of lumbar spine disc degeneration: the Chingford Study. Arthritis Rheum 48: 3112–3117

    Article  PubMed  Google Scholar 

  27. Herbsthofer B, Eysel P, Eckardt A, Humke T (1996) Diagnosis and therapy of erosive intervertebral osteochondrosis. Z Orthop Ihre Grenzgeb 134: 465–471

    PubMed  Google Scholar 

  28. Inaoka M, Yamazaki Y, Hosono N et al. (2000) Radiographic analysis of lumbar spine for low-back pain in the general population. Arch Orthop Trauma Surg 120: 380–385

    Article  PubMed  Google Scholar 

  29. Kerry S, Hilton S, Patel S et al. (2000) Routine referral for radiography of patients presenting with low back pain: is patients‘ outcome influenced by GPs‘ referral for plain radiography? Health Technol Assess 4: 1–119

    Google Scholar 

  30. Kolstad F, Myhr G, Kvistad KA et al. (2005) Degeneration and height of cervical discs classified from MRI compared with precise height measurements from radiographs. Eur J Radiol 55: 415–420

    Article  PubMed  Google Scholar 

  31. Kostova V, Koleva M (2001) Back disorders (low back pain, cervicobrachial and lumbosacral radicular syndromes) and some related risk factors. J Neurol Sci 192: 17–25

    Article  PubMed  Google Scholar 

  32. Krämer J (1997) Bandscheibenbedingte Erkrankungen, 4. Aufl. Thieme, Stuttgart

  33. Krappel FA, Bauer E, Ulrich H (2004) MRI or CT for the diagnosis of stenosis of the lumbar spinal canal? Results of a retrospective study. Z Orthop Ihre Grenzgeb 142: 126–127

    PubMed  Google Scholar 

  34. Krings T, Reinges MHT, Erberich S et al. (2001) Functional MRI for presurgical planning: problems, artefacts, and solution strategies. J Neurol Neurosurg Psychiatry 70: 749–760

    Article  PubMed  Google Scholar 

  35. Lefkowitz DM, Quencer RM (1982) Vacuum facet phenomenon: a computed tomographic sign of degenerative spondylolisthesis. Radiology 144: 562

    PubMed  Google Scholar 

  36. Lotz JC (2004) Animal models of intervertebral disc degeneration: lessons learned. Spine 29: 2742–2750

    Article  PubMed  Google Scholar 

  37. Lowe A, Hopf C, Eysel P (1996) Significance of exact lateral roentgen documentation in Meyerding’s grading of spondylolistheses. Z Orthop Ihre Grenzgeb 134: 210–213

    PubMed  Google Scholar 

  38. Martin MD, Boxell CM, Malone DG (2002) Pathophysiology of lumbar disc degeneration: a review of the literature. Neurosurg Focus 13: E1

    Google Scholar 

  39. Meduri S, De Petri T, Modesto A, Moretti CA (2002) Multislice CT: technical principles and clinical applications. Radiol Med 103: 143–157

    Google Scholar 

  40. Miller P, Kendrick D, Bentley E, Fielding K (2002) Cost-effectiveness of lumbar spine radiography in primary care patients with low back pain. Spine 27: 2291–2297

    Article  PubMed  Google Scholar 

  41. Modic MT (1999) Degenerative disc disease and back pain. Magn Reson Imaging Clin N Am 7: 481–491

    PubMed  Google Scholar 

  42. Nizard RS, Wybier M, Laredo JD (2001) Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am 39: 55–71

    Article  PubMed  Google Scholar 

  43. Ostendorf B, Scherer A, Backhaus M et al. (2003) Bildgebende Verfahren in der Rheumatologie: Magnetresonanztomographie bei rheumatoider Arthritis. Z Rheumatol 62: 274–286

    Article  PubMed  Google Scholar 

  44. Pesch HJ, Bischoff W, Becker T, Seibold H (1984) On the pathogenesis of spondylosis deformans and arthrosis uncovertebralis: comparative form-analytical radiological and statistical studies on lumbar and cervical vertebral bodies. Arch Orthop Trauma Surg 103: 201–211

    Article  PubMed  Google Scholar 

  45. Peterson CK, Bolton JE, Wood AR (2000) A cross-sectional study correlating lumbar spine degeneration with disability and pain. Spine 25: 218–223

    Article  PubMed  Google Scholar 

  46. Pochis WT, Krasnow AZ, Collier BD (1990) Diagnostic imaging of the lumbar spine. Ann Intern Med 112: 310–311

    PubMed  Google Scholar 

  47. Pye SR, Reid DM, Smith R et al. (2004) Radiographic features of lumbar disc degeneration and self-reported back pain. J Rheumatol 31: 753–758

    PubMed  Google Scholar 

  48. Rau R, Lingg G, Wassenberg S et al. (2005) Bildgebende Verfahren in der Rheumatologie: Konventionelle Röntgendiagnostik bei der rheumatoiden Arthritis. Z Rheumatol 64: 473–487

    Article  PubMed  Google Scholar 

  49. Roth C, Papanagiotou P, Krick C et al. (2005) Imaging cervical myelo- and radiculopathy. Radiologe

  50. Repanti M, Korovessis PG, Stamatakis MV et al. (1998) Evolution of disc degeneration in lumbar spine: a comparative histological study between herniated and postmortem retrieved disc specimens. J Spinal Disord 11: 41–45

    PubMed  Google Scholar 

  51. Salminen JJ, Erkintalo MO, Pentti J et al. (1999) Recurrent low back pain and early disc degeneration in the young. Spine 24: 1316–1321

    Article  PubMed  Google Scholar 

  52. Santiago FR, Milena GL, Herrera RO et al. (2001) Morphometry of the lower lumbar vertebrae in patients with and without low back pain. Eur Spine J 10: 228–233

    Article  PubMed  Google Scholar 

  53. Symmons DP, van Hemert AM, Vandenbroucke JP, Valkenburg HA (1991) A longitudinal study of back pain and radiological changes in the lumbar spines of middle aged women. II. Radiographic findings. Ann Rheum Dis 50: 162–166

    PubMed  Google Scholar 

  54. Tallroth K (1998) Plain CT of the degenerative lumbar spine. Eur J Radiol 27: 206–213

    Article  PubMed  Google Scholar 

  55. Tancredi A, Caputi F (2004) Greater occipital neuralgia and arthrosis of C1–2 lateral joint. Eur J Neurol 11: 573–574

    Article  PubMed  Google Scholar 

  56. Thalgott JS, Albert TJ, Vaccaro AR et al. (2004) A new classification system for degenerative disc disease of the lumbar spine based on magnetic resonance imaging, provocative discography, plain radiographs and anatomic considerations. Spine J 4 [6 Suppl]: 167S–172S

    Article  PubMed  Google Scholar 

  57. Tribus CB (2003) Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg 11: 174–183

    PubMed  Google Scholar 

  58. Van den Bosch MA, Hollingworth W, Kinmonth AL, Dixon AK (2004) Evidence against the use of lumbar spine radiography for low back pain. Clin Radiol 59: 69–76

    Article  PubMed  Google Scholar 

  59. Videman T, Battie MC, Gill K et al. (1995) Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine 20: 928–935

    PubMed  Google Scholar 

  60. Walker MH, Anderson DG (2004) Molecular basis of intervertebral disc degeneration. Spine J 4 [6 Suppl]: 158S–166S

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    J. Steinhagen, J. P. Petersen, R. Kothe & W. Rüther

  2. Kommission „Bildgebende Verfahren“ der Deutschen Gesellschaft für Rheumatologie (Sprecher: Rolf Rau, Ratingen), Deutschland

    J. Steinhagen, J. P. Petersen, R. Kothe & W. Rüther

  3. Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    C. R. Habermann

Authors
  1. J. Steinhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. R. Habermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. P. Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Kothe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Rüther
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Steinhagen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steinhagen, J., Habermann, C.R., Petersen, J.P. et al. Bildgebende Verfahren in der Rheumatologie: Bildgebung bei degenerativen Erkrankungen der Wirbelsäule. Z. Rheumatol. 65, 761–770 (2006). https://doi.org/10.1007/s00393-006-0077-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-006-0077-9

Search

Navigation