Degenerative Diseases of the Spine

Abstract

Degenerative chronic spondylitic spinal disease is “markedly underrepresented in the literature. The natural history is not known and most forms of conservative care are unproven.”¹ In the aggregate, the diagnosis and management of degenerative spinal disease constitutes a considerably larger percentage of the day-to-day practice of neuroradiology than any other disorder. Furthermore, the impact that neuroradiologists can have in guiding appropriate care is greater in this area than any other single area of our specialty. Unfortunately, too often the neuroradiologist has little or no training in the clinical management of spinal disease. Reports are generated in a vacuum with little understanding of the patient’s history or the intended procedure. Without proper communication with clinical colleagues, vague terms such as protrusion, bulge, broad-based herniation, and so on, mean different things to different people. All too commonly, the focus is on disk integrity, rather than on the spinal unit as a whole; including cartilaginous injury, ligamentous or musculotendinous injury, facet joint instability, sacroiliac joint disease, or neural foraminal disease.

“ ‘Choose something common,’ says Joseph Blau. ‘You’ll find nobody knows anything about it.’ Wall Street Journal,” Monday, June 17, 1996.