Spondiloz ve osteofitler

Özet

Spondiloz, disk-son plak ünitesinde gelişen osteofitik ve sklerotik dejeneratif kemik değişikliklerini tanımlayan bir görüntüleme terimidir. Kontrastsız BT, omurga dejenerasyonunda kemik yapılarını, son plak sklerozunu ve osteofitleri değerlendirmede temel yöntemdir. Aynı hastada birden fazla düzey etkilenebilir; morfolojik dejenerasyonun belirtiyle eşleşmesi ayrıca gerekir. Posterior osteofit-disk kompleksi kanal veya foramen darlığını gizleyebileceğinden yalnız anterior kemik çıkıntılarına odaklanmak nöroforaminal etkilenmeyi atlatabilir.

Okuma sırası

1. C5-C6 unkovertebral eklemler. Aksiyel C5-C6 kesitinde korpusun posterolateral kenarında ve nöral foramenin önünde uzanan iki unkovertebral eklemi bulun; osteofitin başladığı eklem konturunu izleyin.
2. Daralmış ipsilateral C5-C6 nöral foramen. Unkovertebral osteofitin foramene uzanımını değerlendirin; foramene uzanan kemik çıkıntıları sinirlere bası yapabilir.
3. Karşı taraf C5-C6 nöral foramen. Karşı taraftaki C5-C6 foramenini referans alın; açıklık farkının aynı aksiyel kesitte gerçekten görüldüğünü doğrulayın.
4. C5-C6 son plaklar ve disk aralığı. Sagittal MPR’de disk aralığı ve son plak kenarlarına dönün; osteofitlerin tek düzeyli mi yoksa birden çok komşu seviyede mi bulunduğunu gösterin.
5. Spinal kanal ve anterolateral vertebra kenarları. Son olarak posterior osteofitlerin kanal ön konturuna uzanımını ve uzun segmentte akıcı köprüleşme varsa disk aralıklarının korunup korunmadığını inceleyin.

Faz ve pencere

Kontrastsız tanısal

Kemik algoritmasında son plak kenarlarındaki marjinal osteofitler, endplate sklerozu ve disk aralığındaki dejeneratif daralma görülür; servikal aksiyel ve oblik MPR'lerde unkovertebral osteofitlerin foramene uzanımı aranır.

BT bulguları

• Vertebra korpusunun anterior veya lateral kenarından çıkan, son plak konturunu izleyen marjinal osteofit
• Son plaklarda karşılıklı skleroz, düzensizlik ve kronik dejeneratif yeniden şekillenme
• Osteofit eşliğinde intervertebral disk aralığı kaybı; vakum fenomeni görülebilir ancak zorunlu değildir
• Servikal unkovertebral eklemde kabalaşma ve posterolaterale uzanan osteofitin aynı taraf nöral forameni daraltması
• Posterior vertebral kenar osteofitinin spinal kanal ön konturuna çıkıntı yapması
• Birden fazla komşu korpusta akıcı anterolateral köprüleşme varsa sıradan fokal spondilozdan farklı ossifikasyon paterni
• Spondiloz değerlendirmesinde disk aralığı ve son plak bulgularına ek olarak faset eklem artrozunu, spinal kanal darlığını ve foramene uzanan osteofitlerin sinir basısına yol açıp açmadığını inceleyin.

Ölçütler ve sınıflamalar

Resnick-Niwayama DISH örüntüsünde kesintisiz anterolateral ossifikasyon

En az 4 komşu vertebra

Resnick-Niwayama radyografik DISH ölçütleri

Resnick-Niwayama ölçütleri; en az dört komşu vertebra boyunca akıcı osteofitleri, intervertebral disk aralığının korunmasını, faset ve kostovertebral eklemlerde ankiloz bulunmamasını ve sakroiliak eklem anormalliği olmamasını içerir.

Normalde

Yaşla ilişkili dejeneratif değişikliklerde servikal disk yüksekliği ve nöral foramen boyutları azalabilir.

Ayırıcı tanı

DISH

en az dört komşu vertebrayı tutan akıcı osteofitler ve disk aralıklarının korunmasıyla tanımlanır; bu uzun segmentli görünüm fokal dejeneratif osteofit örüntüsünden ayrımda yardımcı olur.

Ankilozan spondilit

ince marjinal sindesmofitler, vertebra köşesi erozyonları ve sakroiliit eşlik edebilir; kaba dejeneratif osteofit paterni beklenmez

Disk hernisi

disk materyalinin disk aralığı sınırlarının dışına fokal yer değiştirmesidir; posteriora uzanan herniasyon spinal kanal içindeki nöral yapıları etkileyebilir.

Vertebral osteomiyelit

son plak destrüksiyonu, disk aralığının inflamatuvar etkilenmesi ve paravertebral değişiklikler sıradan sklerotik spondilozdan farklıdır

Osteokondrom veya başka kemik lezyonu

fokal ekzofitik oluşumun medüller devamlılığı ve tipik son plak marjininden bağımsız konumu incelenir

Tuzaklar

• Akıcı anterolateral köprüleşme DISH ile karışabilir; köprülerin tek tek disk aralığından kaynaklanan kısa osteofitler mi yoksa uzun ligamentöz ossifikasyon mu olduğunu sagittal MPR'de izle.
• Servikal unkovertebral osteofit intervertebral foramene uzanarak sinirleri sıkıştırabilir ve radikülopatiye yol açabilir.
• Dejeneratif Modic tip 1 kemik iliği değişiklikleri, özellikle disk içi sıvı birikimi eşlik ettiğinde, erken spondilodiskiti taklit edebilir.
• BT, servikal spondilozda osteofit ve kemik foraminal darlığı değerlendirmede kullanılır; konvansiyonel MR kemik anormalliklerini göstermede yetersiz kalabilir.

Kendini dene

1. C5-C6'da unkovertebral kemik çıkıntısı aynı taraf nöral foramenin ön bölümünü daraltıyor. En olası değişiklik nedir?

   • Unkovertebral spondiloz
   • DISH
   • Ankilozan spondilit
   • Vertebral osteomiyelit
   Cevabı göster

   Unkovertebral spondiloz. Unkovertebral eklemden çıkan osteofitin foramene devam etmesi servikal spondilozun tipik kemik paternidir. DISH uzun segment akıcı anterolateral ossifikasyon, ankilozan spondilit ince sindesmofit/sakroiliit, osteomiyelit ise destrüktif son plak-disk değişikliğiyle ayrılır.

2. Birden fazla komşu vertebrada uzun, akıcı anterolateral köprüleşme ve görece korunmuş disk aralıkları hangi paterni düşündürür?

   • DISH
   • Fokal spondiloz
   • Akut disk hernisi
   • Spondilolizis
   Cevabı göster

   DISH. Uzun ve akıcı anterolateral ligamentöz ossifikasyon ile disk aralıklarının korunması DISH örüntüsüdür. Fokal spondiloz genellikle tekil marjinal osteofit ve disk dejenerasyonu; disk hernisi yumuşak doku; spondilolizis ise pars interartikülaris defekti oluşturur.

İlgili konular

• Faset eklem osteoartriti
• Dejeneratif spondilolistezis

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 11 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.