Osteochondrosis of the spine and osteochondrosis dissecans


What is osteochondrosis?

Osteochondrosis or aseptic bone necrosis is a disease that affects children and adolescents in the growth phase (e.g. Osgood-Schlatter’s disease); the bone ends are lengthened by the growth of the bone nuclei contained in the epiphyses and diaphyses.

In this phase, necrosis and degeneration phenomena can occur on the bone and cartilage, which are referred to as osteochondrosis (osteo = bone, chondro = cartilage).
In the second stage of the disease, deformity of the ossification nucleus takes place and healing finally occurs through the gradual absorption of necrosis.
When the expansion and growth phase of the bone is complete, the weak cartilage tissue is replaced by hard, resistant bone tissue and the disease heals on its own.
Children of the male sex between the ages of 4 and 13 are particularly affected; a bilateral occurrence is possible.

What are the causes of osteochondrosis?

The cause of osteochondrosis is unclear, it is suspected that there is a circulatory disorder that causes an undersupply of blood to the tissues (ischemia).

Another theory assumes that the disease is triggered by hormonal predisposition and repeated microviolations.

What forms of osteochondrosis can occur depending on the affected joint?

• osteochondrosis of the heel or Sever-Haglund syndrome

Haglund’s syndrome is a degeneration of the posterior bone process (apophysis) of the heel bone bone in the region of the Achilles tendon attachment.
Those affected are mainly children between the ages of 9 and 12 who engage in running-intensive sports, such as football.
The cause lies in the wrong placement of the foot, usually it is a hollow or flat foot, or inappropriate footwear is used.
Typical symptoms are pain when walking and resulting limping.
The diagnosis is made with the help of an X-ray, which indicates the core growth on the heel.
The benign course of the disease lasts about a year and does not entail physical effects or deformations, but if acute pain occurs, sports activities should be stopped and insoles should be used that provide a more homogeneous placement of the foot.

• Osgood-Schlatter’s disease

Osgood-Schlatter’s disease is an apophysitis of the anterior shin, i.e. inflammation of the tibial bulge (tuberosity tibiae) at the point where the patellar ligament (patellar tendon) attaches.
The disease is counted among the juvenile osteochondrosis, because children and adolescents between the ages of 11 and 16 years are affected, much more often boys than girls (the ratio is about 3:1).
In the majority of cases, patients with Osgood-Schlatter disease are athletes, especially football, volleyball players and runners.
Each time the knee is stretched when running or jumping, there is a violent tension of the thigh muscles, as a result of which a strong impulse is exerted on the patellar tendon; this discharges the tension on the shin bump.
In adolescents, ossification of the tibial bump is not yet complete, therefore the patellar tendon is attached to the less robust cartilage; the kneecap tendon exerts a tensile tension on the bone protrusion of the tibia and causes microfractures in the cartilage tissue, causing inflammation.
When the growth phase is complete, the cartilage has completely ossified (ossified) and no damage can occur to the tendon insertion.
Osgood-Schlatter disease can lead to the formation of a hump at the front of the shin bump.
It can occur unilaterally on one knee or on both knees.

What are the symptoms of Osgood-Schlatter disease?

Typical symptoms include pain in the attachment area of the patellar tendon on the shin; edema or swelling may form here.
There is a relatively severe functional limitation because adolescent athletes are affected and their quality of life is thus significantly impaired.
The young patient can not play football as usual and in the acute pain phase walking and climbing stairs is also painful.
The symptoms improve at rest or disappear completely.

How is Osgood-Schlatter’s disease diagnosed?

The doctor asks the patient about his medical history (anamnesis) and conducts an examination, during which palpation of the painful area is carried out; Muscle tests can be used to find out which movements increase the pain.
If it is a patient who is not yet 15 years old, complains of pain in the shin bump, which also has swelling, the suspicion of Osgood-Schlatter disease is more than justified.

Differential diagnoses include fractures or microfractures of the shin, inflammation of the bursa (bursa infrapatellaris) between the kneecap and shin, osteochondrosis dissecans, Sinding-Larsen-Johansson’s disease, although this occurs very rarely.

Which diagnostic imaging methods are used for Osgood-Schlatter’s disease?

To support the diagnosis, the doctor may schedule an X-ray examination, which will indicate the condition of the cartilage; fragmentation or irregular bone formation (ossification) of the bone protrusion on the shin can be easily detected.

Which therapy is recommended for Osgood-Schlatter’s disease?

Immediate measures for Osgood-Schlatter disease include immobilization and cold treatment (ice).
Unfortunately, the condition consists of cartilage damage and there are no medications or electromedical devices that could fix it, but they can relieve inflammation and pain.
The growth cartilage ossifies over time, i.e. it ossifies, as a result of which the disease heals itself within 2-3 years.
If the patient wants to continue exercising, he can try to relieve the tendon with a kneecap support or bandage, which is applied about 2 cm above the shin bump.
Strengthening the muscles is pointless and, on the contrary, can be harmful, because the pressure on the apophysis of the shin would be increased and the strength of the already overdeveloped quadriceps would be increased.

Other bone necrosis

• Perthes disease

Perthes disease is an aseptic bone necrosis of the middle of the body (proximal) femur end and is the most common of all osteochondrosis, especially in children and adolescents between 3 and 13 years of age.
Symptoms include: pain when palpating at hip level with possible radiance to the knee, limping, muscle weakness of the quadriceps, swelling and limb in external rotation and adduction.

If the disease occurs unilaterally, the thickness of the ossification nucleus at the bone end could be less compared to the healthy side.
Part of the ossification nucleus is characterized by necrosis of the bone balls; the X-ray image shows darker and brighter spots, while the magnetic resonance shows the damage more accurately.
The prognosis is usually favorable, but in some cases, the femur does not develop properly, grows less, and the limb remains shorter.
Treatment includes physiotherapy and prevention to relieve symptoms and avoid early hip osteoarthritis, as well as a tutor to relieve the diseased hip and, in the more severe cases, surgical intervention (osteotomy).

• Köhler disease I

Köhler I’s disease is a relatively rare osteochondrosis of the scaphoid bone (os naviculare) of the root of the foot; it consists in the flattening of the bone and development of regions with increased calcium density and necrotic sites.
It mainly affects young girls.
Symptoms are pain in the inner foot and resulting limping.
Diagnosis is made clinically based on age, medical history and symptoms.
As a rule, the doctor will have an X-ray taken that will indicate the condition of the bone.
The course of the disease is usually benign, the symptoms disappear within about 2 years, in the acute phases a plaster cast or bandage is recommended.

• Köhler II disease

Köhler II’s disease refers to proximal osteochondrosis of the second metatarsal bone; the symptoms correspond to those of Köhler I’s disease, the X-ray sign is the flattening of the second metatarsal bone head with increased calcium density.
Treatment consists in the use of an orthopedic insole, which relieves the transverse arch of the foot.

• Scheuermann’s disease

This disease affects the spine, the typical age for occurrence is between 10 and 14 years; it mainly affects tall and thin boys.
Scheuermann’s disease affects the cartilage nuclei of the vertebrae and causes necrosis; in this way, the growth process of the vertebra is not terminated.
There is a deformation in the form of excessive kyphosis, i.e. a round back.
Diagnosis is made by X-ray, which shows the vertebrae with irregular edges and a wedge shape, with the front side flatter than the posterior one.
Scheuermann’s disease is asymptomatic.
Treatment consists of exercises to strengthen and stretch the abdominal muscles; the orthopaedist may recommend wearing a corset to correct posture.

• Osteochondrosis dissecans

Osteochondrosis dissecans is bone necrosis in a small area of the cartilage layer and subchondral bone.
The femur and shin are among the most commonly affected bones, in the area between the two femoral condyles, but also at the level of the ankle joint.
The patients are mainly boys between 8 and 15 years of age, but also adults.
In the late phase of the disease, the part of the necrotic nucleus dissolves and moves freely in the joint (joint mouse).
The cause is unknown, but a traumatic origin or repeated microtrauma is suspected, even if the condition can occur suddenly.
Computed tomography (CT) and magnetic resonance imaging (MRI) are particularly suitable for a reliable diagnosis.
The symptoms are pain, edema, decreased mobility and over time a regressed quadriceps muscle (hypotrophy).

In the first stage, physiotherapy and bandage are recommended, the symptoms often disappear quite suddenly.
In advanced disease, surgical treatment is carried out to fix the ossification nucleus with absorbable screws; if the core has completely dissolved, it must be removed.
At the end of the procedure, the surgeon inserts small perforations into the part of the bone that is not covered by cartilage to favor the formation of fibrous tissue instead of the articular cartilage.

• Calvé’s disease

This extremely rare disease affects the spine and consists of the flattening of the vertebral bodies (vertebra plana).
The vertebra L1 is mainly affected and usually only one bone is affected.
Diagnosis is made by X-ray, which indicates vertebral deformation and bone sclerosis.
Those affected are usually children and adolescents of the male sex between the ages of 3 and 15 years with a lean stature.
Calvé’s disease is usually asymptomatic but may have pain in the diseased region.
Orthopedists recommend wearing a corset as a treatment measure.

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