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Neuroradiologie Scan 2016; 06(04): 295-322
DOI: 10.1055/s-0042-115256
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© Georg Thieme Verlag KG Stuttgart · New York

Ungewöhnliche Manifestationen von Bandscheibenerkrankungen[1]

Uncommon manifestations of intervertebral disk pathologic conditions
Felix E. Diehn
,
Timothy P. Maus
,
Jonathan M. Morris
,
Carrie M. Carr
,
Amy L. Kotsenas
,
Patrick H. Luetmer
,
Vance T. Lehman
,
Kent R. Thielen
,
Ahmad Nassr
,
John T. Wald
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Publikationsverlauf

Publikationsdatum:
13. Oktober 2016 (online)

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Zusammenfassung

Bandscheibenerkrankungen können sich, über das vertraute Bild des Bandscheibenvorfalls (Diskushernie) mit seinen typischen klinischen Merkmalen hinaus, durch ein breites Spektrum von Bildgebungsbefunden und klinischen Charakteristika manifestieren. Ziel dieses Reviews ist die bildliche Darstellung und Erörterung ungewöhnlicher Manifestationen von Bandscheibenerkrankungen, denen der Radiologe begegnen kann: Bandscheibenvorfälle mit ungewöhnlicher Lokalisation, Erkrankungen mit atypischen Bildgebungsbefunden und solche mit ungewöhnlicher Pathophysiologie. Bei den vorgestellten Beispielen atypischer Bandscheibenvorfälle handelt es sich um Vorfälle in den dorsalen Epiduralraum sowie intradurale, symptomatische thorakale (einschließlich solcher mit sehr großen Kalzifikationen), extrem laterale (retroperitoneale), Fluor-18-Fluordesoxyglukose-avide, akute intravertebrale (Schmorl-Knoten) und massive lumbale Bandscheibenvorfälle. Als Beispiele mit atypischer Pathophysiologie werden Diskuszysten, fibrokartilaginöse Rückenmarksembolien, kalzifizierte Miniaturbandscheiben oder in Höhe eines Bandscheibenfachs auftretende Osteophytensporne als Ursache von Liquorlecks und intrakraniellem Unterdruck sowie die akute kalzifizierende Diszitis des Kindesalters vorgestellt. Die Größe der Bandscheiben ist bei diesem breiten Krankheitsspektrum sehr unterschiedlich und reicht von winzig (z. B. bei den verkalkten Miniaturbandscheiben als Ursache von Liquorlecks mit Austreten großer Liquormengen) bis zu extrem groß (z. B. bei den riesigen kalzifizierten, thorakalen intraduralen Bandscheibenvorfällen als Ursache von Myelopathien). Auch mit Blick auf den akuten Charakter der klinischen Symptomatik ist das vorgestellte Krankheitsspektrum breit: Es reicht von hyperakuten fibrokartilaginösen Embolien als Ursache von Rückenmarksinfarkten über akute Schmorl-Knoten bis hin zu chronischen intraduralen Herniationen. Zudem sind die typischen klinischen Verläufe sehr verschieden, angefangen von den meist verheerenden Folgen eines Rückenmarksinfarkts aufgrund einer fibrokartilaginösen Embolie bis zum gewöhnlich spontanen Abklingen der akuten kalzifizierenden Diszitis des Kindesalters. Bei manchen Krankheiten sind gründliche differenzialdiagnostische Überlegungen erforderlich, während andere anhand der Bildgebungsbefunde relativ leicht zu diagnostizieren sind. Die pathophysiologischen Zusammenhänge sind in manchen Fällen wohlbekannt, in anderen dagegen weitgehend ungeklärt. Der Radiologe muss dieses breite Spektrum ungewöhnlicher Bandscheibenerkrankungen kennen, um richtige radiologische Diagnosen stellen zu können.

Abstract

Beyond the familiar disk herniations with typical clinical features, intervertebral disk pathologic conditions can have a wide spectrum of imaging and clinical manifestations. The goal of this review is to illustrate and discuss unusual manifestations of intervertebral disk pathologic conditions that radiologists may encounter, including disk herniations in unusual locations, those with atypical imaging features, and those with uncommon pathophysiologic findings. Examples of atypical disk herniations presented include dorsal epidural, intradural, symptomatic thoracic (including giant calcified), extreme lateral (retroperitoneal), fluorine 18 fluorodeoxyglucose-avid, acute intravertebral (Schmorl node), and massive lumbar disk herniations. Examples of atypical pathophysiologic conditions covered are discal cysts, fibrocartilaginous emboli to the spinal cord, tiny calcified disks or disk-level spiculated osteophytes causing spinal cerebrospinal fluid (CSF) leak and intracranial hypotension, and pediatric acute calcific discitis. This broad gamut of disease includes a variety of sizes of disk pathologic conditions, from the tiny (eg, the minuscule calcified disks causing high-flow CSF leaks) to the extremely large (eg, giant calcified thoracic intradural disk herniations causing myelopathy). A spectrum of clinical acuity is represented, from hyperacute fibrocartilaginous emboli causing spinal cord infarct, to acute Schmorl nodes, to chronic intradural herniations. The entities included are characterized by a range of clinical courses, from the typically devastating cord infarct caused by fibrocartilaginous emboli, to the usually spontaneously resolving pediatric acute calcific discitis. Several conditions have important differential diagnostic considerations, and others have relatively diagnostic imaging findings. The pathophysiologic findings are well understood for some of these entities and poorly defined for others. Radiologists’ knowledge of this broad scope of unusual disk disease is critical for accurate radiologic diagnoses.

1 © 2016 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2016; 36: 801–823. Online published in 10.1148/rg.2016150223. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.


 

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