[Diagnosis and therapy of erosive intervertebral osteochondrosis]

Pathogenically the erosive intervertebral osteochondrosis is the destructive form of the intervertebral osteochondrosis. This paper aims to define this acute variant by means of diagnostic criteria. In differential diagnosis a spondylodiscitis, an ankylosing spondylitis, a destructive spondylo-arthropathy and a morbus Scheuermann must be considered. Fifteen patients with erosive osteochondrosis were treated at the Department of Orthopaedic Surgery of the University of Mainz between 1990 and 1994. The diagnosis on admission into hospital was incorrect in all cases. Plain X-rays showed a decrease in height in the affected intervertebral room and bony erosions of the adjacent vertebral endplates. Distinction to spondylodiscitis was possible in MRT. In contrast to erosive osteochondrosis in spondylodiscitis edema cannot only be seen in the adjoining vertebrae but also in the affected disc. In later paravertebral inflammatory abscess often can be found. After conservative treatment four patients were free of complaints. 11 patients were operated on due to neurologic symptoms or increasing kyphosis of the lumbar spine. At average follow-up of 16 months intervertebral fusion was found in all operated patients. Lack of publicity and severance to spondylodiscitis seem to be major problems in diagnosing erosive osteochondrosis.