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Sclerosis at the vertebral endplate is a commonly encountered plain film radiographic abnormality, caused by primary or secondary tumors, infection, aseptic necrosis, inflammatory arthritis, trauma, or degenerative disease.1,2 The most frequently encountered lesion is probably degenerative, appropriately called discogenic vertebral sclerosis (DVS). The exact cause for the sclerosis is unknown, but this entity has received much attention in the radiologic literature and has been referred to by a variety of names: non-neoplastic sclerosis,3 pseudoinfection of the intervertebral disc and adjacent vertebrae,4 discogenic vertebral sclerosis,5 atypical degenerative lesion,6 hemispherical spondylosclerosis,7 idiopathic segmental or vertebral sclerosis,8,9 vertebral rim lesions,10 or degenerative spondyloarthropathy.2 However, the disease has been reported infrequently in the orthopedic literature.9
Patients with DVS may show a variety of radiographic changes on plain radiographs, ranging from minimal sclerosis around a Schmorl's node, to intense vertebral body sclerosis resembling the "ivory" vertebra of metastatic disease. The sclerosis may also involve primarily two adjacent vertebral endplates and be mistaken for infection.4
We report three patients with DVS on plain films and describe other radiographic abnormalities which may be encountered in this entity. The appropriate radiographic work-up in patients suspected of having DVS is also included. Orthopedists and radiologists should be familiar with this entity because of its mimesis of more sinister pathology.
CASE REPORTS
Case 1. A 53-year-old woman was evaluated at the gynecology clinic for cervical dysplasia. Physical examination was unremarkable. She had sustained spine trauma 20 years previously and at the time of examination had vague nonradiating low back pain. A lumbar spine series showed an area of sclerosis in the anteroinferior border of L4, with osteophytes at the L4-L5 interspace (Fig 1). The endplates were preserved, and no further work-up was performed. Follow up at 5 years showed little change in the sclerosis, and the patient's pain has been well-controlled with antiinflammatory, nonsteroidal analgesics.
Case 2. A 48-year-old woman presented with low back pain and radiation to the anterior aspect of the left thigh of 6 months duration. There was no apparent history of trauma, and physical examination and laboratory studies were normal. A lumbosacral spine series done 2 years before her referral to our hospital demonstrated intense endplate sclerosis at the LI-L2 interspace with osteophytes (Figs 2AB). These changes showed progression at...