Clinical History
The patient presented with dorsal pain starting 2 years prior to imaging. There was no history of previous trauma or any kind of involvement in sports. The pain was not responding to physiotherapy and analgesics. Due to recent deterioration, the patient was referred for MR imaging.
Imaging Findings
The MR imaging examination consisting of T1-w, T2-w and STIR sequences showed multilevel disc degeneration at the mid- and lower dorsal spine, with disc space narrowing, disc dehydration, endplate irregularity and posterior Schmorl's node (Fig. 1-3). No vertebral wedging was observed throughout the spine. There was no kyphosis or scoliosis.
Discussion
A. Adolescent disc dysplasia (ADD) is a disorder associated with severe back pain and functional limitation. Typically, patients show deterioration of pain with flexion and extension of the spine during physical examination. Currently, there are no validated epidemiological data for this disorder and limited reports exist in the literature [1]. ADD includes endplate irregularity, disc degeneration and disk space narrowing. Schmorl’s nodes may coexist [1]. ADD is quite similar to Scheuermann’s osteochondritis, but the clinical presentation is quite different [2]. The initiation of early disc degeneration in adolescents is not well understood. Mechanical overloading from sports, biochemical changes involving catabolic cell response, cytokines, chemokines, and proteases and failure of the water-binding extracellular matrix, may all contribute to a variable degree.
B. A patient with ADD typically presents with severe back pain that can become chronic. The pain is located in either the thoracic or lumbar spine or both and is not associated with spinal kyphosis [1]. Considering the variety of aetiological agents that can cause dorsal pain, an adequate differential diagnosis is of great importance and should be done by evaluating the patient’s clinical presentation and radiological findings. The role of imaging in ADD is to provide information on the early degeneration of the discs and to rule out other disorders that can cause back pain such as tumours (e.g. osteoid osteoma), Scheuermann’s osteochondritis, inflammatory spondyloarthropathies and spondylolisthesis [3, 4]. Radiologist should convey to the requesting clinician the benign nature of ADD and its difference on imaging grounds with regard to Scheuermann’s osteochondritis.
C. MR imaging is the method of choice for adolescents with back pain due to its ability to image the soft tissues, bone marrow and neural axis. The key findings in MR imaging are irregularities at the end plates, disk space narrowing, nucleus pulposus dehydration and possibly Schmorl’s nodes (Fig. 1-3).
D. Currently, the therapeutic options for ADD are physiotherapy and bracing. Conservative treatment aims to provide a better support for the spine in order to reduce pain. Response to this treatment is quite variable. The patient presented herein showed significant improvement with bracing and non-steroidal anti-inflammatory medication in addition to physiotherapy. MR imaging is invaluable in exploring most of the disorders which are demonstrated with back pain and in particular is able to guide the proper treatment in ADD.
E. It is essential to recognize ADD in adolescents with dorsal pain in order to avoid unnecessary treatment.
Differential Diagnosis List
Adolescent disk dysplasia
Scheuermann\'s osteochondritis
Tumours (e.g. osteoid osteoma)
Axial spondyloarthropathy
Herniated disk
Spondylolysis - Spondylolisthesis
Psychological disorders
Final Diagnosis
Adolescent disk dysplasia
