From the Guidelines
Bone edema adjacent to an osteophyte in lumbar vertebral bodies is more likely degenerative in nature rather than related to axial spondyloarthritis. This distinction is crucial for proper treatment planning, as the management of degenerative conditions and axial spondyloarthritis differs significantly. Degenerative bone marrow edema typically occurs as a mechanical response to altered loading patterns caused by the osteophyte formation and is part of the normal aging process in the spine. It tends to be localized to the endplates and areas adjacent to osteophytes. In contrast, bone marrow edema in axial spondyloarthritis usually presents in a more diffuse pattern, often involving the corners of vertebral bodies (corner lesions or Romanus lesions), and is accompanied by other inflammatory features, such as sacroiliitis and enthesitis 1.
The distribution pattern of the edema is key to differentiating between these conditions - degenerative edema follows biomechanical stress lines, while inflammatory edema in spondyloarthritis tends to be more widespread and symmetrical. Additionally, degenerative edema often coexists with other degenerative findings like disc degeneration, facet arthropathy, and Modic changes, whereas spondyloarthritis typically shows sacroiliitis, enthesitis, and eventually syndesmophyte formation rather than osteophytes. The presence of osteophytes, which are more characteristic of degenerative changes, further supports the likelihood of a degenerative origin of the bone edema.
MRI with fat suppression sequences is the optimal imaging modality to differentiate between these conditions, as it best highlights the pattern and extent of bone marrow edema 1. The use of MRI can help identify the specific characteristics of the bone edema and surrounding structures, allowing for a more accurate diagnosis and treatment plan. In the context of axial spondyloarthritis, MRI findings such as corner inflammatory lesions, fatty corner lesions, and sacroiliitis are critical for diagnosis and monitoring of the disease 1.
Given the information provided and the current understanding of degenerative and inflammatory spinal conditions, a degenerative origin of the bone edema is the most likely diagnosis, and treatment should be focused on addressing the underlying degenerative changes rather than inflammatory processes. However, a comprehensive clinical evaluation, including imaging and laboratory tests, is necessary to confirm the diagnosis and rule out other potential causes of the bone edema.
From the Research
Bone Edema Adjacent to an Osteophyte in Lumbar Vertebral Bodies
- The nature of edema can be either degenerative or related to axial spondyloarthritis.
- A study published in 2022 2 found that bone marrow edema (BME) adjacent to a sclerotic endplate of the lumbar spine is closely associated with low back pain in patients with degenerative lumbar diseases.
- The study used T2-weighted fat-saturated MRI to detect BME and calculated contrast ratios (CRs) of BME and normal bone marrow using signal intensities.
- Another study published in 2016 3 reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes, which are fibrocartilage-capped bony outgrowths that can cause pain and limit range of motion.
Axial Spondyloarthritis
- Axial spondyloarthritis (axSpA) is an inflammatory disease of the axial skeleton associated with significant pain and disability 4, 5.
- The disease can be classified into non-radiographic (nr)-axSpA and radiographic axSpA, with the latter being also termed ankylosing spondylitis.
- Studies have shown that tumor necrosis factor (TNF)-α and interleukin-17 play a relevant role in the pathogenesis of axSpA 4, 5.
- Magnetic resonance imaging (MRI) is currently the most accurate imaging tool used in axial spondyloarthritis, and can be used to assess inflammation on the spine and sacroiliac joints (SIJ) 6.
Differentiation between Degenerative and Axial Spondyloarthritis-Related Edema
- There is limited evidence to distinguish between changes in MRI inflammatory lesions of the spine and SIJ in patients with axial SpA related to TNF alpha inhibitor effects and those due to the natural course of the disease activity 6.
- Further studies are needed to quantify bone marrow edema adjacent to the lumbar vertebral endplate on MRI and to assess its association with degenerative lumbar diseases or axial spondyloarthritis.