ANATOMY AND PATHOLOGY OF THE AGING SPINE

The vertebral column is a complicated anatomical structure which is co mposed of the intervertebral discs and the vertebrae. Both components develop special degenerative changes and morphologic features during l ife. This paper first reviews the anatomical fundamentals and then des cribes the morphological features of the aging intervertebral disc and the subsequent osseous changes of the vertebral bodies and the zygapo physeal joints. The aging intervertebral disc is characterised by proc esses which are labeled as intervertebral chondrosis and intervertebra l osteochondrosis. Often these processes are combined with typical dis locations of intervertebral disc tissue in an anterior or dorsolateral direction. The well known Schmorl's nodules must also be mentioned in this context. Furthermore calcification and ossification of the inter vertebral disc tissue can take place. More severe processes lead to os seous changes of the vertebral bodies. In particular, an osteophytosis of the vertebral bodies can be established. These sturdy osteophytes are able to stiffen the vertebral column. Furthermore the arthrotic ch anges of the zygapophyseal joints are delineated in this paper. The sp ecial appearances of these changes are discussed according to the diff erent and specialised regions of the vertebral column. The advanced de generative changes of the zygapophyseal and uncovertebral joints of th e cervical spine are of essential clinical interest because the compre ssion of the vertebral artery or the narrowing of the intervertebral f oramina by these processes may cause severe neurological symptoms. The arthrotic changes of the medial atlantoaxial joint, which lead to the crowned odontoid, and the pseudospondylolisthesis (so called M. Jungh anns) of the lumbar spine must also be mentioned. It is the aim of thi s paper, not only to explain and review the degenerative changes, but to illustrate the anatomy and pathology of the aging spine on the basi s of macerated osseous specimens in order to make radiological investi gations and pictures more understandable and dear. (C) 1998 Elsevier S cience Ireland Ltd. All rights reserved.