Difference between revisions of "Degenerative disc disease"

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#redirect [[Spine#Degenerative disc disease]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Degenerative_disc_disease_-_high_mag.jpg
| Width      =
| Caption    = Degenerative disc disease. [[HPS stain]].
| Synonyms  =
| Micro      = benign fibrous tissue, nests of chondrocytes
| Subtypes  =
| LMDDx      = [[chondrocalcinosis]], [[synovial cyst]], malignancy (primary or metastasis)
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = vertebral disc - see ''[[spine]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = back pain
| Prevalence = common
| Bloodwork  =
| Rads      = disc herniation
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        = surgical (e.g. discectomy)
}}
'''Degenerative disc disease''', abbreviated '''[[DDD]]''', is a common [[ditzel]], typically generated in the course of a discectomy operation.
 
''Sciatica'',<ref name=pmid26023617>{{Cite journal  | last1 = Suthar | first1 = P. | last2 = Patel | first2 = R. | last3 = Mehta | first3 = C. | last4 = Patel | first4 = N. | title = MRI evaluation of lumbar disc degenerative disease. | journal = J Clin Diagn Res | volume = 9 | issue = 4 | pages = TC04-9 | month = Apr | year = 2015 | doi = 10.7860/JCDR/2015/11927.5761 | PMID = 26023617 }}</ref> ''vertebral disc'' and ''discectomy'' redirect here.
==General==
*Herniated disc - causes back pain.
*May result in ''cauda equina syndrome''.
*Composed of ''fibrous cartilage''.<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Cartilage/Cartil.htm http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Cartilage/Cartil.htm]. Accessed on: 2 January 2010.</ref>
 
==Microscopic==
Features:
*Benign fibrous tissue.
*Nests of chondrocytes (as in immature [[cartilage]]).
*+/-Synovium with or without proliferation.<ref name=pmid16393686/>
*+/-Neovascularization of disc material.<ref name=pmid16393686/>
*Hemosiderin deposits (trauma or previous surgery).
 
DDx:
*[[Chondrocalcinosis]] (CPPD).<ref name=pmid16393686>{{Cite journal  | last1 = Pytel | first1 = P. | last2 = Wollmann | first2 = RL. | last3 = Fessler | first3 = RG. | last4 = Krausz | first4 = TN. | last5 = Montag | first5 = AG. | title = Degenerative spine disease : pathologic findings in 985 surgical specimens. | journal = Am J Clin Pathol | volume = 125 | issue = 2 | pages = 193-202 | month = Feb | year = 2006 | doi = 10.1309/89FV-RT04-EGBV-EUD9 | PMID = 16393686 }}</ref>
*[[Synovial cyst]].
*Malignancy - very rare if not suspected.
**''Not'' reported in a series of 985 specimens.<ref name=pmid16393686/>
** Unexpected malignancy in 2 of 2177 specimens.<ref name=pmid16506461>{{Cite journal  | last1 = Hasselblatt | first1 = M. | last2 = Maintz | first2 = D. | last3 = Goll | first3 = T. | last4 = Wildförster | first4 = U. | last5 = Schul | first5 = C. | last6 = Paulus | first6 = W. | title = Frequency of unexpected and important histopathological findings in routine intervertebral disc surgery. | journal = J Neurosurg Spine | volume = 4 | issue = 1 | pages = 20-3 | month = Jan | year = 2006 | doi = 10.3171/spi.2006.4.1.20 | PMID = 16506461 }}</ref>
 
===Images===
<gallery>
Image:Degenerative_disc_disease_-_intermed_mag.jpg | Degenerative disc disease - intermed. mag. (WC)
Image:Degenerative_disc_disease_-_high_mag.jpg | Degenerative disc disease - high mag. (WC)
</gallery>
<gallery>
Image: Degenerative disc disease -- intermed mag.jpg | DDD - intermed. mag. (WC)
Image: Degenerative disc disease -- high mag.jpg | DDD - high mag. (WC)
Image: Degenerative disc disease -- very high mag.jpg | DDD - very high mag. (WC)
</gallery>
www:
*[http://radiology.rsna.org/content/245/1/43/F3.expansion.html Degenerative disk disease (rsna.org)].<ref name=pmid17885180>{{Cite journal  | last1 = Modic | first1 = MT. | last2 = Ross | first2 = JS. | title = Lumbar degenerative disk disease. | journal = Radiology | volume = 245 | issue = 1 | pages = 43-61 | month = Oct | year = 2007 | doi = 10.1148/radiol.2451051706 | PMID = 17885180 }}</ref>
*[http://library.aua.edu.ag/webpath/webpath/histhtml/normal/norm004.htm Normal vertebral disc (edu.ag)].
 
==Sign out==
<pre>
Disc Material (L4-L5 Disc), Excision:
- Consistent with disc material (gross only).
</pre>
 
<pre>
Disc Material (Left L5-S1 Disc), Excision:
- Consistent with disc material (gross only).
</pre>
 
Note:
*May be [[gross only]] specimens; a minority of institutions handle these specimens this way.<ref name=pmid10050786>{{Cite journal  | last1 = Zarbo | first1 = RJ. | last2 = Nakhleh | first2 = RE. | title = Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions. | journal = Arch Pathol Lab Med | volume = 123 | issue = 2 | pages = 133-9 | month = Feb | year = 1999 | doi = 10.1043/0003-9985(1999)1230133:SPSFGE2.0.CO;2 | PMID = 10050786 }}</ref>
**It is suggested that gross only specimens should have no history or suspicion of malignancy - based on the surgical note, available pathology and imaging.
 
===Block letters===
<pre>
CERVICAL DISC, DISCECTOMY:
- DISC WITH DEGENERATIVE CHANGES.
- NO EVIDENCE OF MALIGNANCY.
</pre>
 
<pre>
LUMBAR DISC, DECOMPRESSION:
- DEGENERATIVE DISC DISEASE.
</pre>
 
==See also==
*[[Spine]].
 
==References==
{{Reflist|1}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 18:30, 8 April 2016

Degenerative disc disease
Diagnosis in short

Degenerative disc disease. HPS stain.
LM benign fibrous tissue, nests of chondrocytes
LM DDx chondrocalcinosis, synovial cyst, malignancy (primary or metastasis)
Site vertebral disc - see spine
Symptoms back pain
Prevalence common
Radiology disc herniation
Prognosis benign
Treatment surgical (e.g. discectomy)

Degenerative disc disease, abbreviated DDD, is a common ditzel, typically generated in the course of a discectomy operation.

Sciatica,[1] vertebral disc and discectomy redirect here.

General

  • Herniated disc - causes back pain.
  • May result in cauda equina syndrome.
  • Composed of fibrous cartilage.[2]

Microscopic

Features:

  • Benign fibrous tissue.
  • Nests of chondrocytes (as in immature cartilage).
  • +/-Synovium with or without proliferation.[3]
  • +/-Neovascularization of disc material.[3]
  • Hemosiderin deposits (trauma or previous surgery).

DDx:

Images

  • Degenerative disc disease - intermed. mag. (WC)

  • Degenerative disc disease - high mag. (WC)

  • DDD - intermed. mag. (WC)

  • DDD - high mag. (WC)

  • DDD - very high mag. (WC)

www:

Sign out

Disc Material (L4-L5 Disc), Excision:
- Consistent with disc material (gross only).

Disc Material (Left L5-S1 Disc), Excision:
- Consistent with disc material (gross only).

Note:

  • May be gross only specimens; a minority of institutions handle these specimens this way.[6]
    • It is suggested that gross only specimens should have no history or suspicion of malignancy - based on the surgical note, available pathology and imaging.

Block letters

CERVICAL DISC, DISCECTOMY:
- DISC WITH DEGENERATIVE CHANGES.
- NO EVIDENCE OF MALIGNANCY.

LUMBAR DISC, DECOMPRESSION:
- DEGENERATIVE DISC DISEASE.

See also

References

  1. ↑ Suthar, P.; Patel, R.; Mehta, C.; Patel, N. (Apr 2015). "MRI evaluation of lumbar disc degenerative disease.". J Clin Diagn Res 9 (4): TC04-9. doi:10.7860/JCDR/2015/11927.5761. PMID 26023617.
  2. ↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Cartilage/Cartil.htm. Accessed on: 2 January 2010.
  3. ↑ 3.0 3.1 3.2 3.3 Pytel, P.; Wollmann, RL.; Fessler, RG.; Krausz, TN.; Montag, AG. (Feb 2006). "Degenerative spine disease : pathologic findings in 985 surgical specimens.". Am J Clin Pathol 125 (2): 193-202. doi:10.1309/89FV-RT04-EGBV-EUD9. PMID 16393686.
  4. ↑ Hasselblatt, M.; Maintz, D.; Goll, T.; Wildförster, U.; Schul, C.; Paulus, W. (Jan 2006). "Frequency of unexpected and important histopathological findings in routine intervertebral disc surgery.". J Neurosurg Spine 4 (1): 20-3. doi:10.3171/spi.2006.4.1.20. PMID 16506461.
  5. ↑ Modic, MT.; Ross, JS. (Oct 2007). "Lumbar degenerative disk disease.". Radiology 245 (1): 43-61. doi:10.1148/radiol.2451051706. PMID 17885180.
  6. ↑ Zarbo, RJ.; Nakhleh, RE. (Feb 1999). "Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions.". Arch Pathol Lab Med 123 (2): 133-9. doi:10.1043/0003-9985(1999)1230133:SPSFGE2.0.CO;2. PMID 10050786.
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