Radiologic and pathologic patterns of end-plate–based vertebral sclerosis

Degenerative spondyloarthropathy is the result of a number of related pathologic processes, including loss of disc elasticity, repetitive mild trauma, and osteoporosis. The effects are manifested microscopically in a number of patterns reflecting alterations in stress, healing microfractures, and bone-cartilage interactions along the vertebral end-plate. The microscopic changes lead in turn to radiographically evident vertebral body sclerosis. The resultant sclerosis is not always in the classic band-like pattern along the vertebral end-plate, and the atypical patterns may be difficult to recognize as degenerative in origin. In a detailed analysis of clinical and postmortem material, we have categorized both the pathologic and radiographic patterns of benign non-Pagetic vertebral body sclerosis. This radiographic classification provides a unified framework for clinical recognition of the various patterns of degenerative sclerosis.