Spinal bone marrow edema: what is it, causes, symptoms, diagnosis, treatment and possible consequences

In the article, we will consider what it is - bone marrow edema of the spine. First of all, we will determine the concept.

Bone marrow is an organ that is located inside the bone tissue and pineal glands (endocrine glands of the neurogenic group) and performs the function of hematopoiesis, which is why it is also called hematopoietic or red brain. Edema of this organ is a fairly common pathology, which in most cases occurs without severe symptoms (or with blurred clinical signs) and is detected by chance during magnetic resonance imaging in connection with other diseases, for example, intervertebral hernia.

Most often, the accumulation of inflammatory exudate in the tissue of the spongy bone and bone marrow occurs due to various infectious processes and injuries leading to inflammation of the synovial membranes of the joints of the spine. Classical methods of therapy using forced diuresis are ineffective in such disorders, therefore self-medication after a diagnosed edema of the red spinal cord of the spine is unacceptable due to the high risk of serious complications.

Description, features of the organ

The hematopoietic (bone) brain is located in a spongy substance, which in medicine is called trabecular tissue, since it consists of trabeculae (loose bone plates and septa). The bulk of the bone marrow is located in the bones of the small and large pelvis, sternum and cranium. In the body of the vertebrae, the volume of brain red matter is significantly less than that in the tubular bones, however, trabecular edema of the spine can cause serious complications, the main of which is a decrease in immune function and the rapid progression of autoimmune pathologies (for example, rheumatoid arthritis).

The structure of the red brain is due to its functions, including participation in the formation of red blood cells, the formation of immune chains when interacting with lymphoid organs in the peripheral system. The bulk of the bone marrow is the skeleton (fibrous stroma). Hematopoietic tissue represents five mature sprouts producing blood cells: red blood cells, lymphocytes, granulocytes (granular leukocytes), megakaryocytes (giant bone marrow cells) and monocytes.

So, spinal bone marrow edema - what is it?

Pathology Description

Edema of the red brain occurs due to excessive accumulation of fluid or inflammatory exudate in the area of ​​the spongy substance of the vertebrae and pineal glands of the sternum and pelvis, therefore this pathology is often interpreted as trabecular edema.

It manifests itself in the form of the following changes in the bone-cartilage structures of the spine:

1. An increase in the amount of fluid in the structure of the trabecular plates. Its normal content in the bones of the spine is approximately 10% (the remaining 90% are inorganic substances and the extracellular matrix). With edema, the fluid volume sometimes reaches 20% or more.
2. An increase in the vertebral body, which is caused by an increase in the volume of the spongy substance.
3. Transition of edema to nearby tissues (including nerve tissue and subarachnoid space).

Not everyone knows what it is - bone marrow edema of the spine.

Some patients call edema of the bone marrow of the spine a bone hematoma, but this is not the right term. A hematoma is an accumulation of blood due to damage to small blood vessels and capillaries that supply blood to the vertebrae, while edema is an excessive accumulation of fluid, mainly inflammatory exudate. The hematoma itself is almost always the cause of swelling of the bone marrow and trabecular substance, and therefore, pathogenetically, these phenomena must be considered different pathologies.

We consider the treatment of spinal bone marrow edema below, but for now let's talk about the causes of the disease.

Why do pathologies develop?

The main reason is a variety of injuries and injuries of the spine. Such edema is called primary, and they develop as a result of falls, bruises, bumps and various injuries of the spine. Hematomas form in the vertebral bodies, and blood and lymph come out of the damaged blood vessels, which begin to exert pressure on the trabecular substance. Edema resulting from injuries is usually localized exclusively in bone tissue, but in some cases it can spread to the paravertebral tissue of the spine (tendons, muscles, ligaments, synovial integument).

Secondary edema of the bone marrow of the cervical spine is not an independent pathology and develops against the background of degenerative and infectious inflammatory processes in the intervertebral discs and vertebral bodies. Extensive and correct diagnosis is of great importance for the appointment of adequate therapy, since the treatment of trabecular edema is always selected taking into account the reasons for their development. They may be:

1. Infectious damage to the spine (spinal tuberculosis, osteomyelitis, spondylitis, spondylodiscitis). As a response to tissue infection, an active release of inflammatory exudate begins, which causes an increase in the vertebrae and their deformation. The most dangerous in this regard is acute hematogenous osteomyelitis, in which many purulent foci are formed near the bone marrow and purulent contents accumulate.
2. An inflammatory process in the joints of the spine called osteoarthritis. Inflammation of the vertebrae and their membranes is accompanied by edema of the bones and nearby tissues and can be manifested by pain and limitation of motor activity.
3. Degenerative-dystrophic pathologies. Such diseases include osteochondrosis, intervertebral hernias, spondylolisthesis, deforming arthrosis, etc.

The likelihood of swelling of the red brain increases significantly if the patient suffers from diseases of the endocrine system or metabolic disorders, since one of the factors of excessive fluid accumulation and protein retention in the intercellular space is considered to be the slowed down process of excretion of sodium ions from the body.

Varieties of edema

The classification of red bone marrow edema is based on the etiological and pathogenetic mechanism of their development.

Types of bone marrow edema :

1. Aseptic - occurs against a background of protracted or pronounced degenerative and degenerative changes in the vertebrae and intervertebral discs that connect them.
2. Traumatic - develops as a result of various injuries and injuries, as well as exposure to mechanical and chemical factors.
3. Reactive edema of the bone marrow of the spine. This is edema, which is formed for no apparent reason due to latent or sluggish inflammatory processes. Allergic edema also falls into this category.
4. Perifocal edema of the bone marrow of the spine. It is characterized by the destruction of bone plates and the formation of edema against the background of tumor processes (including benign neoplasms).
5. Infectious, caused by a bacterial, fungal and viral infection that affects the bones of the spine (including exposure to tuberculosis mycobacteria). Very rarely, the cause of this pathological process can be protozoan invasions and chronic helminthiases.

Depending on where the inflammatory process is localized, edema can be trabecular and subchondral. What's the Difference?

With subchondral edema of the bone marrow of the spine, subchondral bone plates are affected. This pathology is not too common.

With trabecular edema of the bone marrow of the spine, fluid accumulates in the spongy substance. This disease is the most common type of edema of the blood-forming brain.

Symptoms of pathology

The clinical picture in bone marrow edema is almost always blurred, which complicates the diagnosis and often leads to dangerous complications. The first (and in most cases the only) clinical sign of such phenomena is pain. A distinctive feature of pain in such patients is its localization: soreness, as a rule, appears not at the site of the development of the pathological process, but at a certain distance above. This is due to the fact that the vertebra, which swells from excessive accumulation of fluid in it, begins to squeeze the nerve fibers of the spinal cord located above, as well as the muscles and ligaments located in the neighborhood.

With a prolonged absence of necessary therapy, the spinal cord is often involved in the process, therefore, the clinical picture of primary disorders can intersect with neurological symptoms.

Key features

In general, the following symptoms are the main signs of bone marrow edema of the cervical spine:

• aching pain, mainly above the affected vertebra (soreness may increase at rest, as well as with various types of physical activity);
• disturbances in the functioning of the pelvic organs (difficulty urinating, constipation with painful tenesmus, pain during the act of defecation or emptying of the bladder);
• neurological disorders (loss of sensation of limbs).

Constant aching pain above the affected vertebra is the main symptom of bone marrow edema. With damage to the cervical zone, the occurrence of hydrocephalus (excessive accumulation of cerebrospinal fluid in the cavity of the ventricles of the brain), an increase in intracranial pressure, damage to the nerve endings, which are responsible for the innervation of the eye muscles.

If bone marrow edema of the lumbar spine occurs, the symptoms are pain in the pelvis, sacrum, and impaired gait.

Since the bone marrow is involved in the formation of the immune system, pathologies of this organ are manifested by a decrease in the body's resistance to the influence of allergens and pathogenic agents. The patient may have allergic reactions, intestinal and catarrhal infections.

Hemorrhagic syndrome with damage to the bone marrow is pronounced, its localization is not always noted at the site of the pathological process. The patient develops bleeding gums, frequent nosebleeds, and bruises form on the body.

The most important symptom of bone marrow edema is anemia, which is characterized by a decrease in hemoglobin level.

Diagnostics

When choosing diagnostic methods for signs of edema of the bone marrow of the spine, it is important to take into account that radiography does not determine the signs of exudate or fluid accumulation. It will be advisable for such patients to use magnetic resonance imaging (tomography).

The main task of MRI is to identify possible edema and their location. Additional diagnostic techniques are aimed at determining the causes of edema and associated pathological phenomena. Depending on the symptoms, these may be the following methods:

• multispiral computed tomography;
• blood test for rheumatoid factor and tumor markers;
• radiography of the spine;
• examination of cerebrospinal fluid paths (if there are suspicions of complications in the spinal cord located in the central spinal column).

To exclude the presence of oncological processes, a biopsy of biological material can be prescribed with subsequent histological examination.

What is the treatment for spinal bone marrow edema?

Therapy

Given the etiological factors and the causes of bone marrow edema, it can be said that the only therapeutic technique in most cases is surgery. Surgical correction is necessary for a variety of injuries, osteomyelitis, intervertebral hernias and other pathologies, against which there is an excessive accumulation of fluid in the trabeculae.

How to treat bone marrow edema with drugs?

Medicines

Drug therapy may include the following categories of drugs:

• non-narcotic analgesics (Metamizole Sodium);
• psychotropic analgesics from the opioid group with the ineffectiveness of non-narcotic drugs ("Tramadol");
• anti-inflammatory drugs with analgesic effects (Nimesulide, Ketorol, Diclofenac);
• glucocorticoids to reduce exudation and eliminate inflammation ("Hydrocortisone", "Dimexide");
• B vitamins for the normalization of tissue trophism (“Combilipen”);
• medicines stimulating the blood circulation processes (Actovegin, Trental).

To maximize the effectiveness of drug therapy for severe inflammatory processes, potassium iodide is used. If bacterial infections become the cause of the pathology, antibiotics are prescribed (Clarithromycin, Amoxicillin). With tuberculosis of the spine , specific tuberculosis treatment is carried out.

The consequences of bone marrow edema

For the development of edema of the hematopoietic bone marrow of the spine, exposure to certain pathological causes is necessary. The consequences of this pathological condition are very diverse and can vary significantly, starting from a partial violation of all functional qualities and ending with paralysis, and in certain cases a fatal outcome can be observed. The most common complication of this disease is loss of mobility of the limbs, as well as a change in the functioning of the pelvic organs. Nevertheless, with timely treatment, the disease can go away without causing any complications.

We examined what it is - bone marrow edema of the spine.