Spinal bone marrow edema: what is it?

Trabecular edema is an acute, pathologically complex process characterized by changes in the structure of bone tissue (bone marrow trabeculae), which occurs with severe inflammation, fracture, dislocation and injury to bones of any part of the skeleton. Simply put, this is the destruction of bone tissue in the joints. This phenomenon can, for example, manifest itself in arthritis and osteoporosis of the knee, as well as dysplastic processes in the vertebral skeleton. Often, swelling is localized in the hip bone, knee joint (tibia or femur), spine (spinal cord) and other bones (skull, cervical spine). Today there is a system for treating edema of any complexity, and in order to reduce the risk of complications it is necessary to undergo examination, including MRI and MCT of bone tissue.

Causes

Trabecular edema occurs more often in people prone to constant injury, for example, athletes, those who lead an active lifestyle, as well as elderly people in whom swelling occurs after injury or with chronic joint pathology. Doctors identify the following factors for the development of the disease:

1. Edema manifests itself as a result of fractures, operations, inflammation and violations of the integrity of the capillaries of bone tissue.
2. Accumulation of internal fluid of the bone, as well as collagen fibers (at the site of damage, a tumor of varying degrees appears).
3. Bone cells (osteoblasts, osteocytes, osteoclasts) swell. This is a more serious disorder than the accumulation of fluid in the alveoli (pneumonia).

Stopping movement and accumulation of bone fluid in the trabeculae may indicate a bruise or sprain, for example, of ligaments or vertebrae. It can be observed in patients with knee arthritis and spinal osteochondrosis. In this regard, excess fluid inside the bone marrow leads to disruption of hematopoietic processes. Trabecular edema occurs most often with pathologies that are localized in the very center of the bone marrow lesion or near it. This disease develops due to a violation of the composition and integrity of cartilage (tendons, ligaments).

Trabecular edema, types of this condition

As in other similar cases, trabecular edema does not differ in the basic principles of development; it is just an accumulation of excess fluid, but in this case the problem is observed in the bone tissue. But, as mentioned earlier, there are several types of this condition:

• Vasogenic trabecular edema. Occurs due to various types of injuries, inflammation (against the background of injured capillaries). Quite often, this disease affects athletes, and injuries are observed in the area of ​​the hip bone, knee joints (fibula or femur, often in the area of ​​the medial condyle). It can also be provoked by various types of operations in potentially problematic areas,
• Cytotoxic edema. Excess fluid begins to accumulate directly in the bone marrow cells - osteoblasts, osteocytes, and osteoclasts. This is one of the most complex forms of development,
• Interstitial trabecular edema of the bone marrow. In this case, the liquid breaks down in the collagen fibers (intercellular space).

Such a tumor is only a manifestation of other pathological processes that are observed in the lesion. Treatment is aimed at eliminating the underlying disease.

Bone marrow of the knee

Trabecular edema of the bone marrow of the knee
Damages and injuries to the knee most often occur in athletic and active people, as well as the elderly due to sports injuries, stress, and unsuccessful landings from a height. The consequences of this type of injury are often superficial (fractures, bruises, dislocations), but often a knee joint injury can result in intraosseous destruction (bone marrow). Symptoms of trabecular edema of the knee joint: constant aching pain inside the bone, or “itching” bone syndrome, swelling in the area of ​​injury, pain on palpation of the inflamed area. Consequences of prolonged swelling:

• Limitation of range of motion of the knee joint (stiffness);
• Lameness and unsteadiness when moving;
• Reduced formation of new blood cells and immune system, as well as the formation of cartilage and tendons;
• Reduced length of the femur and tibia;
• Suppression of the immune system and its functions.

Treatment for knee swelling includes both medication and surgery, depending on the severity of symptoms of bone damage.

Symptoms

If swelling of the spine occurs, symptoms appear on different sides. The plexuses of nerves extending from the spinal cord are responsible for the functioning of internal organs: the bladder, intestines, kidneys, etc. When the disease occurs, the impulses are dulled, and this leads to urinary and fecal incontinence, or vice versa, constipation.

Neurological symptoms may occur , including a violent reaction of the pupils to light.

At the initial stages of the disease, the following symptoms may occur:

• frequent aching pain,
• irritability of the bone, feeling of constant itching,
• swelling on the damaged surface,
• pain when touching the inflamed area,
• nausea, weakness, sometimes dizziness,
• vasospasm.

With a long period of illness, more serious consequences may occur:

• stiffness in joint movement,
• lameness,
• cessation of the formation of new cartilage and tendons,
• general weakening of the immune system.

Spinal cord

Trabecular edema of the spinal cord on x-ray Swelling
of the spinal cord can occur as a result of new or old injuries and diseases of the spine, tumors, and circulatory disorders. Local and general swelling are divided. The first is observed, for example, with a pinpoint injury or dislocation of the spine or vertebrae, so swelling (or redness) occurs only in the place where the damage occurred. General swelling of the spinal cord occurs in patients with severe forms of diseases (osteochondrosis, spondylosis, dysplastic processes), as well as household injuries (falling from a height, heavy lifting, accidents), in which swelling of the entire spinal region often occurs. Damage to the bone marrow of the spine can manifest itself in different ways, depending on the damaged area: cervical region - impaired function of the arms and legs, thoracic region - torso and lower limbs, lumbar - impaired function of the lower torso. Symptoms:

• The sensitivity of the limbs decreases (legs and arms are taken away);
• Fatigue, dizziness, nausea;
• Acute pain when walking in the area of ​​shock;
• Decreased emptying of urine and rectum (constipation, incontinence).
• Spasm of capillaries and blood vessels.

Diagnosis of bone tumors

The main symptom when a tumor appears is the presence of the tumor itself, often a growing one, and pain in the area of ​​the tumor lesion. Diagnostics comes down to examining the patient by a doctor, performing diagnostic procedures such as X-rays, MRIs, and, if necessary, other more specialized techniques. The crown of the diagnostic trifecta is the morphological examination of the tumor, which involves either the study of biopsy material or the study of the tumor itself, that is, its preparation (surgical material).

Treatment

The main method of treating edema is drug therapy, but sometimes surgical intervention is required when it is necessary to eliminate tumor processes and even dysplasia. Drug (conservative) treatment is primarily necessary to reduce pain, normalize blood circulation and metabolic processes, and restore bone structure. Also, as prescribed by a doctor, physical therapy procedures are required. The average recovery time for this treatment ranges from 6 to 12 months.

It is possible to reduce pain with the help of non-steroidal anti-inflammatory drugs: Diclofenac, Ibuprofen. The following will help improve blood circulation: Trental, Nicotinade, Actovegin, and you can increase metabolism with the help of a complex of B vitamins. These types of medicines are available in the form of ointments, tablets and injections. Surgical treatment is prescribed only by an experienced specialist and after undergoing a full examination, when conservative treatment has failed. Methods of surgical treatment:

1. Arthroscopy – performed using an arthroscope to diagnose and treat injuries in hard-to-reach areas, which helps reduce damage and blood loss during the operation.
2. Chondroplasty is an operation to restore defects in bone tissue, with the possibility of completely replacing cartilage.

Recovery time after surgery varies from six months to several years, but the effectiveness of the surgical method is greater than the conservative one. Bone marrow edema from a simple tumor can develop into a chronic condition, so early diagnosis and treatment will allow the patient to avoid serious illness and even disability. It is undesirable to postpone treatment of this pathology so as not to deprive yourself of a full life.

What it is?

The hematopoietic (bone) marrow is contained in a spongy substance, which is also called trabecular tissue, as it consists of trabeculae (loose bone plates and septa). The largest mass of human bone marrow is located in the bones of the large and small pelvis, skull, and sternum. In the vertebral bodies that make up the human spine, the volume of red medulla is much smaller compared to tubular bones, but despite this, trabecular edema of the spine can cause serious complications, the main of which is the suppression of immune function and the rapid progression of autoimmune diseases (for example , rheumatoid arthritis).

The structure of the bone marrow is determined by its functions, including not only participation in the formation of red blood cells, but also the formation of immune chains when interacting with the lymphoid organs of the peripheral system. The bulk of the mass is fibrous stroma (skeleton). Hematopoietic tissue is represented by five mature sprouts that produce the formed components of blood: erythrocytes, granulocytes (granular leukocytes), lymphocytes, monocytes and megakaryocytes (giant red brain cells).

What cells does bone marrow consist of?

Edema of the hematopoietic brain occurs as a result of excessive accumulation of fluid or inflammatory exudate in the spongy substance of the vertebrae and epiphyses of the pelvic bones and sternum, so the pathology is often referred to as trabecular edema. It manifests itself in the following changes in the osteochondral structure of the vertebra:

1. Increased fluid volume in trabecular plates. The normal water content in the bones of the spine is about 10% (the remaining 90% is made up of extracellular matrix and inorganic substances). With swelling, the fluid level can reach 20% (or more).
2. Swelling of the vertebral body (caused by an increase in the volume of spongy substance).
3. Spread of edema to adjacent tissues (including the subarachnoid space and nervous tissue).

Note! Some traumatologists call bone marrow edema a bone hematoma, but this is not entirely the correct term. A hematoma is an accumulation of blood as a result of damage to small blood vessels and capillaries supplying blood to the vertebrae, and edema is an excessive accumulation of fluid (mainly inflammatory exudate). Despite the fact that the hematoma itself almost always causes swelling of the trabecular substance and bone marrow, pathogenetically these are different pathologies.

Bone structure

Signs and symptoms

The clinical picture of bone marrow edema is almost always blurred, which makes it difficult to make a correct diagnosis in a timely manner and often leads to the development of complications. The first (and often the only) symptom of such disorders is pain. A distinctive feature of the pain syndrome in such patients is its localization: painful sensations do not appear at the site of the pathological process, but several centimeters above. This is due to the fact that the vertebral body, which swells with excess fluid, compresses the nerve endings of the spinal nerves located above, as well as the muscles and ligaments located nearby.

In the absence of necessary treatment for a long time, the spinal cord is often involved in the process, so the clinical picture of primary disorders often overlaps with neurological symptoms.

In general, the symptoms of bone marrow edema include the following:

• aching, constant pain predominantly above the affected vertebra (can intensify both at rest and with various types of stress);
• disruption of the functioning of the pelvic organs (difficulty urinating, constipation with painful tenesmus, pain during bowel movements or bladder);
• neurological disorders (impaired sensitivity of the limbs).

Constantly aching pain, mainly above the affected vertebra, is the main sign of bone marrow edema

If the cervical spine is damaged, hydrocephalus may develop (excessive accumulation of cerebrospinal fluid in the ventricles of the brain), increased intracranial pressure, and damage to the nerves responsible for the innervation of the eye muscles.

Since the bone marrow is also involved in the formation of immunity, pathologies of this organ are almost always manifested by a decrease in the body’s resistance to the effects of allergens and pathogens. The patient may experience various allergic reactions, colds and intestinal infections, and possible exacerbation of radiculitis due to hypothermia.

Hemorrhagic syndrome with bone marrow lesions is strongly expressed, and its localization is not always determined at the site of the pathological process. The patient experiences increased bleeding of the gums, frequent nosebleeds, and bruises and hematomas on the body.

Important! The most important symptom of bone marrow pathologies is anemia, which is detected during a clinical blood test and is characterized by a decrease in hemoglobin levels (normal range is from 120 to 150 g/l). If the results of blood tests reveal anemia in a patient, which is combined with back pain, the doctor may suspect trabecular or subchondral edema of the bone marrow of the spine.

Main symptoms of anemia