Vertebral Body Sclerosis, Diffuse
Bryson Borg, MD
DIFFERENTIAL DIAGNOSIS
Common
Discogenic Sclerosis
Metastases, Blastic Osseous
Chronic Discitis/Osteomyelitis
Healing Fracture
Renal Osteodystrophy
Paget Disease
Sickle Cell Disease
Less Common
Osteopetrosis
Osteosarcoma
Myelofibrosis
Rare but Important
Radiation
Sclerotic Myeloma
Lymphoma
Hypervitaminosis A or D
Fluorosis
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
Discogenic Sclerosis
Sclerotic endplate marrow, correlates to type 3 Modic changes on MR, involving both sides of the disc space
Endplate destruction or abnormal paravertebral soft tissue should prompt consideration of chronic osteomyelitis
Metastases, Blastic Osseous
Typically involves multiple vertebral bodies
Metastases from prostate, breast, carcinoid, and urothelial primaries; in children: Neuroblastoma and medulloblastoma
Chronic Discitis/Osteomyelitis
Marrow sclerosis typically associated with other findings of chronic infection
Advanced endplate destruction
Paravertebral/epidural soft tissue/phlegmon
Renal Osteodystrophy
Osteopenia or osteosclerosis
May manifest with endplate sclerosis (“rugger jersey” spine)
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