Most common cause of a focal sclerotic density

Cortical bone density with faint, spiculated border

Normal uptake on bone scan

Coarse, thickened vertical trabeculations

CT analog to type 3 marrow on MR

Should see advanced degenerative change in the adjacent disc space

Extensive endplate sclerosis: Consider chronic osteomyelitis

Multiple vertebral bodies typically involved

Sclerotic (e.g., prostate, carcinoid, medulloblastoma, neuroblastoma) or mixed sclerotic and lytic (breast, lung)

Reactive sclerosis of portions of the neural arch associated with abnormal biomechanical loading

Can be seen with chronic fractures of the contralateral pedicle or pars, developmentally incomplete neural arch, or advanced degenerative change

Sclerosis can be seen resulting from either trabecular impaction or from the healing response

Advanced destructive endplate changes, paravertebral soft tissue &/or fluid

Typically more extensive involvement of the adjacent vertebral bodies than seen with degenerative endplate changes

Erosions and reactive sclerosis result in square vertebral bodies and “shiny corners”

Central lytic focus with surrounding (reactive) bony sclerosis

Classic history is night pain, relieved by aspirin/NSAIDs