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Commented Glossary for Rheumatic Spinal Diseases, Based on Pathologyf Annals ofthe Rheumatic Diseases 1995; 54: 615-625 615 NOW AND THEN Ann Rheum Dis: first published as 10.1136/ard.54.8.615 on 1 August 1995. Downloaded from Commented glossary for rheumatic spinal diseases, based on pathologyf Robert J Franqois, Frits Eulderink, Eric G L Bywaters Abstract or the posterior facet joints' and in another3 as Objectives-To redefine and comment on 'dissolution of a vertebra' or as 'a condition terms on a pathological basis, in order to marked by platyspondylia, aplasia of the avoid the confusion due to the use ofterms posterior arch, and separation of the pars with different meanings, to standardise interarticularis'. Thus the simplest and most usage among clinicians, radiologists and common meaning, 'separation of the pars pathologists, and to facilitate literature interarticularis', is not given by either of these searches. two authoritative dictionaries. Methods-Within the Committee of The idea of standardising nomenclature in Pathology ofthe European League against this field arose in 1967, at the VIth European Rheumatism, a study group was set up to Congress of Rheumatology in Lisbon.4 It was analyse the medical literature and taken up again by the Committee on Pathology common practice concerning the nomen- of the European League against Rheumatism clature of rheumatic spinal diseases. The (EULAR): a subgroup was appointed to define group tried to amalgamate the main concepts, list synonyms, and recommend trends in the field, to reconcile etymology, preferred terms. After agreement was reached historical background, morphology, and on a number of items pertaining to the normal common practice. anatomy of the spine,5 a list of terms Results-The group warns against use of concerning pathological changes and diseases the terms 'acquired hyperostosis syn- is now proposed. drome', '(von) Bechterew's disease', The area of investigation is restricted to 'Kuimmel's disease', 'pseudospondylo- rheumatic diseases, excluding fractures, listhesis', 'rheumatoid spondylitis', tumours, and congenital pathology. As part of 'spondylarthropathy' in the sense ofspon- the Committee on Pathology, the working darthritis, and 'spondylosis'. It recom- group approached the problem from a mends intercorporal or interapophyseal morphological point of view. The Canadian http://ard.bmj.com/ rather than intervertebral (osteo)chon- Vocabulary of signs and symptoms of the drosis, zygapophyseal diverticulum rather musculoskeletal system6 7 has a different and than cyst, disc hernia rather than broader scope. prolapse, spondyloarthritis rather than spondyloarthropathy, marginal rather than anterior spondylitis, and discar- METHOD throsis. It proposes 'zygarthrosis' to The working party had to represent the on September 26, 2021 by guest. Protected copyright. Laboratoire de designate zygapophyseal osteoarthrosis. mainstreams in the field of spinal pathology. In Rhumatologie, Conclusions-Knowledge of the patho- particular, Anglo-American, French and H6pital Militaire an were Reine Astrid, logical basis of diseases and under- German trends incorporated without B1120 Brussels, standing ofthe original definitions given by omitting the important contributions of other Belgium those who coined new terms make it poss- countries and languages. R J Franqois ible to avoid most of the confusion arising The intention was to compile a glossary to Laboratorium voor from improper use ofspinal terms. be used by pathologists, radiologists, and Pathologie, Rijksuniversiteit, clinicians. Many contacts were made with Leiden, (Ann Rheum Dis 1995; 54: 615-625) interested scientists outside the Committee. The Netherlands The working group aimed to adhere as F Eulderink closely as possible to the following rules: Department of It is common experience that clinicians, 1) to respect the etymological sense of the Rheumatology, University of London, radiologists, pathologists, and other scientists terms; Postgraduate Medical interested in spinal disease use a number of 2) to take account of the historical background School, everyday terms with different meanings, which and to remain faithful to the original definition London, United Kingdom causes considerable confusion. In a recent given by the author who coined the term or E G L Bywaters paper, it appeared that 51 English speaking made it popular; Correspondence to: spine surgeons use 50 different terms for their 3) to give descriptive definitions, accepting Dr R J Francois, four most common diagnoses. 1 only those pathogenetic implications that are 9 avenue de Sumatra, B 1180 Brussels, Belgium. Dictionaries do not solve all problems, as unanimously recognised; tPrepared on behalf ofthe they may differ, and may be incomplete, 4) to avoid using one term in more than one Committee on Pathology of inaccurate, or even totally wrong. For example, meaning; the European League Against Rheumatism. spondylolysis is defined in one dictionary' as 5) if possible, to follow common practice. Accepted for publication 'ankylosis of a vertebral joint' or as It is realised that these rules are partly at odds 13 October 1994 'osteoarthritis of the intervertebral disk space with each other. 616 Franfois, Eulderink, Bywaters PRESENTATION to the hyaline cartilage at the discovertebral Considering it important that people should interface. understand the original meaning ofthe words they Ann Rheum Dis: first published as 10.1136/ard.54.8.615 on 1 August 1995. Downloaded from use, the authors recall the etymology (Etym) of terms before giving a definition (Del), comments - Intervertebral chondrosis (Com), synonyms (Syn), recommended nomen- Deft Schmorl,'5 considering the whole disc as clature (Rec) and, ifapplicable, the historical (His) (fibro)cartilage, used 'intervertebral chon- source. In rare instances, a new term might be drosis' as a synonym of disc degeneration. proposed (Prop). If useful, French (F) and Com: The three components of the inter- German (D) translations are given. When, within vertebral disc do share a common chondral a definition, a term is used that is defined separ- origin, possessing collagen type II and ately in this list, it is marked by an asterisk (*). glycosaminoglycans. However, Schmorl's definition introduces confusion, in that the same word could be used for degenerative THE GLOSSARY changes of three structures: the hyaline The list contains specific spinal terms and cartilage of the disc, the whole disc, and the general concepts that are particularly hyaline cartilage of the apophyseal joints. In important in spinal pathology. accordance to our rule 4, we do not support Schmorl's nomenclature. People who wish to use it should refer to Schmorl when doing so. Ankylosing spondylitis It would be more accurate to speak of discal or see spondylitis*, ankylosis*. intercorporal (between the bodies) chondrosis instead of intervertebral chondrosis. see also osteochondrosis*. Ankylosis Prop: Intercorporal chondrosis. Etym: Ancient Greek ankylosis, crookedness. Syn: Disc degeneration*; intercorporal Def: Fusion of articulating bones, by dense chondrosis. fibrous tissue (syndesmosis), cartilage (synchondrosis) or bone (synostosis) leading to total loss of movement. Cyst, zygapophyseal or facet joint Com: The concept is widely used in the see diverticulum*, zygapophyseal. adjective 'ankylosing' as in ankylosing spondy- litis* and vertebral ankylosing hyperostosis*. Degeneration Deft Change from a higher to a lower form, Baastrup's syndrome8 especially change of a cell, tissue or organ to Def: Painful condition due to abnormal friction a lower or less functionally active form. between spinous processes, as a consequence Com: In a tissue or organ, degeneration can be http://ard.bmj.com/ of reduced lumbosacral angle and/or disc accompanied by reactive processes such as height, or of hyperlordosis. inflammation and/or proliferation; in spite of Com: Pathological changes include bursa for- this, a disease can be called degenerative when mation, thinning of interspinous soft tissues, the first or main changes are degeneration. cartilage lining of adjacent processes, with fibril- Degenerative is often opposed to inflam- lation, eventual ebumation, and bone matory; however, it would be unwise to call sclerosis.9 10 A similar condition in the cervical every non-inflammatory and non-tumoral on September 26, 2021 by guest. Protected copyright. spine was described clinically by Michotte" and condition 'degenerative'. pathologically by Bywaters.'2 see also bursitis*. Degenerative disc disease see disc degeneration*. Bursitis, interspinous Etym: From Latin bursa, purse and the suffix -itist. Diffuse idiopathic skeletal hyperostosis Def: Inflammatory changes in the bursae that (DISH) develop in aging people by synovialisation* of see under hyperostosis*. clefts within the interspinous space.9 12 13 Com: The mechanical variety corresponds to Baastrup's syndrome*. Calcium pyrophos- Disc bulging phate and hydroxyapatite deposits'2 and Deft Protrusion of the whole disc, in contrast rheumatoid changes in adults'2 and to the focal protrusion of a disc herniation. children'2 14 can be seen. t -itis: Suffix to indicate the inflammatory nature of a condition. Chondrosis * -osis: Suffix to indicate either the non-inflammatory Etym: Ancient Greek chondros, cartilage and character of a lesion-most often a degenerative condition-or the widespread nature of a lesion, as in the suffix -osist. chondromatosis. Def: Degeneration* or non-inflammatory In the previous century and in the early 20th century, the of suffix -itis has been
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