The patient presented with dorsal pain starting 2 years prior to imaging. There was no history of previous trauma or any kind of involvement in sports. The pain was not responding to physiotherapy and analgesics. Due to recent deterioration, the patient was referred for MR imaging.
The MR imaging examination consisting of T1-w, T2-w and STIR sequences showed multilevel disc degeneration at the mid- and lower dorsal spine, with disc space narrowing, disc dehydration, endplate irregularity and posterior Schmorl's node (Fig. 1-3). No vertebral wedging was observed throughout the spine. There was no kyphosis or scoliosis.
A. Adolescent disc dysplasia (ADD) is a disorder associated with severe back pain and functional limitation. Typically, patients show deterioration of pain with flexion and extension of the spine during physical examination. Currently, there are no validated epidemiological data for this disorder and limited reports exist in the literature [1]. ADD includes endplate irregularity, disc degeneration and disk space narrowing. Schmorl’s nodes may coexist [1]. ADD is quite similar to Scheuermann’s osteochondritis, but the clinical presentation is quite different [2]. The initiation of early disc degeneration in adolescents is not well understood. Mechanical overloading from sports, biochemical changes involving catabolic cell response, cytokines, chemokines, and proteases and failure of the water-binding extracellular matrix, may all contribute to a variable degree.
B. A patient with ADD typically presents with severe back pain that can become chronic. The pain is located in either the thoracic or lumbar spine or both and is not associated with spinal kyphosis [1]. Considering the variety of aetiological agents that can cause dorsal pain, an adequate differential diagnosis is of great importance and should be done by evaluating the patient’s clinical presentation and radiological findings. The role of imaging in ADD is to provide information on the early degeneration of the discs and to rule out other disorders that can cause back pain such as tumours (e.g. osteoid osteoma), Scheuermann’s osteochondritis, inflammatory spondyloarthropathies and spondylolisthesis [3, 4]. Radiologist should convey to the requesting clinician the benign nature of ADD and its difference on imaging grounds with regard to Scheuermann’s osteochondritis.
C. MR imaging is the method of choice for adolescents with back pain due to its ability to image the soft tissues, bone marrow and neural axis. The key findings in MR imaging are irregularities at the end plates, disk space narrowing, nucleus pulposus dehydration and possibly Schmorl’s nodes (Fig. 1-3).
D. Currently, the therapeutic options for ADD are physiotherapy and bracing. Conservative treatment aims to provide a better support for the spine in order to reduce pain. Response to this treatment is quite variable. The patient presented herein showed significant improvement with bracing and non-steroidal anti-inflammatory medication in addition to physiotherapy. MR imaging is invaluable in exploring most of the disorders which are demonstrated with back pain and in particular is able to guide the proper treatment in ADD.
E. It is essential to recognize ADD in adolescents with dorsal pain in order to avoid unnecessary treatment.
Adolescent disk dysplasia
1. MRI images show multiple thoracic vertebral endplates with slightly irregular structure. The intervertebral discs are slightly thinned in some areas, and certain discs exhibit reduced signal intensity, suggesting nucleus pulposus dehydration.
2. Some vertebral bodies display signal changes adjacent to the endplates, and there may be Schmorl’s nodes (indentations of the endplate into the vertebral body).
3. No obvious wedge-shaped deformities of the vertebral bodies or significant kyphotic deformity of the spine were observed. No distinct abnormal signal changes were found in the paraspinal soft tissues or the intraspinal nerve structures.
Considering the patient is a 15-year-old adolescent with persistent back pain for 2 years, and the imaging findings consistent with disc degeneration (irregular endplates, narrowed disc spaces, desiccated nucleus pulposus), while excluding significant fractures, spinal deformities, infections, or tumors, the most likely diagnosis is:
Adolescent Disc Dysplasia (ADD).
1. Conservative Treatment: This includes physical therapy (physiotherapy, manual therapy, muscle strengthening exercises), use of braces (back support), and non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. Research and clinical experience show that such a comprehensive approach can alleviate pain and prevent further degeneration.
2. Rehabilitation/Exercise Prescription (following the FITT-VP principle):
Example routine:
• Start each session with 5 minutes of heat therapy and stretching for the lower back.
• Then perform supine core exercises (e.g., plank) and back extension exercises (e.g., prone back extension) for 10–15 repetitions, 2–3 sets each.
• In later stages, incorporate resistance bands or light weights to gradually increase the difficulty.
If severe pain or discomfort occurs, reduce or pause training and consult a rehabilitation specialist.
3. Surgical Indications: For cases where conservative management fails, especially if there are neurological symptoms or severe disc degeneration, a spine surgeon should evaluate. However, for most cases of ADD, conservative treatment typically suffices.
4. Other Considerations: Since adolescents are still in their growth phase, avoid overloading or improper strength training. Maintain a healthy weight to reduce extra stress on the spine. Schedule regular check-ups to assess disc and spinal health.
Disclaimer: This report is a reference analysis based on imaging and clinical data. It should not replace in-person consultations or professional medical advice. If you have urgent or complex issues, please seek prompt medical attention and follow the guidance of a specialist.
Adolescent disk dysplasia
