Costovertebral Osteoarthrosis: Rare Differential Diagnosis of Back pain in young patients. Case Report.

The differential diagnosis of dorsal thoracic pain can be a challange due to the proximity of the dorsal column to vital organs as well as to its unique anatomy, innervation, and rib joint. The patterns of referred visceral pain require, in most cases, extensive complementary diagnostic tests in order to exclude severe conditions. Referred pain patterns often result in numerous and expensive visceral workups in order to exclude serious conditions, and costovertebral joint osteoarthritis is usually only considered when the origin of the pain remains unexplained. The authors present the case of a 40-year-old man with disabling dorsal pain due to isolated costovertebral osteoarthrosis. The symptomatology was controlled after injection of methylprednisolone guided by computed tomography. This clinical case aims to describe the clinical presentation of a rare entity that should be considered in the differential diagnosis of back pain.

Costovertebral Osteoarthrosis: Rare Differential Diagnosis of Back pain in young patients. Case Report / Osteoartrose costovertebral: Diagnóstico diferencial raro de dorsalgia no paciente jovem. Relato de caso

Abstract The differential diagnosis of dorsal thoracic pain can be a challange due to the proximity of the dorsal column to vital organs as well as to its unique anatomy, innervation, and rib joint. The patterns of referred visceral pain require, in most cases, extensive complementary diagnostic tests in order to exclude severe conditions. Referred pain patterns often result in numerous and expensive visceral workups in order to exclude serious conditions, and costovertebral joint osteoarthritis is usually only considered when the origin of the pain remains unexplained. The authors present the case of a 40-year-old man with disabling dorsal pain due to isolated costovertebral osteoarthrosis. The symptomatology was controlled after injection of methylprednisolone guided by computed tomography. This clinical case aims to describe the clinical presentation of a rare entity that should be considered in the differential diagnosis of back pain.

Resumo O diagnóstico diferencial de dorsalgia revela-se um desafio pela proximidade da coluna dorsal a órgãos vitais assim como por sua anatomia única, inervação e articulação com as costelas. Os padrões de dor referida visceral obrigam, na maioria das vezes, a extensivos exames complementares de diagnóstico de forma a excluir condições graves. A osteoartrose da articulação costovertebral é um diagnóstico pouco reconhecido, e habitualmente é somente considerado quando a fonte de dor continua sem explicação após extensa investigação. Os autores apresentam o caso de um homem de 40 anos de idade com dor dorsal incapacitante devido a osteoartrose costovertebral isolada. A sintomatologia foi controlada após a injeção de metilprednisolona guiada por tomografia computadorizada. Este caso clínico tem como objetivo descrever a apresentação clínica de uma entidade rara que deverá ser considerada no diagnóstico diferencial de dorsalgia.

[New perspectives on degenerative disease treatment]. / Novas perspectivas no tratamento da doença degenerativa discal.

The degenerative disc disease (DDD) is a chronic and multifactorial condition of the intervertebral disc that can manifest itself by axial pain, radiculopathy, myelopathy and spinal stenosis. It constitutes an increasing cause of lumbar pain and morbidity in Western Societies, with important socio-economic implications. The available treatment options do not modify the intervertebral disc degeneration process and they are not always capable of relieving symptoms. The loss of proteoglycan content of nucleus pulposus appears to be the main event on DDD pathophysiology. The balance between synthesis and catabolism of the extracellular matrix can be altered by the use of several proteins, including growth factors. The transfer of genes encoding these proteins is an attractive treatment option and has been successfully achieved in animal models. Moreover, the transfer of steam cells in order to repopulate the degenerated disc and to revert the pathologic process might be another promissory strategy. The authors describe the actual knowledge about DDD and the investigation that has been made in gene therapy for DDD. The comprehension of the biological mechanisms of degeneration, as well as genetic manipulation and transfer of steam cells could be decisive and revolutionary in the understanding and treatment of this epidemic condition.