Orthopedics - Oleksa A.P. 2006

Osteochondropathies
Osteochondropathies of the lower limb bones
Osteochondropathy of the vertebral body (Calvé's disease)

Widening and flattening of a vertebral body is termed platyspondylia, whereas a reduction in height is known as brachyspondylia. The combination of these two vertebral deformations is referred to as platybrachyspondylia.

In 1925, the French orthopedist Calvé described a distinct spinal disorder that simulated Tuberculous Spondylitis (Pott's disease). Subsequently, in 1929, Harrenstein suggested the term "vertebra plana". This led to the adoption of the name "vertebra plana Calvé"—representing vertebral osteochondropathy, or Calvé's disease (Fig. 360).

This spinal pathology is rarely encountered in orthopedic practice and, consequently, is still frequently confused with tuberculous spondylitis or congenital vertebral anomalies.

Vertebral osteochondropathy occurs exclusively in children aged 3–11 years, most commonly presenting between ages 4 and 7 (Reinberg, S.A., 1964). Children typically complain of pain in the region of the affected vertebra during weight-bearing, which subsides at rest and in the recumbent position. This pain triggers a protective spasm of the back Muscles (antalgic contracture). Over time, a mild thoracolumbar Kyphosis develops, as the pathological process is most frequently localized to a single vertebra within the Th₁₀–L₂ segment. Occasionally, the spinous process of the affected vertebra may appear prominent, though not as markedly localized as in tuberculous spondylitis. Muscle spasm leads to some limitation of spinal mobility. Palpation and Percussion over the spinous processes reveal localized tenderness at the site of the lesion.

Class="center">

Fig. 360. Osteochondropathy of the vertebral bodies (after S.A. Reinberg).

While these clinical signs may raise suspicion of tuberculous spondylitis, normal body Temperature, Blood test results, and radiographic findings rule out an active inflammatory process.

Radiographs, particularly lateral views, reveal a nearly pathognomonic radiological complex in vertebral osteochondropathy, clearly demonstrating a uniform flattening of the vertebral body, the degree of which depends on the duration of the disease.

In the Cytology/cytology/16.html">Early stages of the disease, Rosselet observed pronounced vertebral decalcification, accompanied by a gradual alteration of the initially normal vertebral shape. The internal Bone Structure subsequently changes: the flattened vertebra becomes denser, occasionally exhibiting a mottled appearance, and its anterior margin slightly projects forward. Other anatomical elements of the vertebra and the intervertebral discs remain normal, sometimes appearing even somewhat accentuated.

In some cases, vertebral osteochondropathy must be differentiated from congenital anomalies, such as butterfly vertebra or congenital platyspondylia. Computed tomography (CT) and Magnetic Resonance imaging (MRI) help to clarify the Diagnosis.

Treatment. Given the slow and protracted Nature of the condition, treatment centers on decompressing the spine for the duration of the healing process. Bed rest is prescribed with a hyperextension pad placed beneath the affected vertebral segment. To ensure proper positioning, a plaster bed is used—similar to that employed in the management of tuberculous spondylitis. Bed rest should be maintained throughout the entire period of vertebral body regeneration and gradual restoration. Since the children must continue their education during treatment, it is highly beneficial to place them in a specialized sanatorium (such as in Yevpatoria), where a standard school curriculum is integrated with medical care.

Additionally, patients are prescribed muscle massage, Therapeutic Exercises (physical therapy), physiotherapeutic Procedures, sunbaths, and a balanced, vitamin-rich diet. The healing process is monitored radiographically. Following this course of treatment, patients are fitted with a supportive brace for 2–3 years and permitted to ambulate.