Rugger jersey spine

What is Rugger jersey spine?

Rugger jersey spine is the band-like osteosclerosis of the superior and inferior margins of the vertebral bodies.

This condition describes the prominent endplate densities at multiple contiguous vertebral levels to produce an alternating sclerotic-lucent-sclerotic appearance.

Why is this condition named as the Rugger jersey spine?

This condition mimics the horizontal stripes of a rugby jersey.

The striate pattern is reminiscent of rugby players alternating color horizontally striped shirts.

The rugger jersey spine appearance is virtually pathognomonic of hyperparathyroidism, particularly the secondary form related to chronic renal failure, where it is a feature of renal osteodystrophy

Rugger jersey spine is only seen in patients with secondary (not primary) hyperparathyroidism.

Pathophysiology

Osteoblasts form an increased amount of osteoid that does not contain hydroxyapatite.

This mechanism is in response to increased bone resorption due to excessive parathyroid hormone (PTH) secretion and subsequent loss of bone mass.

This feature does appear opaque on radiographs. 

The sclerotic bands on the superior and inferior endplates of the vertebral bodies represent accumulations of excess osteoid and appear opaque because of their increased volume when compared to normal bone.

How is Rugger jersey spine at Imaging?

This sign can also be depicted at CT and MR imaging even though it has originally been described on a standard radiograph.

Vertebral sclerosis may disappear after successful treatment of the underlying disease.

Differential diagnosis

What are the radiographic findings of hyperparathyroidism?

The pathognomonic sign is subperiosteal bone resorption, which is most commonly seen along the radial aspect of the middle phalanges of the hands.

Other findings include erosion of the terminal tufts of the distal phalanges, osteosclerosis of spinal vertebrae predominantly next to endplates, leading to a “rugger-jersey” configuration, osteopenia, brown tumors, chondrocalcinosis (i.e., calcification of cartilage), and soft tissue calcification.

The frequency of some of these findings is different in primary hyperparathyroidism compared to secondary hyperparathyroidism.

Summary

  • Rugger jersey is a metaphor that describes the radiographic appearance of vertebral bodies in patients with renal osteodystrophy.
  • Spine radiographs reveal superior and inferior vertebral body endplate sclerotic bands, alternating with the more lucent central vertebral bodies and disk spaces.
  • In chronic renal insufficiency, diminished renal filtration causes phosphate retention and decreased calcitriol synthesis. Resultant decreased serum calcium stimulates parathyroid hormone (PTH) secretion, thus causing secondary hyperparathyroidism.
  • PTH increases osteoclast activity in an effort to restore calcium levels via bone resorption. Osteoblasts respond by depositing poorly mineralized osteoid, which then accumulates as a transverse sclerotic stripe.
  • Although originally described on standard radiographs, the appearance can also be seen at CT and MR imaging.
  • The ‘‘rugger jersey’’ spine is considered to be virtually pathognomonic of the bony changes of secondary hyperparathyroidism related to chronic renal failure

References

  1. Terry R. Yochum, Lindsay J. Rowe. Yochum and Rowe’s Essentials of skeletal radiology. Philadelphia, Pa. : Lippincott Williams & Wilkins, c2005. ISBN:0781739462. Read it at Google Books – Find it at Amazon
  2. Wittenberg A. The rugger jersey spine sign. Radiology. 2004;230 (2): 4912. doi:10.1148/radiol.2302020388 – Pubmed citation

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