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Category: Spine and Spinal Cord Imaging

It is clear, after multiple research studies to assess the usefulness of imaging in low back pain, that uncomplicated acute low back pain is a benign, self-limited condition that does not warrant any imaging studies. The vast majority of patients are back to their usual activities within 30 days. Radiographic evaluation of the lumbar spine includes frontal and lateral radiographs. These are indicated in the evaluation of back pain and weight loss, after mild trauma in patients older than 50 y/o, in patients with unexplained fever, immunosuppression, history of cancer, prolonged use of steroids and focal neurologic, or disabling symptoms. Oblique views are useful for the assessment of defects to the pars interarticularis when suspecting spondylolysis and for the evaluation of the nerve root foramina. The relative radiation dose level for a routine radiographic examination of the lumbar spine is between 1 and 10 mSv (56). Although plain radiographs remain valuable for detecting many types of spine fractures and degenerative changes, the high resolution of osseous and soft-tissue structures provided by CT and MRI has made these modalities invaluable for the diagnosis of degenerative, traumatic, neoplastic, and infectious diseases of the spinal column and spinal cord.

Spondylolysis and Spondylolisthesis

Spondylolysis and Spondylolisthesis

Spondylolysis is a defect in the pars interarticularis, commonly involving the L5 and occasionally the L4 vertebrae. Most spondylolysis is thought to be produced by repetitive stress. The gravitational and muscular loads acting across the steep incline of the upper surface of the sacrum can be resolved into a shearing component, which tends to displace the L5 vertebral body forward on S1, and a compressive component at right angles to the superior surface of S1 (Fig. 6-63). In accordance with…

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Lumbar Spinal Stenosis and Foraminal Stenosis

Lumbar Spinal Stenosis and Foraminal Stenosis

Like cervical stenosis, lumbar spinal stenosis is frequently precipitated by disc degeneration with subsequent marginal osteophytosis of the vertebral body ends, hypertrophic degeneration of the facet joints, and bulging of the ligamenta flava. Lumbar stenosis may be lateral, central, or combined. The lower lumbar vertebrae normally have shorter pedicles that cause the superior articular processes to intrude into the spinal canal to cut off narrow lateral recesses (Fig. 6-61A–E). The lateral nerve roots of the next spinal nerve to exit…

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Lumbar Disc Herniation

Lumbar Disc Herniation

The correlation of lumbar disc herniation with a patient’s complaints of low back pain or sciatica is not always clearly established. It has been estimated that as many as 20% of patients with radiologic findings of disc herniation are asymptomatic (67). Furthermore, when disc herniation occurs in symptomatic patients, other findings are often present that also could explain the clinical findings. Lumbar disc herniations occur most frequently posterolaterally because the annulus is thinnest in the posterior quadrants but reinforced in…

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Cervical Spinal Stenosis and Foraminal Stenosis

Cervical Spinal Stenosis and Foraminal Stenosis

Cervical spinal stenosis can be congenital or acquired. In the less common congenital stenosis, a small spinal canal is produced by short pedicles and thick laminae (62). It commonly remains asymptomatic until degenerative changes are superimposed on the congenital stenosis later in life. Acquired stenosis can be produced by a host of hyper- trophic degenerative changes often collectively referred to as cervical spondylosis. These include osteophytic lipping of the posterior margins of the vertebral body ends bordering the disc, hypertrophic…

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Cervical Disc Herniation

Cervical Disc Herniation

Disc herniation is typically preceded by degenerative changes in the mucopolysaccharides of the nucleus pulposus, which produce fibrillation of the collagen (60). This eventually causes dehydration and loss of disc volume. As a result, the nucleus pulposus no longer serves as a normal load-dispersing mechanism, and excessive stress is borne by the annulus fibrosus. This produces annular fissuring and tears that can culminate in herniation of the nucleus pulposus. The loss of the load-diffusing function of the normal disc also…

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Degenerative Disc Disease

Degenerative Disc Disease

The intervertebral disc space is a cartilaginous joint with a central nucleus pulposus surrounded by an annulus fibrosus. Degenerative change in the nucleus pulposus is termed inter-vertebral osteochondrosis (Fig. 6-49A,B). Early signs of disc disease may include loss of fluid signal within the nucleus pulposus (dehydration), which results in decreased signal within the central portion of the disc on T2-weighted images, and blurring of the transition between the nucleus pulposus and the annulus fibrosus. This is followed later by narrowing…

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Degenerative Spine Disorders

Degenerative Spine Disorders

CT and MRI provide complementary information about degenerative diseases of the spine. MRI is often the modality of choice in assessing degenerative changes within the spine due to its superior soft-tissue contrast. CT has superior spatial resolution and provides better conspicuity of osseous and calcified structures. The advent of MDCT technology allows for superb reconstruction in the sagittal and the coronal planes that allows for better depiction of pathologic processes and hardware evaluation in the post–operative spine (57). MRI permits…

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Spinal Trauma

Spinal Trauma

Although much spinal trauma is well visualized on plain films, CT has a number of advantages over this modality. These include the demonstration of fractures not seen in plain films, an accurate determination of the amount of spinal canal encroachment by fracture fragments (Fig. 6-66A,B), the identification of neural foramen impingement by fractures involving its boundaries, and a more precise evaluation of facet disruption. MR can display impingement on the dural sac or the spinal cord by bone fragments, as…

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