CT Spinal Column

Cervical Spine

The cervical spine shows a normal degree of lordosis in the lateral survey scan, with no segmental malalignment.

The vertebral bodies show normal configuration and trabecular structure. The cortical margins are of normal thickness and are free of osteophytes.

The bony spinal canal shows normal sagittal diameter. The intervertebral disks show normal CT density and normal posterior concavity. The disks do not project past the posterior surface of the vertebral bodies. The spinal cord is centrally placed and of normal width. It has homogeneous density and shows no circumscribed narrowing or expansion.

The nerve roots show a normal course and passage through the neuro-foramina, which are of normal size and structure. The facet joints and uncovertebral joints are unremarkable.

The prevertebral and paravertebral soft tissues show no abnormalities. Interpretation

The examined segments of the cervical spine appear normal.

Checklist

Position

Bony spinal canal

Vertebral bodies

Cervical lordosis

No segmental malalignment (lateral survey scan)

Normal position of dens (see below)

Width (see below)

Shape

Shape

Cortex (thickness, margins: smooth, sharp) No marginal osteophytes Trabeculae (uniform honeycomb arrangement, no rarefaction or circumscribed voids, no narrowing or expansion)

Intervertebral disk space

Spinal cord

Neuroforamina

Nerve roots Facet joints

Soft tissues

Bony structure (if evaluable: no lytic defects, fracture lines, or osteoplastic areas)

Width

Margins (smooth, sharp) Straight posterior disk contour No disk protrusion past posterior surface of adjacent vertebral bodies Position (central) Width (see below)

No circumscribed narrowing or expansion Density (homogeneous) Perimedullary thecal space clear: — No encroachment from the anterior side (e.g., by an intervertebral disk or osteophyte) or posterior side (e.g., by a hypertrophic liga-mentum flavum) Configuration Width

No encroachment from the anterior side (e.g., by an intervertebral disk, osteophyte, or uncovertebral arthrosis) or posterior side (e.g., by hyper-trophic spondylarthrosis) Course and passage through the neuroforamina No circumscribed expansion Shape, symmetry Pars interarticularis Vertebral arches intact

Spinous processes (shape, length, bony structure)

Symmetrical arrangement on both sides of the vertebral bodies and spinous processes No masses

Prevertebral soft-tissue structures (especially the pharynx and thyroid gland; no masses)

Important Data

1 Anteroposterior diameter of preodontoid space:

2 Sagittal diameter:

3 Width of spinal canal:

• Transverse diameter at level of pedicles > 20-21 mm

4 Width of spinal cord:

Thoracic Spine

The thoracic spine shows a normal degree of kyphosis in the lateral survey scan, with no segmental malalignment.

The vertebral bodies show normal shape and trabecular structure. The cortical margins are of normal thickness and are free of osteophytes. The bony spinal canal has normal sagittal diameter. The intervertebral disks show normal CT density and normal posterior concavity. The disks do not project past the posterior surface of the vertebral bodies. The spinal cord is centrally placed and of normal width. It has homogeneous density and shows no circumscribed narrowing or expansion.

The nerve roots show a normal course and passage through the neuro-foramina, which are of normal size and structure. The costovertebral and costotransverse joints are unremarkable.

The prevertebral and paravertebral soft tissues show no abnormalities. Interpretation

The examined segments of the thoracic spine appear normal.

Checklist Position

Bony spinal canal

Vertebral bodies

Intervertebral disk space

Spinal cord

Thoracic kyphosis

No segmental malalignment (lateral survey scan)

Width (see below)

Shape

Shape

Cortex (thickness, margins: smooth, sharp) No marginal osteophytes Trabeculae (uniform honeycomb arrangement, no rarefaction or circumscribed voids, no narrowing or expansion) Width (see below) Margins (smooth, sharp) Straight posterior disk contour No disk protrusion past posterior surface of vertebral bodies Position (central) Width

No circumscribed narrowing or expansion Density (homogeneous)

Neuroforamina

Nerve roots

Facet joints

Soft tissues

Perimedullary thecal space clear: no encroachment from the anterior side (e.g., by an intervertebral disk or osteophyte) or posterior side (e.g., by a hypertrophic ligamentum flavum) Configuration Width

No encroachment from the anterior side (e.g., by an intervertebral disk or osteophyte) or posterior side (e.g., by hypertrophic spondylarthrosis) Course and passage through the neuroforamina No circumscribed expansion Shape, symmetry Pars interarticularis Vertebral arches intact

Spinous processes (shape, length, bony structure)

Costotransverse joints Costovertebral joints (no hypertrophy) Ribs

Symmetrical arrangement on both sides of the vertebral bodies and spinous processes No masses

Prevertebral soft-tissue structures (especially the lungs, heart, and aorta)

Important Data

1 Width of spinal canal:

• Transverse diameter at level of pedicles > 20-21 mm

2 Sagittal diameter:

3 Jones-Thomson ratio (= AxB/CxD):

• Between 0.5 and 0.22 = normal (< 0.22 = spinal stenosis)

4 Width of intervertebral disk spaces:

Lumbar Spine

The lumbar spine shows normal lordotic curvature in the lateral survey scan, with no segmental malalignment.

The vertebral bodies have normal shape and trabecular structure. The cortical margins are of normal thickness and are free of osteophytes. The bony spinal canal has a normal sagittal diameter. The intervertebral disks show normal density and normal posterior concavity. The disks do not project past the posterior surface of the vertebral bodies.

The conus medullaris shows a normal position at L1 with normal subdivision into filaments. The dural sac is of normal width. The nerve roots show a normal course and passage through the neuro-foramina, which are of normal size and structure. The facet joints are unremarkable.

The prevertebral and paravertebral soft tissues show no abnormalities. Interpretation

The examined segments of the lumbar spine appear normal.

Checklist

Position

Bony spinal canal

Vertebral bodies

Intervertebral disk space

Dural tube

Lumbar lordosis

Lumbosacral angle (see below)

No segmental malalignment (lateral survey scan)

Shape

Width (see below) Shape

Cortex (thickness, margins: smooth, sharp) No marginal osteophytes Trabeculae (uniform honeycomb arrangement, no rarefaction or circumscribed voids, no narrowing or expansion) Width (see below) Margins (smooth, sharp)

No disk protrusion past posterior surface of vertebral bodies (posterior disk contour is concave at L1-L4, straight at L4/5, and slightly convex at L5/S1) Normal width

• No circumscribed narrowing or expansion

• Contents of fluid attenuation

• Conus medullaris (at L1 level, configuration)

• Filaments show normal width and arrangement with no posterior adhesion and no circumscribed anterior encroachment (e.g., by an intervertebral disk or osteophyte) or posterior encroachment (e.g., by a hypertrophic ligamentum flavum)

Neuroforamina • Configuration

• No anterior encroachment (e.g., by an intervertebral disk, osteophyte, or uncovertebral arthrosis) or posterior encroachment (e.g., by hypertrophic spondylarthrosis)

Nerve roots • Course and passage through the neuroforamina

• No circumscribed expansion

Facet joints • Shape, symmetry

• Pars interarticularis

• Vertebral arches intact

• Spinous processes (shape, length, bony structure)

Soft tissues • Symmetrical arrangement on both sides of the vertebral bodies and spinous processes

• Prevertebral soft-tissue structures (aorta, vena cava), no masses

Important Data

1

Lumbosacral angle (S1/horizontal plane):

• 26-57°

2

Width of intervertebral disk space or height of lumbar in-

tervertebral disks:

• Approx. 8-12 mm, increasing from L1 to L4/5, decreasing

again at L5/S1

3

Width of spinal canal:

• Transverse diameter at level of pedicles: L1-L4 >20-

21 mm, L5 > 24 mm

4

Sagittal diameter:

• 16-18 mm (simple formula: not less than 15 mm; 11-

15 mm = relative stenosis, less than 10 mm = absolute ste-

nosis)

5

Jones-Thomson ratio (= AxB/CxD):

• Between 0.5 and 0.22 = normal (<0.22 = spinal stenosis)

6

Lateral recess (sagittal diameter):

• > 4-5 mm

7

Ligamenta flava:

• Width < 6 mm

8

CT density of intervertebral disks:

• 70 ± 5 HU

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