Figure 1813

Needle placement for discogram, lumbar, lateral view. Intradiscal injection of contrast will provoke characteristic pain and will allow for a radiographic visualization of the annular tear and disc protrusion. Indications Often, multilevel disc pathology is observed on MRI, and the determination of the painful pathologic disc is necessary for planning the appropriate treatment or surgical intervention. Discogram is necessary in the workup of chronic back pain when Z joint or SI joint pathology...

Type OneAVM

Type one AVM occurs predominantly in the lower thoracic and upper lumbar regions of adult males in the fifth through seventh decades and represents about 60-80 of AVM diagnoses. In this condition an intradural-extramedullary fistula develops. The fistula drains into the vertebral venous outflow system. Symptoms develop secondary to increased venous pressure, which results in venous stasis within the spinal cord. These changes lead to increased intramedullary pressure and congestion. Cord edema...

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Traction Spur Elbow

Plain lateral films usually show degenerative disc disease and vertebral slip at L4-L5. It is not uncommon to find anterior or posterior slippage in vertebrae above L4. No pars defects are seen (Figure 510). Facet arthropathy and vacuum phenomenon are frequently found. Traction spurs are present at the L4 or L5 vertebral bodies. Unlike osteoarthritic spurs, which emanate from the vertebral body corner, traction spurs originate 1-2 mm away from the vertebral corner, at the attachment point of...

Figure 102

Potts Disease Thoracic Spine Image

Lateral X-ray showing that both the superior and inferior endplates have been affected leading to a kyphotic deformity. disease progression. Over the course of time, patients develop additional fractures that may result in kyphotic deformities leading, in a significant percentage of patients, to chronic persistent back pain and, at times, to neurological complications and pulmonary dysfunction. When osteoporosis or vertebral fractures are detected, systemic...

Figure 1713

Plate pseudoarthrosis. (A) AP X-ray of the lumbosacral junction showing bilateral lateral bony fusion between the transverse processes of L5 and the sacral ala. (B) Axial CT through the same area as (A), showing a plate pseudoarthrosis. For example, the T1- and T2-weighted images (T1WI and T2WI) reflect different aspects of proton relaxation, and therefore the examined substance will appear differently in the two sequences. This becomes even more intricate as a substance on T2WI will appear...

Figure 1125

Sagittal T1WI with contrast showing a large, lobulated, strongly hyperintense ependymoma. Courtesy Dr. J. Houten. interpedicular distance, scalloping of the posterior vertebral bodies, and at times widened foraminae and eroded pedicles. CT discloses the enlarged spinal canal and might depict an isodense intradural mass that might enhance following contrast administration. On MRI, an isointense mass on T1WI that appears hyperintense to the cord on T2WI and intensely enhances following contrast...

Osteoporosis

Osteoporosis is commonly seen in postmenopausal Caucasian women. However, it is found in women of all racial groups including black women. The disease does not spare males in the late stages of life they too may be affected by senile osteoporosis. Osteoporosis may be caused by endocrinopathies, nutritional deficiencies, drugs (long-term steroid therapy), or immobilization. Smoking is a well-recognized risk factor for osteoporosis. Osteoporosis may be akin to a silent thief. As it evolves, the...

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH), also known as ankylosing hyperostosis or Forestier disease, is a common degenerative condition that affects the elderly. It may be more common in diabetics and affects males more frequently. It is seen mostly in people of Caucasian origin. In many instances it is found as an incidental discovery. At times, however, it may cause symptoms. DISH most commonly affects the thoracic spine, but in many patients the cervical and lumbar regions may be...

Figure 1717

Pseudomeningocele

Postsurgical vertebral osteomyelitis and epidural abscess. (A) Sagittal T1WI showing endplate irregularities with bone edema suggesting spondylodiscitis (same patient as in Figure 17-8). (B) The best sequence for evaluating an epidural abscess is the postcontrast T1WI because the signals of an abscess and of CSF are both hyperintense, making it difficult to distinguish between them on T2WI. Following contrast administration enhancement at the periphery of the epidural abscess is noted. (C)...

Epidural Lipomatosis

Epidural lipomatosis (EL) is an uncommon but not a rare condition that frequently leads to spinal stenosis. EL occurs due to excessive epidural accumulation of fatty tissue. It is most frequently encountered in the thoracic region, especially in the mid-thoracic section. Less commonly it is seen in the lower lumbar and sacral regions. In the thoracic region the fat usually accumulates posteriorly to the cord, whereas in the lumbar region it may be circumferential, surrounding the thecal sac....

Clinical Presentation

Syringomyelia has no gender preference. It may be asymptomatic usually centrally located and found incidentally in patients undergoing imaging studies for spinal column pathology. At times, it presents with clinical symptoms such as gait disturbances due to spastic paraparesis or radicular pain, weakness, and dissociated sensory loss pain and temperature sensation are affected whereas light touch, position, and vibration sense remain intact. The patient may sustain painless burns or injuries in...