SpineSpine

Imaging Techniques:Imaging Techniques:Plain film………traumaPlain film………traumaMRI………can see spinal cord & MRI………can see spinal cord &

nerves.nerves.CT……….spinal traumaCT……….spinal traumaRadionuclide bone Radionuclide bone

scan…..metastasesscan…..metastasesMyelography.Myelography.

Plain filmPlain film

Normal appearance:Normal appearance:

Vert. body is rectangular in shape in the lateral Vert. body is rectangular in shape in the lateral view.view.

Schmorl’s node; shallow indentations on the upper Schmorl’s node; shallow indentations on the upper & lower surfaces due to protrusion of the disc & lower surfaces due to protrusion of the disc material into the verteb. end plates ( of no clinical material into the verteb. end plates ( of no clinical significance).significance).

Disc spaces; normally have the same height at all Disc spaces; normally have the same height at all levels in the C. & D. spine. In the L.Spine increases levels in the C. & D. spine. In the L.Spine increases in height going down.in height going down.

Signs of abnormalitySigns of abnormality Disc space narrowingDisc space narrowing

Collapsed verteb. body …..lost height. Seen in the lateral Collapsed verteb. body …..lost height. Seen in the lateral view, or sagittal MRI. Look at the adjacent disc and view, or sagittal MRI. Look at the adjacent disc and pedicles.pedicles.

Pedicles Pedicles

Dense vertebraeDense vertebrae

Lytic lesion in the vertebraeLytic lesion in the vertebrae

Paravertebral shadowParavertebral shadow

Disc space narrowingDisc space narrowing

Causes;Causes;

DDDDDD

Infection.Infection.

Causes of Collapsed vertebraCauses of Collapsed vertebra Metastases & M.M. Metastases & M.M. Discs…..Normal Discs…..Normal Pedicles….destrcted in Metastases.Pedicles….destrcted in Metastases.

Infection……..Infection…….. adjacent disc narrow or obliterated. adjacent disc narrow or obliterated. Pedicles intact.Pedicles intact.

Osteoporosis & osteomalacia…Osteoporosis & osteomalacia… Disc normal or slight increase in heightDisc normal or slight increase in height Pedicles intactPedicles intact

Trauma.. Wedge shape with concave sup. surface. Trauma.. Wedge shape with concave sup. surface. Normal disc. Normal disc. Associated fracture of pedicles, neural archAssociated fracture of pedicles, neural arch

Eosinophil granuloma in children & young adults ………“vertebra Eosinophil granuloma in children & young adults ………“vertebra plana” plana”

the adjacent discs & pedicles are intact.the adjacent discs & pedicles are intact.

PediclesPedicles

On plain films …..On plain films ….. best assessed in the frontal view, except best assessed in the frontal view, except

in the C. spine….oblique view. in the C. spine….oblique view. very well seen in CTvery well seen in CT

Destruction or sclerosis of one or more is Destruction or sclerosis of one or more is aliable sign of metastases.aliable sign of metastases.

Flattening & increase interpedicular Flattening & increase interpedicular distance…. Intra-spinal SOL.distance…. Intra-spinal SOL.

Dense vertebraeDense vertebrae

Sclerosis may affect one or more vert.Sclerosis may affect one or more vert.Causes:Causes:

Metastases:…. …Ca prostate, & breast.Metastases:…. …Ca prostate, & breast.

LymphomaLymphoma

Paget’s dis. Enlarged verteb with coarse Paget’s dis. Enlarged verteb with coarse trabecular pattern.trabecular pattern.

Hemangioma; vertical striation in a normal size Hemangioma; vertical striation in a normal size vertebravertebra

Lytic lesion within a vertebra Lytic lesion within a vertebra

May affect one or more vertebraeMay affect one or more vertebraeCauses:Causes: Metastases….Lung, breast, kidneys.Metastases….Lung, breast, kidneys.

M.M or Plasmacytoma.M.M or Plasmacytoma.

Lymphoma.Lymphoma.

Infection….Lysis of two adjacent vert with Infection….Lysis of two adjacent vert with narrowed the intervening disc.narrowed the intervening disc.

Paravertebral shadowParavertebral shadow Dorsal region is the easiest place to recognize itDorsal region is the easiest place to recognize it

Lumber spine ….large enough to displace psoas shadow.Lumber spine ….large enough to displace psoas shadow.

C. Spine; Lateral view shows ant. displacement of the pharyngeal C. Spine; Lateral view shows ant. displacement of the pharyngeal air.air.

Causes;Causes; InfectionInfection

Malignant neoplasm.Malignant neoplasm.

Hematomas following trauma.Hematomas following trauma.

Myeloma/Myeloma/Metastases/Metastases/Lymphoma Lymphoma M.M. cause lytic lesions only.M.M. cause lytic lesions only.

Multiple lytic lesions are either M.M. or Metastases.Multiple lytic lesions are either M.M. or Metastases.

Metast. & M.M. both cause collapse verteb.Metast. & M.M. both cause collapse verteb.

Metastases often involve both verteb bodies & pedicles.Metastases often involve both verteb bodies & pedicles.

Lymphoma & metastases may cause lytic. Sclerotic or Lymphoma & metastases may cause lytic. Sclerotic or mixture of both.mixture of both.

MRI is the most accurate test for all.MRI is the most accurate test for all.

MRI will show compression of the spinal cod or nerve roots MRI will show compression of the spinal cod or nerve roots by soft tissue mass.by soft tissue mass.

InfectionInfection Common infecting organisms. TB & Staph.Common infecting organisms. TB & Staph.

The hallmark is destruction of two vertebral bodies with the The hallmark is destruction of two vertebral bodies with the intervening disc.intervening disc.

Collapse of verteb. bodies leading to gibbus formation.Collapse of verteb. bodies leading to gibbus formation.

Paravertebral soft tissue shadow which may calcify in TB.Paravertebral soft tissue shadow which may calcify in TB.

Plain film, CT & MRI all can show the changes. MRI is the Plain film, CT & MRI all can show the changes. MRI is the best.best.

Needle biopsy under CT or fluoroscopy Needle biopsy under CT or fluoroscopy

Spinal TraumaSpinal Trauma Plain films: Look for Plain films: Look for Fractures & alignment.Fractures & alignment.

CT in Major trauma:CT in Major trauma: no manipulation no manipulation difficulties in monitoring patients in MRI.difficulties in monitoring patients in MRI.

In unconscious patients:In unconscious patients: CT of C. spine with CT of head…. CT of C. spine with CT of head…. Reconstruction of the images in sagittal and coronal planes. Reconstruction of the images in sagittal and coronal planes.

Look for fracture C1,C2 (atlanto-axial interval) & C7-T1Look for fracture C1,C2 (atlanto-axial interval) & C7-T1

CT can show # laminae & pedicles CT can show # laminae & pedicles bony fragments inside the spinal canal (burst #)bony fragments inside the spinal canal (burst #)

MRIMRI

The spine is divided into 3 columns:The spine is divided into 3 columns: Ant…………ALL & ant 2/3 verteb bodyAnt…………ALL & ant 2/3 verteb body

Middle……post 1/3 of verte. body & PLLMiddle……post 1/3 of verte. body & PLL

Post………Pedicles, laminae & spinus pro. Post………Pedicles, laminae & spinus pro.

The spinal stability depends on the integrity of the The spinal stability depends on the integrity of the middle and post. columns.middle and post. columns.

Fractures of ant. 1/3 stable # like the commonly Fractures of ant. 1/3 stable # like the commonly seen wedge fractures of osteoporosisseen wedge fractures of osteoporosis

Spinal StabilitySpinal Stability

Three lines;Three lines; A line along the ant border of vert. bodyA line along the ant border of vert. body

A line along the post border of vert. bodyA line along the post border of vert. body

A line along the junction of the laminae and spinus A line along the junction of the laminae and spinus processes.processes.

Spinal canal bet. 2 & 3Spinal canal bet. 2 & 3 Interruption of these lines…..there may be serious injury.Interruption of these lines…..there may be serious injury.

Para-vertebral soft tissue swelling …..an important Para-vertebral soft tissue swelling …..an important indication of injury.indication of injury.

Alignment of vertebral bodiesAlignment of vertebral bodies

Jefferson #.... Lat. Masses of atlas Jefferson #.... Lat. Masses of atlas

Hangman’s #.....Arch of C2 …Severe Hangman’s #.....Arch of C2 …Severe hyperextension.hyperextension.

Tear drop #.... Tear drop #.... On the ant. surface of verte. body …On the ant. surface of verte. body … as a result of severe flexion injury…..may indicate as a result of severe flexion injury…..may indicate

a serious injury a serious injury

Whiplash injuryWhiplash injury

MRI in Spinal traumaMRI in Spinal trauma

Valuable in pat. with neurological deficits as Valuable in pat. with neurological deficits as it may demonstrate a potentially treatable it may demonstrate a potentially treatable abnormality like disc protrusion or abnormality like disc protrusion or hematoma.hematoma.

MRI can show hemorrhage & contusion of the MRI can show hemorrhage & contusion of the spinal cord.spinal cord.

SCIWORA syndrome…….Spinal Cord Injury SCIWORA syndrome…….Spinal Cord Injury Without Radiological Abnormality ..in childrenWithout Radiological Abnormality ..in children

DDD (degenerative disc DDD (degenerative disc disease)disease)