Neuroimaging of Spinal Diseases: A Pictorial Review

 

 Buy Article Permissions and Reprints

ABSTRACT

Magnetic resonance imaging (MRI) has become a valuable noninvasive, cost-effective tool for accurately evaluating spine disorders. This article affords a comprehensive review of normal anatomy as it relates to MRI interpretation with specific attention to accurately defining nerve root abnormalities. It gives in-depth detail on disc herniation nomenclature with specific examples of disc bulge, disc protrusion, disc extrusion, and disc sequestration. In addition, there are illustrations of various forms of degenerative spine disease, including intradiscal degenerative disease, reactive end plate changes, spinal stenosis, synovial cyst formation, and spinal instability. Differentiating features for separating osteoporotic spine fracture from underlying neoplastic pathologic fracture are illustrated. Finally, examples of both benign and malignant disease are illustrated in the spine with corresponding clinical and MRI examples.

REFERENCES

• 1 Frymoyer J W. Back pain and sciatica.  N Engl J Med. 1988;  318 291-300
  CrossrefPubMedGoogle Scholar
• 2 Jensen M C, Brant-Zawadzki M N, Obuchowski N, Modic M T, Malkasian D, Ross J S. Magnetic resonance imaging of the lumbar spine in people without back pain.  N Engl J Med. 1994;  331 69-73
  CrossrefPubMedGoogle Scholar
• 3 Boden S D, Davis D O, Dina T S et al.. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.  J Bone Joint Surg Am. 1990;  72 403-408
  PubMedGoogle Scholar
• 4 Chin C T. Spine imaging.  Semin Neurol. 2002;  22 205-220
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Haijiao W, Koti M, Smith F W, Wardlaw D. Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging.  J Spinal Disord. 2001;  14 143-149
  CrossrefPubMedGoogle Scholar
• 6 Ross J, Brant-Zawadzki M, Moore K. Diagnostic Imaging Spine. Salt Lake City, UT; Amirsys 2004
  Google Scholar
• 7 Breton G. Is that a bulging disk, a small herniation or a moderate protrusion?.  Can Assoc Radiol J. 1991;  42 318
  PubMedGoogle Scholar
• 8 Milette P C. Reporting lumbar disk abnormalities: at last, consensus!.  AJNR Am J Neuroradiol. 2001;  22 428-429
  PubMedGoogle Scholar
• 9 Levin K. Neck and low back pain. Neurologic Clinics. Philadelphia, PA; WB Saunders 2007 25: 450
  Google Scholar
• 10 Deyo R A. Back surgery—who needs it?.  N Engl J Med. 2007;  356 2239-2243
  CrossrefPubMedGoogle Scholar
• 11 Lejeune J P, Hladky J P, Cotton A et al.. Foraminal lumbar disc herniation. Experience with 83 patients.  Spine. 1994;  19 1905-1908
  PubMedGoogle Scholar
• 12 Epstein N E. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures.  Spinal Cord. 2002;  40 491-500
  CrossrefPubMedGoogle Scholar
• 13 Modic M T, Steinberg P M, Ross J S et al.. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging.  Radiology. 1988;  166 193-199
  CrossrefPubMedGoogle Scholar
• 14 Blumenthal S L, Roach J, Herring J A. Lumbar Scheuermann's: a clinical series and classification.  Spine. 1987;  12 929-932
  CrossrefPubMedGoogle Scholar
• 15 Kirkaldy-Willis W H, Farfan H E. Instability of the lumbar spine.  Clin Orthop Relat Res. 1982;  165 110-123
  PubMedGoogle Scholar
• 16 Butler D, Trafimow J H, Andersson G BJ, McNeill T W, Huckman M S. Discs degenerate before facets.  Spine. 1990;  15 111-113
  CrossrefPubMedGoogle Scholar
• 17 Wiltse L L, Widell E H, Jackson D W. Fatigue fracture: the basic lesion in isthmic spondylolisthesis.  J Bone Joint Surg Am. 1975;  57 17-22
  PubMedGoogle Scholar
• 18 Rossi F. Spondylolysis, spondylolisthesis, and sports.  J Sports Med Phys Fitness. 1978;  18 317-340
  PubMedGoogle Scholar
• 19 Fredrickson B E, Baker D, McHolick W J, Yuan H A, Lubicky J P. The natural history of spondylolysis and spondylolisthesis.  J Bone Joint Surg Am. 1984;  66 699-707
  PubMedGoogle Scholar
• 20 Cavalier R, Herman M J, Cheung E V et al.. Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural history, and nonsurgical management.  J Am Acad Orthop Surg. 2006;  14 417-424
  PubMedGoogle Scholar
• 21 Chad D A. Lumbar spinal stenosis.  Neurol Clin. 2007;  25 407-418
  CrossrefPubMedGoogle Scholar
• 22 Kasdan R. Degenerative diseases and related conditions of the spine. Presented and published for the Annual Meeting of American Academy of Neurology May 1, 2007 Boston, MA;
  Google Scholar
• 23 Qasho R, Raymundo O E, Maraglino C et al.. Epidural lipomatosis with lumbar radiculopathy in one obese patient. Case report and review of the literature.  Neurosurg Rev. 1997;  20 206-209
  PubMedGoogle Scholar
• 24 Ohta Y, Hayashi T, Sasaki C et al.. Cauda equina syndrome caused by idiopathic sacral epidural lipomatosis.  Intern Med. 2002;  41 593-594
  CrossrefPubMedGoogle Scholar
• 25 Apostolaki E, Davies A M, Evans N, Cassar-Pullicino V N. MR imaging of lumbar facet joint synovial cysts.  Eur Radiol. 2000;  10 615-623
  CrossrefPubMedGoogle Scholar
• 26 St. Amour T E, Hodges S C, Laakman R W, Tamas D E. Arachnoid (meningeal) cysts. In: St. Amour TE, Hodges SC, Laakman RW, Tamas DE MRI of the Spine. New York, NY; Raven Press 1994
  Google Scholar
• 27 Boden S D, Davis D O, Dina T S et al.. Contrast-enhanced MR imaging performed after successful lumbar disk surgery: prospective study.  Radiology. 1992;  182 59-64
  PubMedGoogle Scholar
• 28 Bundschuh C V, Stein L, Slusser J H et al.. Distinguishing between scar and recurrent herniated disk in postoperative patients: value of contrast-enhanced CT and MR imaging.  AJNR Am J Neuroradiol. 1990;  11 949-958
  PubMedGoogle Scholar
• 29 Ledermann H P, Schweitzer M E, Morrison W B et al.. MR imaging findings in spinal infections: rules or myths?.  Radiology. 2003;  228 506-514
  CrossrefPubMedGoogle Scholar
• 30 Etchepare F, Roche B, Rozenberg S, Dion E, Bourgeois P, Fautrel B. Post-lumbar puncture arachnoiditis. The need for directed questioning.  Joint Bone Spine. 2005;  72 180-182
  CrossrefPubMedGoogle Scholar
• 31 Sather M D, Gibson M D, Treves J S. Spinal subarachnoid hematoma resulting from lumbar myelography.  AJNR Am J Neuroradiol. 2007;  28 220-221
  PubMedGoogle Scholar
• 32 Shih T T, Huang K M, Li Y W. Solitary vertebral collapse: distinction between benign and malignant causes using MR patterns.  J Magn Reson Imaging. 1999;  9 635-642
  CrossrefPubMedGoogle Scholar
• 33 Yuh W T, Zachar C K, Barloon T J et al.. Vertebral compression fractures: distinction between benign and malignant causes with MR imaging.  Radiology. 1989;  172 215-218
  PubMedGoogle Scholar
• 34 Fu T S, Chen L H, Liao J C et al.. Magnetic resonance imaging characteristics of benign and malignant vertebral fractures.  Chang Gung Med J. 2004;  27 808-815
  PubMedGoogle Scholar
• 35 Cuénod C A, Laredo J D, Chevret S. Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadolinium-enhanced MR images.  Radiology. 1996;  199 541-549
  PubMedGoogle Scholar
• 36 Moore K R, Tsuruda J S, Dailey A T. The value of MR neurography for evaluating extraspinal neuropathic leg pain: a pictorial essay.  AJNR Am J Neuroradiol. 2001;  22 786-794
  PubMedGoogle Scholar
• 37 Hansen J T, Koeppen J M, Netter F, Perkins J, Craig J. Atlas of Neuroanatomy and Neurophysiology: Selections from the Netter Collection of Medical Illustrations. Teterboro, NJ; Icon Custom Communications 2002
  Google Scholar
• 38 Banna M. Clinical Radiology of the Spine and Spinal Cord. Rockville, MD; Aspen Systems Corp 1985
  Google Scholar
• 39 Rao K CVG, Williams J P, Lee B CP, Sherman J L. MRI and CT of the Spine. Baltimore, MD; Williams & Wilkins 1994
  Google Scholar

Richard B KasdanM.D. 

Associates in Neurology of Pittsburgh

5750 Centre Avenue, Suite 100, Pittsburgh, PA

Email: jhoward@presgar.com