Spinal stenosis and lumbar disc pathology: what every radiologist should know.

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1 Spinal stenosis and lumbar disc pathology: what every radiologist should know. Poster No.: C-1301 Congress: ECR 2011 Type: Authors: Educational Exhibit A. Ovelar Ferrero 1, N. Alvarez de Eulate León 2, Á. Hidalgo Ovejero 1, A. Teijeira Azcona 3, F. Tajadura Iso 1, P. Atienza Arellano 1, M. E. ESLAVA GURREA 4, L. Miranda Orella 1 ; 1 Pamplona/ES, 2 Elcano (Navarra)/ES, 3 Toledo/ES, 4 OLLACARIZQUETA/ES Keywords: DOI: MR, CT, Spine /ecr2011/C-1301 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Learning objectives The objectives of this presentation are for the learner to be able to: a) Describe the normal anatomy of the lumbar spinal canal and its contents, b) Describe normal and pathologic conditions of lumbar discs, using a precise terminology. c) Differentiate between congenital and acquired lumbar spinal canal stenosis. d) Define the radiologic features of lumbar spinal canal stenosis. Background The terminology for disc abnormalities is very confusing and inconsistent in the literature. Deficiencies have been addressed in standarization and current practice of the language defining conditions of the lumbar discs. To address the remaining needs and in hopes of securing endorsement sufficient to result in universal standardization, joint task forces were formed by the North American Spine Society (NASS), the American Society of Neuroradiology (ASNR), and the American Society of Spine Radiology (ASSR) to provide a universally acceptable nomenclature, based on the anatomy and pathology, that serves a system of classification and reporting built upon that nomenclature. Lumbar spinal canal stenosis is narrowing of the central spinal canal, neural foramen, lateral recess of any combination of these anatomic regions by soft tissue or osseous structures that impinge on neural elements and may result in symptoms. Even if there are congenital abnormalities of the spine that narrow the canal, patients rarely have symptoms of spinal stenosis unless they have superimposed degenerative changes (acquired stenosis). Imaging findings OR Procedure details We kindly ask you to click on the adjacent PDF files to see the content (text and images) of this section: Page 2 of 8

3 1.- NORMAL ANATOMY OF THE SPINAL CANAL AND ITS CONTENTS 2.- NORMAL LUMBAR DISCS and DISC DEGENERATION 3.- ABNORMALITIES IN DISC MORPHOLOGY 4.- LUMBAR SPINAL CANAL STENOSIS Images for this section: Fig. 1: NORMAL ANATOMY OF THE SPINAL CANAL AND ITS CONTENTS Page 3 of 8

4 Fig. 2: NORMAL LUMBAR DISCS and DISC DEGENERATION Page 4 of 8

5 Fig. 3: ABNORMALITIES IN DISC MORPHOLOGY Page 5 of 8

6 Fig. 4: LUMBAR SPINAL CANAL STENOSIS Page 6 of 8

7 Conclusion In this work we provide a radiologic review of the normal and pathologic conditions of the lumbar spinal canal and lumbar discs, with a special focus on a nomenclature built up by a multidisciplinary task force to describe conditions of lumbar discs. Clear understanding of disc terminology between radiologists and clinicians is essential for clinical diagnostic and therapeutic decision making. Clinical significance of the pathologic imaging findings depends on correlation with clinical and neurophysiological data and cannot be inferred from morphologic data alone. Personal Information A. Ovelar Ferrero 1, N. Alvarez de Eulate León 1, Á. Hidalgo Ovejero 2, A. Teijeira Azcona 3, F. Tajadura Iso 1, P. Atienza Arellano 1, ME. Eslava Gurrea 4, L. Miranda Orella 1 1 Department of Radiology. Complejo Hospitalario de Navarra. Pamplona (Navarra). SPAIN 2 Department of Traumatology. Complejo Hospitalario de Navarra. Pamplona (Navarra). SPAIN 3 Department of Clinical Neurophysiology. Complejo Hospitalario de Toledo. Toledo. SPAIN 4 Department of Radiology. Hospital García Orcoyen. Estella (Navarra). SPAIN References 1. Boos N and Aebi M. Spinal disorders. Fundamentals of Diagnosis and Treatment. Springer Brock M, Patt S, Mayer HM. The form and structure of the extruded disc. Spine 1992; 17: Fardon DF and Milette PC. Nomenclature and classification of lumbar disc pathology. Spine 2001; 26(5):E93-E113 Page 7 of 8

8 4. Jinkins JR. Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiscal structures of the spinal column and perispinal soft tissues. Eur J Radiol. 2004; 50: Kaplan PA, Helms CA, et al. Muskuloskeletal MRI. Ed. Saunders. 1 st Edition Kieffer SA, Stadlan EM, Mohandas A, et al. Discographic-anatomical correlation of developmental changes with age in the intervertebral disc. Acta Radiol [Diagn] (Stockholm) 1969; 9: Laredo JD, de Sèze S et al. Escaner del raquis lumbar. Masson, McCarron R et al. The inflammatory effect of nucleus pulposus: a possible element in the pathogenesis of low back pain. Spine 1987; 12: Modic MT et al, Degenerative disc disease: assessment of changes in the vertebral body marrow with MR imaging. Radiology 1988; 166: Nathan H. Osteophytes of the vertebral column. An anatomical study of their development according to age, race, and sex, with consideration as to their etiology and significance. J Bone Joint Surg Am 1962; 44: Netter FH. Interactive atlas of clinical anatomy. Saunders Icon Learning Systems. 12. Resnick D, Niwayama G. Degenerative disease of the spine. In: Resnick D, ed. Diagnosis of Bone and Joint Disorders. ed 3. Philadelphia: WB Saunders, 1995: Sartoris DJ et al. Age related alterations in the vertebral spinous processes and intervening soft tissues: radiologic pathologic correlation. AJR 1985; 145: Schellhas KP et al, Lumbar disc high intensity zone: correlation of magnetic resonance imaging and discography. Spine 1996; 21: Shin JO. Principles of Clinical Electromyography. Case studies. Williams and Wilkins Baltimore (Ma). 16. Twomey LT, Taylor JR. Age changes in lumbar vertebrae and intervertebral discs. Clin Orthop 1987; 224: Yasuma T, Koh S, Okamura T, et al. Histologic changes in aging lumbar intervertebral discs. J Bone Joint Surg [Am] 1990; 72: Yasuma T, Makino E, Saito S, et al. Histologic development of intervertebral disc herniation. J Bone Joint Surg [Am] 1986; 68: Yu S et al. Anulus fibrosus in bulging intervertebral disks. Radiology 1988; 169: Yu S, Haughton VM, Sether LA, et al. Annulus fibrosus in bulging intervertebral disks. Radiology 1988;169: Page 8 of 8

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