Cervical spine radiographs. Spinal Imaging. Overview. Cervical spine - MRI. Cervical spine - MRI. Overview 09/05/2015

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1 Cervical spine radiographs Spinal Imaging Dr Sachit Shah Consultant Neuroradiologist Lysholm Department of Neuroradiology The National Hospital for Neurology & Neurosurgery Adapted from ML Richardson, Univ. Of Washington Cervical spine - MRI T2w sagittal midline T2w - parasagittal Cervical spine - MRI Sag T2w Ax T2w 1

2 Lumbar spine - AP Lumbar spine - MRI Adapted from ML Richardson, Univ. Of Washington Sag T2w Ax T2w Lumbar spine - lateral Intervertebral disc - MRI Adapted from ML Richardson, Univ. Of Washington Lumbar spine - MRI Sag T1w Sag STIR 2

3 Acute back pain red flags irefer Acute back pain no red flags Imaging referral guidance from RCR Produced to help clinicians (inc GPs) determine most appropriate imaging investigation Evidence based Easy to use Accessible via the NHS (N3) network irefer Chronic back pain 3

4 Neck pain 42y/o female L brachalgia Left C6/7 disc protrusion with compression of left C7 nerve root Cervical spondylosis Cervical spondylosis 4

5 50y/o Japanese male Features of progressive cervical myelopathy Lumbar disc disease Adapted from Lumbar disc disease Spinal cord compression from ossified posterior longitudinal ligament Adapted from 38y/o male Acute left sciatica Lumbar disc disease Central Subarticular Foraminal Extraforaminal Left L5/S1 disc extrusion compressing left S1 nerve root in subarticular space Adapted from 5

6 29y/o male athlete Longstanding low back pain with new sciatica Foraminal stenosis Neural foramen L5/S1 spondylolisthesis secondary to bilateral pars defects 70y/o male Worsening claudication 32y/o female 6 week history of neck pain and fever Multilevel lumbar vertebral canal stenosis Discitis with epidural abscess Lumbar canal stenosis 70y/o female 3/12 hx of mid-thoracic pain to umbilicus Disc bulge, facet hypertrophy and flaval ligament thickening combine to cause central canal stenosis Intradural extramedullary tumour: thoracic meningioma 6

7 Classification of spinal lesions Extradural = outside thecal sac (including bone lesions) Intradural extramedullary = within thecal sac but outside cord Intramedullary = within spinal cord Extradural: : vertebral metastases Classification of spinal lesions Cord Dura Extradural Intradural Extramedullary Intramedullary Where is the lesion? Extradural Intradural Extramedullary Intramedullary 7

8 Modic endplate change Syrinx? Hydromyelia: dilatation of central canal (lined by ependyma) Syringomyelia: cavitary lesion within cord parenchyma (not lined by ependyma) Syringohydromyelia: term used for either of the above, as they cannot be discriminated on imaging and may overlap Syrinx: Common term for all of the above Oedema (active) Fatty (chronic) Sclerosis (chronic) Modic I endplate change Sag T1w Sag STIR Spondylo? Spondylosis = degenerative spine Spondylitis = inflammed spine (e.g. ankylosing ) Spondylolysis = chronic fracture of pars interarticularis with non-union ( pars defect ) Spondylolisthesis = anterior slip of vertebra typically from bilateral pars defects Any questions? 8

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