Nomenclature in spine mri
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Nomenclature in spine mri

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Nomenclature in spine mri Nomenclature in spine mri Presentation Transcript

  • Imaging Degeneration of the Lumbar Spine: THE 1 LESSONS ST Hieder A`ala 601 MUST
  • Course Outline• Introduction, Nomenclature, Evidence for Imaging• Natural History and Prognosis• New Techniques
  • Spine Nomenclature and Evidence for Imaging
  • Talk Objectives• “Background”• Nomenclature for disc findings• Who should be imaged- evidence basis?
  • 15 Century Turkish thTreatment- Cauterization
  • 21st Century American Treatment
  • Frequency of Back Pain Types 2% visceral 1% tumor, infection, inflammatory arthritis 97% “mechanical”
  • “Mechanical” Causes of Low Back Pain• Lumbar strain, sprain (70%)• Degen (disc and facets) (10%)• Herniated disc (4%)• Spinal stenosis (3%)• Osteoporotic comp fracture (4%)
  • The Least We Can Do:Speak the Same LanguageNomenclature for disc findings
  • Consensus Nomenclature
  • Question???• What is the ASNR/NASS nomenclature for describing lumbar discs?
  • Consensus Nomenclature• normal• degeneration• anular tears• herniation
  • Consensus Nomenclature• normal –well hydrated disc –central dark band= central fibrosusage-related changes=NOT normal
  • Intranuclear Cleft
  • Normal
  • Consensus Nomenclature• normal• degeneration –desiccation –narrowing –bulging –endplate changes –osteophytes
  • Glossary of disc pathology terms• Herniation: nonspecific term subject to misinterpretation. – Not recommended.• Bulge: diffuse enlargement of disc area – Very common – Usually not clinically important – May contribute to spinal stenosis• Protrusion: nucleus pulposis pushes focally through fibers of annulus fibrosis – Base wider than apex – May focally impinge on nerve or thecal sac
  • Glossary of disc pathology terms• Extrusion: nucleus material pushes out beyond posterior longitudinal ligament but remains in contact with disc space – Apex wider than base – Likely to impinge on nerve roots• Sequestration: Disc fragment isolated from parent disc
  • Glossary of disc pathology terms• Localizing terms: –Central –Paracentral –Foraminal –Lateral
  • Disc DegenerationDesiccation Narrowing
  • Disc Degeneration: Findings? Narrowing Osteophytosis Vacuum DiscEndplate sclerosis
  • Bulging
  • Consensus Nomenclature• normal• degeneration• anular tear=anular fissure (high intensity zones=HIZ)• herniation
  • Degeneration and Tears
  • Degeneration and Tears
  • Degeneration and Tears
  • Consensus Nomenclature• Herniation – localized displacement of disc o >50% (180 ) = bulge <50% = herniation
  • Consensus Nomenclature• normal• degeneration• anular tears• herniation –protrusion –extrusion
  • Disc Normal BulgeBonyEndplate Canal Protrusion Extrusion
  • Disc Classification
  • Protrusion
  • Protrusion
  • Extrusion
  • Extrusion
  • Extrusion
  • Extrusion
  • Classification of Nerve Root Condition• Normal• Contacted• Displaced• Compressed
  • Normal Nerve Roots
  • Contacted Nerve Root
  • Contacted Nerve Root
  • Displaced Nerve Root
  • Compressed Nerve Root
  • Displaced andCompressed Nerve Root
  • Displaced andCompressed Nerve Root
  • Talk Objectives• “Background”• Nomenclature for disc findings• Who should be imaged- evidence basis?
  • Prevalence of Disc Findings in Subjects without LBP100%80% 64%60%40% 32%20% 6% 0% Bulge bulge Protrusion protrusion Extrusion extrusion
  • Disc Degeneration• Signal loss on T2-weighted images• Height loss
  • Disc Degeneration
  • Disc Degeneration
  • Anular Tear
  • Take Home Points Regarding Prevalence• many imaging findings are common in asx’s• certain findings are related to prior low back pain and more likely to be clinically important –extrusions, root comp, stenosis
  • Rationale for Imaging• r/o low prob red flag condition• rule-in treatable conditions –stenosis –herniated disc –spondyloarthropathy ? –instability
  • Early Imaging Red Flags• ? Fx –h/o major trauma –minor trauma in older or osteoporotic pt
  • Red Flags• age>50 or <20• h/o malignancy• constitutional sx• ↑ infection risk (IVDA, HIV, etc)
  • Red Flags• possible cauda equina syndrome –saddle anesthesia –urinary retention –severe/progressive neurologic deficit in lower extremity