Radiology 5th year, 5th lecture/part one (Dr. Ameer)


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The lecture has been given on May 19th, 2011 by Dr. Ameer.

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Radiology 5th year, 5th lecture/part one (Dr. Ameer)

  1. 1. Degenerative disc disease Spondylosis Spondylitis Spondylolysis Spondylolisthesis Spondylosis; occurs maximmally in the lower cervical & lower lumber regions Results from degeneration of the intervertebral disc. The degenerated disc may herniate & press on the S.C. & nerve roots causing pain & neurological deficits. The degen. discs often stimulate formation of osteophytes which together with soft tissue thickening may press upon the SC or nerve roots. OA of the facet joints (apophyseal joints) may aggravate the condition.
  2. 2. Plain film findings in spondylosis <ul><li>Mostly asymptomatic </li></ul><ul><li>When symptomatic , little correlation between the Sign & symptoms & the radiolog. findings. </li></ul><ul><li>A normal plain film will not exclude disc prolapse. </li></ul><ul><li>So the main aim of taking radiographs is to exclude other disease that may be present. </li></ul>
  3. 3. Signs of spondylosis on plain films <ul><li>Disc space narrowing. </li></ul><ul><li>Osteophytosis & sclerosis of the adjoining surfaces of the vertebral bodies. </li></ul><ul><li>Post. Osteophytes may narrow the spinal canal or encroach on the nerve roots in the intervertebral foramina. </li></ul><ul><li>The interverteb. Foramina of the C.spine are best seen in oblique views. </li></ul>
  4. 4. MRI in the spondylosis <ul><li>Dehydration (Reduced signal in T2) </li></ul><ul><li>Reduction in the height of the disc & may bulge. </li></ul><ul><li>Changes of facet joint arthropathy. </li></ul><ul><li>These joints may become inflamed causing </li></ul><ul><li>hypertrophy of the joints </li></ul><ul><li>osteophyte formation & thickening of ligament flavum leading to the pressure on the nerve roots in the exit foramina . In the c.spine the osteophytes may compress the S.C. leading to ischemic changes. </li></ul>
  5. 5. Disc herniation <ul><li>May be small bulge or large </li></ul><ul><li>May central or posterolateral or far lateral. </li></ul><ul><li>May detach & migrate (sequestrated). </li></ul><ul><li>The common sites for disc herniation are the lower C.& L.Spine. </li></ul>
  6. 6. MRI Lumber disc herniation <ul><li>Majority occur posterolaterally at L4-L5 & L5-S1 levels. </li></ul><ul><li>> 1/3 of demonstrably herniated discs are asymptomatic. So the criteria for surgery must be clear-cut evidence of compression of the clinically affected nerve roots. </li></ul><ul><li>Failed back syndrome Scarring Vs recurrent disc. Scarring enhances, while disc herniation does not. </li></ul>
  7. 7. Cervical disc herniation <ul><li>Majority occur at the lower three disc levels. </li></ul><ul><li>MRI can identify disc herniation encroaching on the spinal cord & or nerve roots. </li></ul>
  8. 8. Spinal stenosis <ul><li>A narrow spinal canal may lead to cord or nerve root compression esp. when spondylotic changes supervene </li></ul><ul><li>Symptomatic spinal stenosis is encountered in the C.& L. regions. </li></ul><ul><li>MRI is th ideal method of demonstrating the size & the shape of the spinal canal and thus diagnosing SCS </li></ul><ul><li>MRI can show the HNP & any bony or soft tissue encroachment upon the narrowed spinal canal. </li></ul>
  9. 9. Ankylosing Spondylitis <ul><li>Affects principally SI joints and the spine. </li></ul><ul><li>Both SI joints are invariably affected by the time spinal involvement has occurred. </li></ul><ul><li>The earliest changes are haziness of the SI joints followed by erosions. Finally there will be obliteration of the joint space with bony ankylosis. </li></ul><ul><li>In the spine; squaring of the vertebral bodies with ossification of the lig. & vertical bony bridges bamboo spine </li></ul>
  10. 10. Spina bifida <ul><li>Incomplete closure of the spinal canal. </li></ul><ul><li>Usu. Seen in the L.S. spine. </li></ul><ul><li>May be associated with Spinal cord abnormality. </li></ul><ul><li>Malformatin of the vertebral bodies </li></ul><ul><li>(Spinal dysraphism)……Dx antenatally by US. </li></ul><ul><li>Spina bifida occulta of no significance </li></ul>
  11. 11. Spondylolysis & spondlyolisthesis <ul><li>Defect in the pars interarticularis </li></ul><ul><li>Foreward slip of one vertebral body on the one below. Occurs most frequently at L.S. junction & bet. L4 & L5. </li></ul><ul><li>Seen in the lateral view. </li></ul>
  12. 12. Spinal cord Compression <ul><li>MRI can show the site, size & extent of the compression. </li></ul><ul><li>Extra-dural lesions; metast, TB, Cervical disc herniation. Lumber disc prolapse causes no cord compression as the cord does not extend below L1 </li></ul><ul><li>Intradural but extramedullary( within the dura but not the cord) like neurofibroma and meningioma. </li></ul><ul><li>Intramedullary lesions tumors like ependymoma or hemorrhage. </li></ul>
  13. 13. Other lesions of the spinal cord <ul><li>Syringomyelia </li></ul><ul><li>Demyelinating plaques of MS </li></ul>