This files are made for class lectures.

1. SOHEL RANA SUMON
BSC(RADIOLOGY), DMRT, PG(DMU), MPH.
LECTURER
DEPARTMENT OF RADIOLOGY & IMAGING.
STATE COLLEGE OF HEALTH SCIENCES.
Radiological Evaluation of
Spine Disease.

2. Anatomy :
 Cervical Spine – 7
 Thoracic Spine -12
 Lumber spine -5
 Sacral Spine -5 (fused)
 Coccyx - 4
……………………………………………………….
Total - 33 vertebra

3. Important terms
1. Spondylosis
2. Spondylolysis
3. Spondylolisthesis
4. Spondylodiscitis
5. Sacroiliitis
6. Ankylosing spondylitis
7. Scoliosis

4. Spondylosis
 Degenerative changes of intervertebral disc space .
 Joint space narrowing .
 Osteophyte formation .
 Endplate sclerosis.
 Symptom
 Back pain.

5. Spondylolysis
 A fracture that extend from the pars interarticularis.
 Its evident on a oblique radiograph (scotty dog).
 Defect in lamina.(scotty dog sign neck)

7. Spondylolisthesis
 The parse defect anterior or posterior displacement of
vertebral alignment.
 It has 4 grade:1,2,3,4
>Symptom
 Back pain

8. Grade 1 : 25% slippage
Grade 2 : 25-50% slippage
Grade 3 : 50-75% slippage
Grade 4 : 75% to above slippage .
 Reduce intervertebral disk space.
 Slippage vertebra anteriorly(Anterolisthesis) or
posteriorly(posterolisthesis), it measurement by lower part of vertebral
alignment.
Spondylolisthesis

9. Spondylitis /Infection
 Vertebral-TB :
 Paget disease :
 Spondylodiscitis :
 Inflammatory spondyloarthropathy :

10. MRI-
>Hypointense on T1 images.
>Hyperintense on T2 images.
>Contrast enhanced
hyperintensity on T1 images.
Spondylitis

11. T1
 Low signal in disc space (fluid)
 Low signal in adjacent endplates (bone marrow edema)
T2:
 High signal in disc space (fluid)
 High signal in adjacent endplates (bone marrow edema)
 Loss of low signal cortex at endplates.
 High signal in paravertebral soft tissues.
 Hyperintensity within the psoas muscle.
T1 C+ (Gd)
 Peripheral enhancement around fluid collection(s)
 Enhancement of vertebral endplates
 Enhancement of paravertebral soft tissues
 Enhancement around low-density center indicates abscess formation.
MRI-features

12. Spondylodiscitis
 Infection involve the intervertibral disc (discitis) and
adjacent vertebra (spondilitis).
 Evident paravertibral soft tissue mass.
MRI-
>Hypointense on T1 & T2 images.
>Contrast enhanced hyperintensity
on T1 images.

13. Ankylosing spondylitis
 Ankylosing spondylitis is a type of arthritis characterized by long-
term inflammation that affects the spine, The spine's bones (vertebrae) fuse
together, resulting in a rigid spine.
>>RG sign:
 Syndesmophyte.
 Bamboo spine.
 Shiny cornar.
 Dagger sign,trolly track sign.
 SI joint involve.
(syndesmophyte)
 Symptoms : pain and stiffness from the neck down to the lower back.

14. Sacroiliitis
 Sacroiliitis is an inflammation of one or both sacroiliac joints.
 Erosion & sclerosis on SI joint.
 widening of joint spaces.
 The best demonstration on MRI T2 STAIR sequences.
 high T2/STIR signal if active.
 low T1 signal.
Sacroiliitis can cause pain in your buttocks or lower back, and can extend down one or both legs.
Prolonged standing or stair climbing can worsen the pain.

15. Sacralization
 Sacralization is a congenital anomaly in which the transverse process of the
last lumbar vertebrae fuses to the sacrum or ilium.
Tarlov cysts

16. Schmorl’s node
 Schmorl's nodes are the intervertibral disc herniation
through the vertebral body endplate and into the adjacent
vertebra.

17. Disc herniation (PLID).
 Disc herniation can occur in any disc in the spine anteriorly or
posteriorly .
 Prolapse lumber intervertebral disc (PLID).
 MRI showing T1 & T2 images a large posterior harniation.
 Axial images a disc harniation compressing the adjacent nerve
root.

18. Limbus vertebra
 Limbus vertebra is a well-corticated unfused secondary ossification center,
usually of the anterosuperior vertebral body corner, that occurs secondary
to herniation of the nucleus pulposus through the vertebral body endplate
beneath the ring apophysis.

19. Intercalary bones
 It is common discal ossification that are usually
triangular in morphology.
 It found in the anterior annular fibers of disc.

20. Scoliosis
 Scoliosis is a medical condition in which a person's spine has a
sideways curve (with a cobb angel grater than 10 degree)

21. Vertebral haemangioma
 It is most common benign vertebral neoplasm.
>> RG feature :
X-Ray : Corduroy cloth appearance.
CT-Scan : polka dotted appearance.
MRI : T1- hyperintense its fat content.
T2- hyperintense its water content.
T1C - significant enhancement seen its high vascularity.
x-ray CT MRI

22. Multiple myeloma
 Multiple myeloma causes cancer cells to accumulate in the
bone marrow.
 Its forms in a type of white blood cell called a plasma cell.

23. Multiple bone metastases
 Multiple bone metastases, including the pedicle metastasis
responsible for the plain film appearances . The winking owl
sign refers to the appearances of the spine, when a pedicle is
absent - almost always due to a bony metastasis.

24. Metastasis
 Ivory vertebra : most common findings, radiologists can identify increased density
of a vertebral body, referred to as ivory vertebra.
(ivory vertebra)

25. Metastasis
MRI:
T1: hypointense
T2: hypointense
T1 C+ (Gd): enhancement usually
present.

26. Vertebra plana
 Causes:

27. Pott disease
 It destroy the spine causing collaps of the vertebra,which result paravertebral abces formation.
 Vertebral distraction may lead to - 1.vertebral plana ,
2. kyphosis -------
3. gibbus deformity---------

28. Hyperparathyroidism
 Hyperparathyroidism is an increase in parathyroid hormone (PTH) levels
in the blood.
 Classical radiological appearances of a rugger jersey spine. These
appearances occur in hyperparathyroidism.

29. Diffuse Idiopathic Skeletal Hyperostosis
(DISH)
 Flowing osteophytes of at last 4 contiguous vertebral body.
 Preserved disk height.
 No sacroilitis .
 Calcification of ligament & tendone.

30. Achondroplasia
 Achondroplasia is a genetic disorder that results in dwarfism.
 Limb shortening (micromelia).
 A characteristic finding is that the spine typically narrowing of
the interpedicular distance is a caudal direction.

31. Spina Bifida
 Spina bifida is a neural tube defect, it is congenital malformation consisting
of a defect in the closure of the vertebral arch.
 AP view of the lumbar spine shows at L5 and SI with inadequate development of the
posterior arches at both levels. & Lateral view of the lumbar spine shows a grade I
spondylolisthesis of L5 on S I with inadequate development of the posterior element
of L5 and S 1. MRI- Hypointense on T1 images & hyperintense on T2 images.

32. Renal osteodystrophy
 Renal osteodystrophy is currently defined as an alteration of bone morphology in
patients with chronic kidney disease (CKD). It is one measure of the skeletal
component of the systemic disorder of chronic kidney disease-mineral and bone
disorder (CKD-MBD).
* chronic renal failure featuring some combination of :-
 Osteomalacia (adults)
 Rickets (children) T1 T2
 2° hyperparathyroidism
 Osteosclerosis
 Soft-tissue + vascular calcifications
 mineralization of normal osteoid tissue following closure of the growth plates.

33. Cervical Ribs
 A cervical rib in humans is an extra rib which arises from the
eventh cervical vertebra. Sometimes known as "neck ribs", their presence is a
congenital abnormality located above the normal first rib.

34. Neoplasm's of spinal canal

35. Neoplasm's of spinal canal
 Intramedullary :
a. Ependymoma.
b. Astrocytoma
c. Haemangioblastoma.
d. Ganglioglioma
e. Metastasis.
 Intradural Extramedullary :
a.Schwannoma
b.Neurofibroma
c.Meningioma
d. Metastasis.
 Extradural :
> Bony tumors

36. Spinal Ependymoma
Intramedullary

37. Astrocytoma Haemangioblastoma.
Ganglioglioma Metastasis

38. Spinal Meningioma

40. Schwannoma Neurofibroma

41. Multiple Sclerosis ( Spinal cord )

43. Syringomyelia

44. Tethered Cord Syndrome

45. Brachial plexus of nerves:
The brachial plexus is a network (plexus) of nerves formed by the anterior
rami of the lower four cervical nerves and first thoracic nerve (C5, C6, C7 ).
The most serious brachial plexus injury occurs when the nerve root is torn
from the spinal cord .
Common symptoms of brachial plexus injuries are:
1. Numbness or loss of feeling in the hand or arm.
2. Inability to control or move the shoulder, arm, wrist or hand.
3. An arm that hangs limply.
4. Burning, severe and sudden pain in the shoulder or arm.

46. Neurolymphomatosis neuritis
Pseudomeningocele
Pseudomeningocele
Level- C5–T1 neural
foramen.
rupture

48. .

49. Question
1. Define spondylosis, spondylolysis, spondylolisthesis, scoliosis, spondylitis,
Spondylodiscitis, Sacroiliitis, Ankylosing spondylitis,Scoliosis.?
2. Write down the radiological features of
spondylosis, spondylolysis, spondylolisthesis,
scoliosis, spondylitis, Spondylodiscitis,
Sacroiliitis, Ankylosing spondylitis, Scoliosis.
3. Short notes of
pott’s disease,
spina bifida,
vertebral plana,
Ankylosing spondylitis?
Metastasis.
Multiple myeloma.
4. Write down the components of intervertibral disc ?

50. 5. Write down about the degenerative disc and its
radiological features?
6. Write down the causes of low back pain and short about
radiological features?
7. What do you mean PLID and its radiological features?
8. Radiological anatomy of whole spine ?
9. Write down the Name of Neoplasm's of spinal canal?
10. Write short about brachial plexus of nerves ?