MRI and CT scans are commonly used to evaluate the spine for various indications such as disc lesions, postoperative evaluation, tumors, degenerative diseases, trauma, and congenital abnormalities. Preparations for CT and MRI may include fasting and administration of contrast material. Contrast is used for postoperative lumbar spine, inflammatory disorders, and neoplastic lesions but not for disc lesions or trauma. CT provides bone and soft tissue windows while MRI is better for visualizing soft tissues like discs and spinal cord. Both are useful for evaluating spinal structures.

1. What are the indications for MRI & CT: Disc lesionsPost-operative spine(after surgery)TumorsAny degenerative diseaseTraumaCongenital abnormalities of the spine

2. Preparations for CT & MRI:1-Fasting for 4-6 hours2-Contrast material Urographin ,telebrix 1-2 mg/kgAdministration of contrast:Yes: In post-operative lumbar spine, inflammatory disorders& neoplastic lesions.No:disc lesions, trauma.AnesthesiaUsed with children & uncooperative patients.

3. Patient position: Is usually supine, sometimes side lying, & rarely prone. How to see:Scanogram: primitive picture to detect the site of lumbar spine

4. Computed tomography (CT):. Usual scanning. . Axial slides 2-4 mm. 2 mm in cervical spine / 4 mm in lumbar spineHas bone & soft tissue window. CT screening:. Whole segment of the spine 5 mm in cervical spine, 8 mm in lumbar spine.. Selective Scanning Every 3 mm especially in trauma, also in cervical disc lesions. N.B:If I want to see one vertebra e.g. L3 I have to take 1 vertebra above (L2 )& 1 below (L4).

7. CT Myelography:Is considered as intrathecal contrast injection with L- puncture needle.

8. We have 2 windows

9. Soft tissue & bone window.What are the structures I should evaluate in CT of lumbar spine:Lumbar spinal canal diameter normally 13 mm.Disc lesions.Others.facet, sacroiliac joints & paravertebral soft tissue.

10. Soft &bone window (CT) Lumbar

12. 1. Lumbar spinal canal diameter:Spinal canal is bony structure, so we see it in bone window.The spinal canal must be closed (at the level of pedicles).We measure the AP diameter. Types of canal stenosis:1-Relative:11-12 mm & this doesn’t need operation but it needs operation if there’s disc.2- Absolute: 8 -10 mm & it must be operated.

13. Disc lesions:We detect it in soft tissue window. Posterior border of the disc is more important as it has relation to the disc. The normal posterior border of the disc is CONCAVE.The abnormal is STRAIGHT OR CONVEX.

14. N.B:. Normally due to overload ,the disc of L5-S1 is CONVEX& the abnormal is also convex,so to judge if it’s normal or no look at the next slide if: the posterior border of the disc is convex so it is ABNORMAL.. The angle of inclination in L5-S1 is more than 30 & the device accept up till 30 only so part of the slide will contain bone & part will contain disc.

17. Normal CT Lumbar

18. Disc herniation (CT axial)

19. MRI – LUMBAR SPINEMNERVE ROOTSFORAMENAXIAL VIEW

20. Manifestations of arthritis in any joint: (Spondylosis in spine and osteoarthritis of other joints)Osteophytic lipping.Narrow joint space.Subarticular bone sclerosisSub cortical pseudo cystic changes.Intra articular air.(vaccum phenomena)

21. Vacuum phenomena

22. CT of cervical spine

23. We have 2 types of joints:Neurocentral joint:Is the articulation between one vertebra above & one vertebra below which makes the shape of the body of the vertebral end plate .Facet joint:Is the articulation between the inferior lip of the transverse process of one vertebra above with the superior lip of the transverse process of the vertebra below, it’s called Hamburger’s Sandwich. Arthritis of the neurocentral or facet joint gives the same manifestations of nerve compression due to disc lesion.

24. Cervical disc in CT:We see it in soft tissue window .The disc in cervical spine is very narrow so every slide will contain both disc & bone, therefore there isn’t a slide of pure disc, So we choose the slide which contain more disc for assessment.. All posterior edges of cervical spine are normally convex.. See if there’s disc substance protruded than the bone.. Normal spinal cord picture is kidney shaped.

25. Difference between cervical & lumbar spine in CT

29. Stages of disc pathology (4 stages)

30. CT of the spine

31. CT axial bone& soft tissue widow

33. CT machine

40. MRI CT plain x-Ray

41. CT– CERVICAL SPINEC2-3 INTERVERTEBRAL DISC FORAMENDISCFORAMENFACET JOINTFACET JOINTSPINOUS PROCESSAXIALSAGITTAL

42. CT- CERVICAL SPINEC-1 SECTIONARCH OF C-1DENSBASE OF SKULLMASTOIDAXIALSAGITTAL

43. CT- LUMBAR SPINEPOST MYELOGRAM DISCSPINOUS PROCESS

44. CT– CERVICAL SPINEC- 3 SECTIONPEDICLEPEDICLELAMINAAXIALSAGITTAL

45. CT-- CERVICAL SPINEC-2 SECTIONC-2 BODYDEGENERATEDC6-7C-2 SPINOUS PROCESSAXIALSAGITTAL

46. CT axial CT sagittal

47. CT- LUMBAR SPINEPOST MYELOGRAMAxialPEDICLEPEDICLENERVE ROOTS

48. Posterior arch #(CT)

49. Burst # (CT) axial

50. sagittal CT

51. CT axial section (base of the skull)

52. CT- LUMBAR SPINEPOST MYELOGRAMFORAMENFORAMEN

53. CT of cervical spine(sagittal)

54. CT axial

55. CT of cervical spine (axial)

56. CT sagittal

57. CT sagittal tear drop # dislocationTear drop # dislocation(plain)

58. CT-LUMBAR SPINEPOST MYELOGRAMTHECAL SACLAMINALAMINA

59. CT- LUMBAR SPINEPOST MYELOGRAMFACET JOINTS

60. CT- LUMBAR SPINEPOST MYELOGRAMPEDICLEPEDICLENERVE ROOTS