This document provides an overview of radiology of the spinal cord. It begins with an introduction and outlines the topics to be covered, including anatomy of the spinal cord and vertebral column, various radiological investigations such as plain X-rays, myelograms, CT, CT myelograms, and MRI. It then describes the anatomy of the spinal cord and vertebral bones, different radiological methods, and provides examples of the radiological presentation of some spinal cord diseases such as disk herniation, infection, fracture-dislocation, and spinal cord injury.

2. RADIOLOGY
OF
SPINAL CORD
September 2013
TAJUDDIN MALABAREY

3.  Welcome to the the Radiology Of Spinal
Cord (Imaging module).
 After completing this module you should be
able to:
 identify, and distinguish between, common
types of Radiographic Images
 including Plain X-rays, X-Ray Myelograms,
 CT, CT Myelograms, and MRI.
 You should also be able to recognize some
RADIOLOGICAL presentation of spinal cord
diseases.
Radiology Of Spinal Cord

4. Radiology Of Spinal Cord
 Outline of presentation:
 Anatomy of spinal cord.
 Anatomy of vertebral column.
 Radiological Investigations.
 Plain X-rays,
 X-Ray Myelograms,
 CT,
 CT Myelograms, and
 MRI.
 some RADIOLOGICAL presentation of spinal cord
diseases.


5. Spinal cord and Vertebral bone

6. SPINAL CORD ANATOMY

7. ►Continuous with
medulla oblongata
►Extends to
approximately L2
►Connected to 31
pairs of spinal nerves
Spinal Cord

8. AN

9.  Between the dura mater and periosteum of
the vertebrae is the epidural space that
contains many blood vessels and fat.
 Space between dura mater and archnoid-
subdural space-no CSF.
 Space between arachnoid and pia mater-
subarchnoid space-CSF, blood vessels, spinal
roots.
Meningeal Spaces

10. Three membranes
surround all of CNS
1) Dura mater - "tough
mother", strong
2) Arachnoid meninx -
spidery looking, carries
blood vessels, etc.
Subarachnoid space
3) Pia mater - "delicate
mother", adheres tightly
to surface of spinal cord
2) Arachnoid
3) Pia mater
1) Dura mater
Spinal Meninges

11. Cross-Sectional Anatomy
of the Spinal Cord

12.  Plain X-rays,
 X-Ray Myelograms,
 CT,
 CT Myelograms, and
 MRI.
Radiological Methods
Of
Investigations

13. Plain X-rays

14. Plain X-rays
D.Sp Lt
L.Sp AP
L.Sp Lt
T.Sp Lt
T.Sp AP
C.Sp AP
C.Sp Lt

15. Myelogram
 A Myelogram
 (also known as myelography)
 is a diagnostic tool that uses radiographic
contrast media (dye) that is injected into the
spinal canal’s fluid (cerebrospinal fluid, CSF).
After the dye is injected, the contrast dye
serves to illuminate the spinal canal, cord,
and nerve roots during imaging.

16. (dye)
radiographic contrast media
AN
(NO DYE)

17. Puncture made at
L2-L3 or L3-L4 space
17
AN

18. AN
C. SP AP NO
CONTRAST
C. SP AP With CONTRAST
in spinal canal

19. 1
7
Lumbar myelogram (AP, Lateral & both oblique
views)
1 = conus medullaris 2 = Cauda equina 3 = Left S1
nerve root 4 = Osteophyte
5 = epidural compression due to herniated L4-5 disk
7= Root sleeve

20. Computerized Tomographic
Imaging
CT

21. PHYSICAL PRINCIPLES OF COMPUTED TOMOGRAPHY
AN

22. AN

23. CT Myelograms

24. AN

26. Magnetic resonance imaging
MRI
( study of choice )

27. AN

28. Magnetic Resonance Imaging
T1 T2
AN
Plain X-rays,
CT

29. AN

30. Imaging Decisions
Plain Radiographs (x-rays) are usually
the first series of images to be
ordered by the physician.
If fractures, or other bony defects,
are suspected, CT images can provide
very detailed information.
When soft tissue injury is suspected,
MRI is usually the imaging
technology of choice.

31. IMAGING DECISION
It is often necessary to utilize multiple imaging
modalities. X-ray, CT and MRI to get all the
information required for treatment.

32. SOME RADIOLOGICAL PRESENTATION
OF
SPINAL CORD DISEASES

34. Bilateral Interfacetal Dislocation
Bilateral interfacetal dislocation.
50% anteroposition C5C6 as a result of the
dislocation.
In unilateral dislocation the anteroposition is
usually only 25%.
Widened space between spinous processes C5
and C6 due to ligament rupture.
Ruptured disc space.
CT-images of the same patient, which
confirm the bilateral dislocation.
Near one of the facets there is a small fleck
of bone, but there is no major fracture, so
this is basically just a hyperflexion soft
tissue injury.
The MRI-findings are:
Soft tissue swelling anteriorly
Disruption of the disc
Non-hemorrhagic cord injury

36. 36
Lumbar disk herniation.
Myelogram shows extradural lesion

40. Infection
 Epidural abscess
 Usually bacterial
( staphylococcus is
common).
 Spread through:
 hematogenous route.
 Adjacent focus.
 Direct inoculation.

41. Infection
 Infection of spine
 Uncommon
 Either vertebral
osteomyelitis Or less
commonly intraspinal
infection.
 Causative organism :
(staph, Strep, E.coli,TB)
 Occasionally due to unusual
organisms like:
Salmonella or brucella.

42. Fracture-dislocation. This is an unstable injury involving bone and
soft tissue in which a vertebra may move off an adjacent vertebra (displaced). These
injuries frequently cause serious spinal cord compression.

43. Spinal cord injury
There are two types of injury
to the spinal cord:
Non-hemorrhagic with only
high signal on MR due to
edema.
Hemorrhagic with areas of
low signal intensity within the
area of edema.
Non-hemorrhagic and hemorrhagic spinal cord injury