This document provides an overview of classifications and types of scoliosis including idiopathic, congenital, neuromuscular, and those caused by tumors or underlying bone conditions. It also describes imaging findings and classifications for common spinal conditions like Scheuermann's disease, disc herniations, spinal stenosis, and degenerative changes. Example imaging reports are presented to demonstrate pathological findings and the importance of correlating clinical details with imaging interpretation.

1. Scoliosis
Classification:
Idiopathic: 80%
Infantile <3; Juvenile 4-10; Adolescent: 10-18
Or:
Early onset <5; Late onset >5
Congenital:
Osteogenic: hemivertebra, fused vertebra
Neurogenic: tethered cord, syringomyelia, Chiari
Developmental:
Achondroplasia
NF
OI
Neuromuscular:
Cerebral palsy
Tumour:
Osteoid osteoma
BPNST

2. Xray report- there is a mild thoracic scoliosis convex to the left
centered at T10.

5. Adolescent gymnast

8. 16 F
Fit & well
Curve noticed 12 yrs of age
Left thoracic and right T/L curve
O/E Absent abdominal reflex ,
Brisk lower limb reflexes,? Up going plantars

11. Scheuermann's Disease
Thoracic pain
Kyphosis of greater than 40 degrees
Vertebral end plate abnormality
Variable wedging of at least 3 consecutive thoracic vertebra

12. 16 yr M
Chronic cough
No pain
CXR report- Scheuermann's disease of the thoracic spine is
noted.

14. 22 yr M
Chronic Thoracic Pain
Increasing kyphosis

17. Nomenclature of disc herniations
and spinal stenosis
Consistent
Reflect common usage where appropriate
Surgically relevant
‘Able to visualize over the phone’
2 morphological characteristics:
Nature of disc pathology
Location
Able to add further descriptors
Neural structures
Clinical context
www.asnr.org/spine_nomenclature/reporting

18. Disc Degeneration
Annular Tear/Fissure
Disc Bulge
Disc Herniation – Protrusion
-- Extrusion
Disc Sequestration

19. Annular tear/ fissure
‘Tear’ and ‘fissure’ interchangeable
‘Tear’ more common usage
Does not imply trauma

20. Disc bulge
Generalised extension of disc tissue beyond intervertebral
disc space
‘Generalised’ = >50% circumference (>1800)
Relatively short distance, <3mm

21. Disc Protrusion
Involves less than 180% of the disc
The base of the herniation is wider than the height.
<180 but >90% - broad based
<90% - focal

22. DISC PROTRUSION: CT &
MRI

23. Extruded disc
Greatest distance in any plane between
edges > base
T1

25. Sequestered disc
Extruded disc material that has no continuity with the disc
of origin
= free fragment
Migrated disc:
Disc material displaced away from site of extrusion

26. T2 T2
T1

27. Image interpretation
A few cases

28. 68M
Sudden onset bilateral leg pain and weakness
Urinary retention

32. Dx: Cauda equina syndrome
Cause: massive sequestration
Other causes:
Tumour
Primary of lower cord: ependymoma
Primary of nerve: BPNST
Primary of dura: meningioma
Primary of vertebral body: chordoma, giant cell tumour
Secondary
Trauma

33. Clinical details:
54M. Left leg pain, paresthesia and
weakness.

36. MR LUMBAR SPINE
Clinical details: 54M. Left leg pain, paresthesia and weakness.
Sequences: T1, T2 transverse and sagittal
Findings:
Conclusion:
Multilevel disc degeneration.
Spondylolisthesis at L5/S1 with associated degenerative changes.
The most significant lesion is a broad based left central disc extrusion at L4/5
compressing the left side of thecal sac displacing the left L5 and S1 nerve roots.

37. CT LUMBAR SPINE
Clinical Details:
57 M. Episodes of feeling both lower limbs being weak and giving way.

39. CT LUMBAR SPINE
Clinical Details:
57 M. Episodes of feeling both lower limbs being weak and giving way.
Findings:
Conclusion: Severe facet joint degeneration and disc degeneration at the
L4/5 level resulting in moderately severe central canal stenosis and bilateral
subarticular stenosis, more marked on the left.

40. CT LUMBAR SPINE
Clinical Details:
57M. Moderately severe back pain for one year.

43. CT LUMBAR SPINE
Clinical Details:
57M. Moderately severe back pain for one year.
Findings:
Conclusion: Bilateral L5 pars defects and L5/S1 spondylolisthesis
with secondary degenerative changes as described.