
Spine radiology ( lec 1&2
)

Imaging techniques :
1. MRI
2. CT scan
3.Plain radiograph
CT-myelography )
)
4.Myelography
5.Radioisotope study.

Radiographic anatomy of spine


-vertebral marrow should be of high signal in both T1 & T2
-IVD of low signal in in T1 & high signal in T2
-CSF of high signal inT2


Radiographic signs of spinal abnormality
1-disc space narrowing
reduction in IVD height usually implies
degenerative disc
disease and may be associated with endplate sclerosis and
osteophytes around the endplate, also seen
in infection

2. Collapse of vertebral bodies
Neoplasm (metastases and myeloma)
Osteoporosis
Trauma
Infection
Eosinophilic granuloma




3.Pedicle abnormalities


4.Dense vertebrae
Sclerosis, which is demonstrated on
plain films or CT, may affect just one vertebra or may be
part of a generalized process involving many bones.
Common
causes include the following
• Metastases
• Lymphoma
• Paget’s disease
• Haemangioma
• Healing fracture



Spinal trauma
Cervical spine injuries are important to identify
as significant neurological damage can occur if
an unstable injury is unrecognized.
Plain films are the commonest initial
investigation
for trauma to the spine and will usually comprise
a lateral, AP and open mouth or peg view :

The following should be looked for
• Alignment of the vertebral bodies and facet joints.
• Fractures of the vertebral bodies, pedicles, laminae
and spinous processes.
• Indirect signs
of fracture such as prevertebral soft
tissue swelling


it may remain difficult
to obtain satisfactory films, so
CT scan is indicated
1. in severely ill patients, so the entire spine
segment can be imaged.
2.patients with high risk of spinal injury
3
.
Un explained soft tissue swelling
4.a fracture is seen on the plain radiograph

MRI is indicated
in any patient where a
potential spinal cord injury is suspected clinically or
there are progressive neurological defects such as due
to a contusion of the cord.
Children may suffer a significant ligamentous injury
without evidence of any fractures on radiographs or
CT, called SCIWORA (spinal cord injurywithout
radiological abnormality), and are best imaged with
MRI.





mechanism of injury : 1.Hyperflexion is the commonest
where
the anterior structures are in compression and the posterior elements
are distracted

2. Hyperextension injuries
may also result in teardrop-shaped fragments of bone
arising from the anterior vertebral body due to avulsion by
the anterior longitudinal ligament but is not usually associated with cord
injury

A more severe hyperextension injury can result in a fracture
involving the pars interarticularis of C2, which is known as a
‘hangman’s fracture

Blows to the top of the head (3.axial force) can result in
fractures of the lateral masses of C1 – a fracture known as
Jefferson’s fracture
.


Degenerative spinal disease
Degenerative spine disease or spondylosis results primarily
from degeneration of the inter vertebral disc and occurs
maximally in the lower cervical and lower lumbar region
radiological signs of spndylosis :
-reduced disc height with loss of hydration
-
-secondary bone changes of osteoarthritis such as
osteophytes
-tear in the annulus fibrosis seen as hyper signal intensity
in T2-weighted MRI images
- facet joint arthropathy. ( become inflammed ,
hypertophied with osteophytes ).


Disc herniation can be :
1-Degenerative , when degenerated annulus fissures
may allow herniation of disc material beyond the
normal margins of the intervertebral space
2-post trumatic and can be seen on CT but is best
identified on MRI , it can be small Focal or wide
base according to its size , variable in position (
central , para central , foraminal ) .


MRI is also useful in patients who
continue to have symptoms following surgery for back
pain. Symptomatic postoperative scarring impinging a
nerve root can be distinguished from disc herniation if
contrast-enhanced images are obtained. Scarring
enhances following contrast administration in
contradiction to recurrentdisc herniation, which does
not enhance


Infection
The spread of infection to the spine is usually via the
haematogenous route .
1. pyogenic infection
- destruction of the intervertebraldisc and adjacent
vertebral bodies, there is narrowing of the disc space
with erosion of the adjoining vertebral endplate.
- collapse of the vertebral body and sclerosis in Later
coarse of the disease

2.Tuberculous infection
-
-may allow preservation of the disc space in the early
coarse of disease
-
-may present with complications such as bone
collapse resulting in sharp angulation (focal kyphosis)
known as a gibbus
-
- Involvement of local soft tissue can be seen in both,
such as a paravertebral abscess which, in the lumbar
spine,may spread into the adjacent psoas muscles.


MRI signs of infection : is the preferred investigation as it
can demonstrate
1.disc space narrowing with fluid (pus) in the disc
2. altered signal in the adjacent vertebral body (infection or
oedema
3.adjacent soft tissue swelling and any spinal cord or nerve
root compression .
4.Bony fusion of the vertebral bodies across the obliterated
disc spaces occurs with healing and tuberculous
paravertebral abscesses may eventually calcify.


Congenital abnormalities
Spina bifida is a result of an in utero incomplete closure
of the embryological neural tube, usually in the
lumbosacral region, and may be associated with
neurological complications
vertebral body anomalies such as hemivertebrae ,
butterfly
vertebrae or segmentation anomalies where there is
failure of disc formation. These are often associated
with
varying degrees of focal spine deformities such as
kyphosis or scoliosis .


Spinal cord and cauda equine
compression
The causes of intraspinal compression can be divided
according to the site of origin of the responsible SOL :
• Extradural lesions: myeloma, lymphoma and
metastases
are the commonest malignant spinal tumours that can
compress the dural sac and its contents, potentially at
multiple
sites .
Infection and degenerative disc protusions
may also cause extrinsic compression of the cord or
cauda equina.


.Intradural extramedullary lesions (i.e. within the dural
sac but not within the spinal cord): meningioma and
nerve sheath tumours such as neurofibromas or
schwannomas
• Intradural intramedullary lesions (i.e. within the spinal
cord): primary spinal cord tumour such as ependymoma
astrocytoma or metastases .


Transverse myelitis and multiple sclerosis
Transverse myelitis is an inflammatory condition of the
spinal cord can be seen in
multiple sclerosis
Connective tissue diseases
vasulitis and infection
It can only be identified on MRI with T2-hyperintense
lesions which typically do not involve the entire cross-
section of the cord and do not respect the grey–
white junction.
In multiple sclerosis, cord lesions will often
be associated with white matter plaques in the
brain
.
