Spine (All Other)

Scheuermann Disease

  • Essentially kyphosis secondary to multiple schmorl’s nodes which causes anterior wedging of the vertebral body and therefore secondary kyphosis (exact mechanism debated)

  • Primarily affects thoracic spine

  • Mostly seen in kids 13-17

  • Sorensen criteria (abbreviated)

    • 3+ contiguous vertebra with >5 degrees of wedging AND

    • Thoracic kyphosis >40 degrees (or thoracolumbar kyphosis >30 degrees)

  • May also need schmorl’s nodes and anterior end-plate irregularities based on source

Chance fracture

Bertolotti Fracture

  • Transitional lumbar vertebra with associated back pain

Herniations

Disc Protrusion

  • Cannot have free fragment

Discitis-Osteomyelitis

  • Starts in disc endplate —> disc —> next vertebral level endplate

  • Note: mets will look similar but almost never involves the disc

  • TB

    • Multilevel endplate disease, commonly anterior spread

    • Spares the discs

    • Concurrent psoas abscess common

    • Gibbus deformity may be seen

      • Severe kyphosis with destruction of vertebral body

Disc Extrusion

  • Can have free fragment

Guillain Barre Syndrome

  • Nerve root enhancement

    • Anterior nerve roots affected more than posterior nerve roots

  • Ascending flaccid paralysis

  • Facial nerve enhancement is most commonly affected CN

Disc Sequestration

  • This is the free fragment

  • Piece of disc breaks off and migrates

Tethered Cord Syndrome

  • End of cord normally ends at T12-L2

  • In Tethered cord the conus typically terminates below L2 (85% of cases) and is normal 15% of the time

  • Typically has filar cyst or lipoma at end of thecal sac

    • I think of this mass being the anchor that pulls the cord all the way down pulling it taught so that it is beyond the normal endpoint

    • Thickened filum terminale (>2 mm) may be the only finding if the cord terminates at normal level

  • Associated with dysraphic sacrum

  • Who should get screened? Patients with

    • Anal atresia - VACTERL

    • Spina bifida

    • Note: Patients with dimples below the gluteal crease do not need to be screened

Spinal Cord Ischemia/Infarction

  • Double barrell sign/snake eye sign

    • Symmetric T2 hyperintense appearance of central gray matter in spinal cord

    • Look at T1 —> if low signal then means these lesions are basically holes and not just edema, if they were edema could also be things like transverse myelitis, paraneoplastic myelopathy

  • Look for associated infarction of the vertebral bodies

Spinal AVF

  • Flow voids around the cord

    • Looks like bunch of little dots

  • Foix-Alajouanine Syndrome

    • Progressive myelopathy from chronically increased venous hypertension from a spinal dural AVF

  • Coup de Poignard Michon

    • Catastrophic subarachnoid hemorrhage caused by a spinal AVF

    • Sudden onset excruciating back pain (thunderclap headache for your back)

    • Like you got stabbed in back (poignard = dagger)

Chronic

  • T1 - return of fatty marrow signal

  • T2/STIR - no edema

  • Minimal to no enhancement

  • Endplate sclerosis

CIDP

  • Basically chronic GBS

  • GBS improves in 8 weeks, CIDP does not

  • Thickened, enhancing nerve roots

    • Resemble onion bulbs

    • Really just looks like a lot of nerve roots because they’re so thick

  • Charcot-marie tooth also looks like this

Arachnoiditis

  • Clumped nerve roots

  • Empty central thecal sac with peripheralization of the nerve roots

  • Enhancement of nerve roots is normal for up to 6 weeks post-op

    • >6 weeks = abnormal

Very early/Occult

  • Hours-days or before visible height loss

  • Edema occurs before height loss

  • Band edema + T1 hypointensity

  • Minimal to no visible height loss

Compression Fractures

Compression Fractures

  • Endplate irregularities with signal changes as below

  • Note: When a kyphoplasty is performed for a compression fracture the adjacent levels are at increased risk for getting a compression fracture because when you strengthen the previously fucked up level more of the axial load gets placed on the level adjacent to the previously crushed vertebral body which predisposes it to more trauma

    • So when reading a post-op study after a kyphoplasty you really need to look at the levels above and below the kypho to make sure there is not a new subtle compression fracture

Acute

  • Hours-2 weeks

  • T2/STIR hyperintense + T1 hypointensity, signal usually diffuse rather than linear band like

  • Diffuse internal enhancement

  • Endplates irregular and sharp

Subacute

  • Patchy T1 since fat is retruning

  • Persistent but decreasing T2/STIR signal

  • Less intense, heterogenous enhancment

  • Band like edema maybe again

References:

  • Case courtesy of David Cuete, Radiopaedia.org, rID: 24864 (Bertolotti syndrome)