SPINAL MRI TERMINOLOGY IS TOUCHING THE SAME AS ABUTTING?

Discs bulges and extrusions Annular tears Sequestration The Sponds Spinal stenosis Osteoporotic fractures The degenerate meniscus

DISC DISEASE

Normal spine

Degenerate Discs

Mild diffuse bulge

Disc bulge with annular tear

Small extrusion touching root

A large disc extrusion

A LARGE SEQUESTERED DISC

Lateral disc

CERVICAL DISC

OLD DISC WITH CORD ATROPHY AND MYELOMALACIA

The Sponds Spondylosis Spondylitis Spondylolysis Spondylolisthesis

Spondylosis and Modic change

FORESTIER’S DISEASE- DISH

SPONDYLITIS-as in AS

SPONDYLOLYSIS

DEGENERATIVE SPONDYLOLISTHESIS

SPINAL STENOSIS

Osteoporotic insufficiency fractures

THE DEGENERATE MENISCUS

An acute meniscal tear

Degenerate meniscal tear

KNEE MRI AND THE DEGENERATE MENISCUS BMJ 2015 Degenerative meniscal tears are common and correlate poorly with symptoms; no clinical features are diagnostic Avoid routine magnetic resonance imaging in primary care unless the patient has a locked knee (sudden inability to fully extend) or serious disease is suspected First line treatment comprises non-operative modalities, such as education, self management, exercise, weight loss if overweight or obese, walking aids if indicated, paracetamol, non-steroidal anti-inflammatory drugs, and intra-articular glucocorticoids. Current evidence does not support a role for arthroscopic debridement, washout, or partial meniscectomy

BMJ 2016 The observed difference in treatment effect was minute after two years of follow-up, and the trial’s inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option

BMJ 2017 We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation This recommendation applies to patients with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden symptom onset Healthcare administrators and funders may use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care.

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