1. February 2007 SPINAL CASES SAJID BUTT CONSULTANT RADIOLOGIST RNOH AND HOLLY HOUSE HOSPITAL

2. February 2007 Elderly man with low back pain. No history of trauma

3. February 2007

6.  Insufficiency fractures are caused by the effect of normal or physiologic stress upon weakened bone.  The most common cause of insufficiency fracture is postmenopausal osteoporosis.  Bone scintigraphy and MR imaging are the imaging modalities of choice

7. February 2007  senile osteoporosis, pelvic irradiation, corticosteroid therapy, and rheumatoid arthritis  Management is conservative  healing is expected within 4 months

8. February 2007 Forty-year-old woman with low back pain radiating into the leg

9. February 2007

10. Spinal Osteomyelitis  Plain films may be normal for 8-10 days following infection  Increased signal intensity in the disk and vertebral body  Contrast enhancement  Soft tissue mass (inflammation, abscess)

11. February 2007  Staphylococcus aureus is the most common cause of spine infection in adults  Blood cultures are often negative, so the diagnosis is made by disc biopsy  Spine infections progress from spondylitis to diskitis to epidural abscess to cord abscess  On MRI staphylococcus infections can be detected early as isolated osteomyelitis  Destruction of the disc space implies pyogenic infection as opposed to tuberculous spondylitis which typically spares the disc.

12. February 2007 Man with lower extremity weakness and sensory deficit

13. February 2007

14.  Schwannoma  Meningioma: Isointense on T1 & T2, moderate enhancement, dural tail  Epidermoid/Dermoid: Follows CSF in signal intensity, no enhancement  Metastasis  Intradural disk herniation

15. February 2007 Actual diagnosis: Schwannoma  Most common intradural extramedullary spinal neoplasm  Associated with neurofibromatosis  Symptoms similar to disk herniation: Pain, radiculopathy, weakness, sensory loss  MR: T1 - iso/hypointense; T2 - hyperintense, enhances homo/heterogeneously

16. February 2007 Man with right-sided radicular symptoms

17. February 2007

18. Extradural mass:  Tumor schwannoma schwannoma neurofibroma neurofibroma meningioma meningioma arachnoid cyst arachnoid cyst metastasis metastasis  Degenerative bulging /herniated disc bulging /herniated disc sequestered nucleus pulposus sequestered nucleus pulposus synovial cyst/ganglion synovial cyst/ganglion  Inflammation epidural abscess epidural abscess  Vascular hematoma hematoma

19. February 2007 juxta-facet cyst  Very characteristic imaging findings allowing for accurate preoperative diagnosis.  Almost always associated with degenerative changes in adjacent facet joint.  Located posterolateral to nerve root.  Hemorrhage into cyst is common usually with acute aggravation of symptoms

20. February 2007 Adult with lumbosacral pain radiating down the left leg. Absent left quadriceps reflex

21. February 2007

22.  sequestered disk fragment  synovial cyst  epidural abscess  metastases

23. February 2007  90% of disk herniations in the lumbosacral spine occur at the L4-L5 or the L5-S1 level.  L4/5 disc problem, which root?

24. February 2007 Elderly male with neck pain after falling

25. February 2007

26. Ossification of the posterior longitudinal ligament (OPLL) Ossification of the posterior longitudinal ligament (OPLL)  Ossification of the posterior longitudinal ligament primarily effects Asian patients.  OPLL can result in spinal stenosis and put effected individuals at risk for cord contusion with minimal trauma.  OPLL can easily be distinguished from DISH and OLF by the location of the ossification directly posterior to the vertebral bodies. 20% of cases of DISH will be associated with OPLL.

27. February 2007