1. SPINAL MRI TERMINOLOGY IS TOUCHING THE SAME AS ABUTTING?

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

3. DISC DISEASE

4. Normal spine

5. Degenerate Discs

6. Mild diffuse bulge

7. Disc bulge with annular tear

8. Small extrusion touching root

9. A large disc extrusion

10. A LARGE SEQUESTERED DISC

11. Lateral disc

12. CERVICAL DISC

13. OLD DISC WITH CORD ATROPHY AND MYELOMALACIA

14. The Sponds
Spondylosis
Spondylitis
Spondylolysis
Spondylolisthesis

15. Spondylosis and Modic change

16. FORESTIER’S DISEASE- DISH

17. SPONDYLITIS-as in AS

18. SPONDYLOLYSIS

19. DEGENERATIVE SPONDYLOLISTHESIS

20. SPINAL STENOSIS

21. Osteoporotic insufficiency fractures

22. THE DEGENERATE MENISCUS

23. An acute meniscal tear

24. Degenerate meniscal tear

25. 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

26. 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

27. 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.

28. ANY QUESTIONS?