1. What are the indications for MRI & CT:
Disc lesions
Post-operative spine(after surgery)
Tumors
Any degenerative disease
Trauma
Congenital abnormalities of the spine

2. Preparations for CT & MRI: 1-Fasting for 4-6 hours 2-Contrast material Urographin ,telebrix 1-2 mg/kg
Administration of contrast:
Yes: In post-operative lumbar spine, inflammatory disorders& neoplastic lesions.
No: disc lesions, trauma.
Anesthesia
Used with children & uncooperative patients.

3. Patient position:
Is usually supine, sometimes side lying, & rarely prone.  
How to see:
Scanogram: primitive picture to detect the site of lumbar spine

4. CT screening: Computed tomography (CT): . Axial slides 2-4 mm.
. Usual scanning.
. Axial slides 2-4 mm.
2 mm in cervical spine / 4 mm in lumbar spine
Has bone & soft tissue window.
 CT screening:
. Whole segment of the spine
5 mm in cervical spine, 8 mm in lumbar spine.
. Selective Scanning
Every 3 mm especially in trauma, also in cervical disc lesions. 
N.B:
If I want to see one vertebra e.g. L3 I have to take 1 vertebra above (L2 )& 1 below (L4).

7. Soft tissue & bone window.
CT Myelography:
Is considered as intrathecal contrast injection with L- puncture needle.
We have 2 windows
Soft tissue & bone window.
What are the structures I should evaluate in CT of lumbar spine:
Lumbar spinal canal diameter normally 13 mm.
Disc lesions.
Others.
facet, sacroiliac joints & paravertebral soft tissue.

8. Soft &bone window (CT) Lumbar

10. 1. Lumbar spinal canal diameter:
Spinal canal is bony structure, so we see it in bone window.
The spinal canal must be closed (at the level of pedicles).
We measure the AP diameter. 
Types of canal stenosis:
1-Relative:
11-12 mm & this doesn’t need operation but it needs operation if there’s disc.
2- Absolute:
8 -10 mm & it must be operated.

11. Disc lesions:
We detect it in soft tissue window.
Posterior border of the disc is more important as it has relation to the disc.
The normal posterior border of the disc is CONCAVE.
The abnormal is STRAIGHT OR CONVEX.

12. N.B:
. Normally due to overload ,the disc of L5-S1 is CONVEX & the abnormal is also convex, so to judge if it’s normal or no look at the next slide if: the posterior border of the disc is convex so it is ABNORMAL.
. The angle of inclination in L5-S1 is more than 30 & the device accept up till 30 only so part of the slide will contain bone & part will contain disc.

15. Normal CT Lumbar

16. Disc bulge(CT axial)

17. MRI – LUMBAR SPINEM
NERVE ROOTS
FORAMEN
AXIAL VIEW

18. Manifestations of arthritis in any joint:
 (Spondylosis in spine and osteoarthritis of other joints)
Osteophytic lipping.
Narrow joint space.
Subarticular bone sclerosis
Sub cortical pseudo cystic changes.
Intra articular air.(vaccum phenomena)

19. Vacuum phenomena

20. CT of cervical spine

21. We have 2 types of joints:
Neurocentral joint:
Is the articulation between one vertebra above & one vertebra below which makes the shape of the body of the vertebral end plate .
Facet joint:
Is the articulation between the inferior lip of the transverse process of one vertebra above with the superior lip of the transverse process of the vertebra below, it’s called Hamburger’s Sandwich.
 Arthritis of the neurocentral or facet joint gives the same manifestations of nerve compression due to disc lesion.

22. Cervical disc in CT:
We see it in soft tissue window
.The disc in cervical spine is very narrow so every slide will contain both disc & bone, therefore there isn’t a slide of pure disc, So we choose the slide which contain more disc for assessment.
. All posterior edges of cervical spine are normally convex.
. See if there’s disc substance protruded than the bone.
. Normal spinal cord picture is kidney shaped.

23. Difference between cervical & lumbar spine in CT
Item
Cervical
Lumbar
Slide Width
2 mm
4mm
Neurocentral joint
Present
Absent
Spinal canal diameter
No diameters, but assessed by vision  the spinal cord is kidney shaped & surrounded by C.S.F.
13 mm
Posterior edge of disc
Is usually convex
All lumbar discs are concave except L5-S1 is normally convex or flat.

24. HNP with nn root impingement
HNP with nn root impingement. Sx radicular (radiating) pain down extremity. Signs= hyporeflexia, weakness, atrophy.

25. HNP without nerve root impingement
HNP without nerve root impingement. Sx localized back pain since disc has pain fibers.

26. Bulging (Herniated) Disc can cause Radiculalgia (pain down arm/leg), Radiculopathy (weakness, atrophy, hyporeflexia).

27. Stages of disc pathology (4 stages)
Intervertebral Disc Diagnoses:
Degenerative Disc Disease (Pre-Existing)
Prolapse = Herniated
Extruded/Sequestered Require Surgery

28. CT of the spine

29. CT axial bone& soft tissue widow

31. CT machine

38. MRI CT plain x-Ray

39. C2-3 INTERVERTEBRAL DISC
CT– CERVICAL SPINE
C2-3 INTERVERTEBRAL DISC
FORAMEN
DISC
FORAMEN
FACET JOINT
FACET JOINT
SPINOUS PROCESS
AXIAL
SAGITTAL

40. CT- CERVICAL SPINE C-1 SECTION
ARCH OF C-1
DENS
BASE OF SKULL
MASTOID
AXIAL
SAGITTAL

41. CT- LUMBAR SPINE
POST MYELOGRAM
DISC
SPINOUS PROCESS

42. CT– CERVICAL SPINE C- 3 SECTION
PEDICLE
PEDICLE
LAMINA
AXIAL
SAGITTAL

43. CT-- CERVICAL SPINE C-2 SECTION
C-2 BODY
DEGENERATED
C6-7
C-2 SPINOUS PROCESS
AXIAL
SAGITTAL

44. CT axial CT sagittal

45. CT- LUMBAR SPINE
POST MYELOGRAM
Axial
PEDICLE
PEDICLE
NERVE ROOTS

46. Posterior arch #(CT)

47. Burst # (CT) axial

48. sagittal CT

49. CT axial section (base of the skull)

50. CT- LUMBAR SPINE
POST MYELOGRAM
FORAMEN
FORAMEN

51. CT of cervical spine(sagittal)

52. CT axial

53. CT of cervical spine (axial)

54. CT sagittal

55. CT sagittal tear drop # dislocation
Tear drop # dislocation(plain)

56. CT-LUMBAR SPINE
POST MYELOGRAM
THECAL SAC
LAMINA
LAMINA

57. CT- LUMBAR SPINE
POST MYELOGRAM
FACET JOINTS

58. CT- LUMBAR SPINE
POST MYELOGRAM
PEDICLE
PEDICLE
NERVE ROOTS