LOOK AT THE NERVE ROOT ITSELF
LOOK AT ENTIRE IMAGE
ECMT 2013
LOOK AT ALL IMAGES
T1-w
T2-w
ECMT 2013
2805883
F 55 LBP rad syndr S1?
Hnp L5 S1no root compression
CHANGESAROUND THE DISC
Ö
Ö
ÖÖ
AROUND THE DISC
Modic
Inflammation
Infection
Fracture
Schmorls nodes
Source: Radiologyassistant.nl
•Modic type I• T1 - low• T2 - high• oedema and inflammation è LBP++
•Modic type II• T1 - high signal• T2 - iso to high signal• normal red marrow => yellow fatty marrow• result of marrow ischaemia è LBP????
•Modic type III• T1 - low signal• T2 - low signal• subchondral bony sclerosis, LBP--
Modic changes
Modic type 1 low on T1WI and high on T2WI
Rahme R , and Moussa R AJNR Am J Neuroradiol 2008;;29:838-842
Modic type 2 changes high on T1WI and iso or high on T2WI
Modic type 3 low on both T1WI and T2WI
VERTEBRAL FRACTURE
sag T2w fat sat
Triad:• Compression # • Local pain• Bone oedema
CANAL NARROWINGVENTRAL & DORSAL
• Discus• Bony spurs
ventral
DORSAL •FACET ARTHROSIS
•NARROWING
•SCLEROSIS
•HYPERTROPHY
•CYST FORMATION
• LIG FLAVUM HYPERTROPHY
=> STENOSIS
• ROOT CANAL
• LATERAL RECESS
• VERTEBRAL CANAL
FACET JOINT HYPERTROPHY
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RECESS STENOSIS BY FACETHYPERTROPHY
Abnormal T shape normal O shape
F 53y neurogenic claudication
post laminectomy L3-4
Stenosis and waiving
T
FAILED BACK PATIENTSSurgically treatable or not?
Female, 44y post OR
paraesthesias S1 right
with iv gadolineum
Scar tissue
•1y post laminectomy L4 - L5 •radicular complaints S1•grade 1 anterolisthesis•Root compression by
• facet arthrosis• synovial cyst
POTENTIAL DIAGNOSTIC PROBLEMS
Which level? Enhancement:
scar or inflammation?
T2-w: white area in dark enhancing tissue nucleus or pus?
discitisECMT 2013
Give usLumbar spine Xray
clinical info bloodcultures
etc
unless you want to figure it out yourself