L4

L5

LOOK AT THE NERVE ROOT ITSELF

LOOK AT ENTIRE IMAGE

ECMT 2013

LOOK AT ALL IMAGES

T1-­w

T2-­w

ECMT 2013

T1-­w

T2-­w

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

4062198

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