Spinal Imaging – AI-Enhanced WordPress Builder

•Arthritis of the spine

Frequently reported on imaging as “degenerative changes;” however, be comfortable seeing the term spondylosis (both are synonymous with arthritis)

Arthritis of the cervical and lumbar spine are very common as we age.

Early signs (i.e. what you should look for) include “disc height loss,” also called “disc desiccation,” and the presence of osteophytes.

Osteophytes may form (new abnormal bone formation). (To me, osteophytes frequently just make the clear/straight lines over the vertebrae more rough in appearance).

ProTip: Depending on where the osteophytes form and if they are in a position to irritate a nerve, patients may report more pain/symptoms with flexion vs. extension.

•Ankylosing Spondylitis

Inflammatory condition involving the spine

Nicknamed “bamboo spine”

Natural history of disease: Can lead to fusion over time, limiting mobility

In General: The body deposits calcium in areas of chronic inflammation; calcium is a rock, and rocks don’t bend.

•Special note: X-rays can be ordered in certain positions (such as flexion/extension) which can highlight certain features and help support findings for specific diagnoses

•Spinal lesions

Lesions in the spine are non-specific

They can also be challenging to find

A strong radiologist will mark a specific area of interest on the image itself

(We call this a “positive arrow sign”)

Do help your radiologist when ordering imaging

(If there is pertinent history to a case, include that information in the order)

This image is from a patient with a history of MS:

Official Radiology Read:

“There is an ill-defined central area of T2/STIR signal hyperintensity within the spinal cord at the C3 and C4 vertebral levels. This finding is nonspecific. Evaluation is limited in the absence of intravenous gadolinium contrast.”

•Radiculopathy

Definition: Irritation of a nerve root coming off of the spinal column

Must come with “radicular symptoms” (numbness, tingling, or weakness, in the distribution of that nerve)

ProTip: If you suspect a radiculopathy, this is where knowing the innervations of muscles, or the pattern of dermatomes, is helpful.

Compromise of nerve roots are best seen on MRI

They can still be challenging to see

There is actually a lot of geometry in the spine

Stenosis (narrowing) can occur in multiple ways. Ways to know:

Central (canal) stenosis: Tightness or compression of the nerves in the spinal cord itself

Foraminal stenosis: Tightness around the “window” the nerve goes through as it exits the spinal column

•Official Radiology Read:

IMPRESSION:

1. Preservation vertebral body height and alignment without fracture or listhesis.

2. Multilevel disc disease and facet arthropathy without resultant central canal or foraminal stenosis.

3. At L3-L4, there is a disc herniation extending to the right subarticular zone and which exerts mass effect on the descending right L4 nerve root. This indents on the thecal sac anteriorly, without significant canal stenosis. The left foramen is patent.

•Note: Based on exam, we expected this finding.

•Also Note: If the symptoms were at another level (or in the other leg), then this finding doesn’t make sense, and we have more investigating to do.

•Vertebral compression fracture

A good thought process:

Picture the spine as a column (hence “spinal column”).

The vertebrae are just “bricks” stacked on top of each other.

A compression fracture is when the “brick” fails to carry the load, and is crushed.

Most radiology reads that identify a compression fracture will include commentary about how much has been crushed.

“Compression fracture of L2 with ~30% height loss”