Spine Imaging: A Case-Based Guide to Imaging and Management
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Spine Imaging uses a classic, case approach to provide multi-modality imaging studies and management guidance of spine pathologies for the consulting radiologist as well as the neurologist, orthopedist, or emergency clinician diagnosing and managing spinal patients. Eighty cases, featuring over 650 images, are organized into sections by pathologic process and include a clinical description followed by discussion on radiologic findings, clinical management, and a summary of key points. An additional section on imaging signs closes the volume. Cases address which image findings are clinically significant and which are not, how to understand the severity of an injury, and when additional advanced imaging is needed, making Spine Imaging an essential resource for managing these complex pathologies.
cervical collar and activity restriction for 4–6 weeks. The neurological status for patients with cord or nerve root dysfunction is carefully monitored. A subgroup of patients prone to hyperextension injury (DISH or AS) may need operative stabilization or halo-vest immobilization as this injury in those patients can be highly unstable and conservative measures are less likely to be successful than in other patients. Teaching Points ▶ Hyperextension cervical injuries are not uncommon. ▶
in alterations in spinal curvature (scoliosis) or muscular contractions/shortening (torticollis). Radiological Evaluation The initial workup of patients typically will include plain radiographs and computed tomography. MRI can provide additional information in those patients in whom the symptomatology is not typical, or if there is associated neurological deficits (as in this case). Typical features on plain films include reactive sclerosis. On CT, especially in larger lesions, regions of
confirming the diagnosis of angiolipoma. 110 Management Angiolipomas are benign lesions, but can enlarge and compress neurological structures. When compression results in progressive neurological symptoms, surgical excision is the primary approach to these symptomatic tumors. Teaching Points ▶ The spinal tumor location helps narrow the differential diagnosis. ▶ Predominantly fatty tumors have a short differential, with homogeneous enhancement a distinguishing characteristic of angiolipoma.
present at only one or two levels, anterior cervical discectomy and fusion (ACDF) is typically the preferred intervention as it has shown reproducibly favorable outcomes. Posterior decompression, such as laminectomy and fusion or laminoplasty, are typically performed in cases that require multilevel decompression or in cases in which anterior surgery carries increased risk, such as OPLL or a calcified disc causing stenosis. Combined anterior–posterior procedures are sometimes required in cases of
41.5 and 41.6). Depiction of endplate erosions, bone destruction, loss of disc space height, and paraspinal involvement improves specificity and sensitivity. Figure 41.7 152 Figure 41.8 Figure 41.9 A 66-year-old male presents with discitis/osteomyelitis at T10–T12 (Figures 41.7, 41.8, and 41.9). A sagittal CT reformation (Figure 41.7) demonstrates osseous destruction mainly of T11, but also with involvement of both T10 and T12. CT poorly characterizes soft tissue involvement, and,