|
Back pain is an extremely common symptom
and the spine is one of the areas most frequently imaged with
MRI. MRI beautifully demonstrates the anatomical components
of the spine and their relationships.
The whole spine can be subdivided into its
component parts - cervical spine(neck), thoracic spine(chest
level), lumbar spine & sacrum(lower spine). These are
anatomically different areas with a separate structure and
function.
There are several functions of the spine
- support & mobility and it also contains the spinal cord.
The spinal cord is a communication highway that carries electrical
messages between the brain and the peripheral parts of the
body. It is protected by a bony spinal canal. Nerves travel
from the spinal cord to the peripheral parts of the body.
Pressure on either the spinal cord or the related nerves can
cause pain, tingling, weakness or sensory alteration like
numbness.
The mechanical strength of the spine is
provided by the bony vertebral bodies and the intervertebral
discs which separate them. The functions of the disc include
cushioning, mechanical strength and flexibility. The spinal
column is further strengthened by ligaments which attach to
the bony vertebrae.
 |
|
 |
| |
Normal Lumbar
Spine
All the discs return normal signal and disc height is
maintained throughout. |
|
|
|
 |
|
 |
| |
Degenerative Changes
Low back pain can be caused by a variety of abnormalities.
One of the most common findings is degenerative change(wear & tear).
We are living longer and longer and combined with a physical lifestyle
this can take its toll on the intervertebral discs, joints and ligaments
in the spine.
Symptoms: Pain,
stiffness.
MRI: Narrowed disc spaces, small bony
‘’osteophytes’’ arising from the vertebrae. Degenerative
Changes in Lumbar spine
|
|
|
|
|
|
|
| |
Disc Prolapse ‘’Slipped
Disc’’
Disc bulging or prolapse is a frequent
finding. This can occur at any level but is most frequently
seen in the lumbar spine. Disc bulging or prolapse can
vary in size, shape and position. Depending on the position
of a disc prolapse different symptoms may result. If
a disc prolapse is pressing on a spinal nerve there
may be pain or altered sensations which radiates through
the buttock, down the leg or into the calf or foot.
Symptoms: Pain (which
may start suddenly), sensory changes – tingling
, numbness which can radiate down the leg. Immobility.
MRI: The disc arrowed is bulging &
pressing on the spinal nerve. Lumbar disc prolapse
|
|
|
|
|
|
|
| |
Spinal Canal Narrowing(Spinal
Stenosis)
The bony spinal canal (surrounding
the spinal cord/nerves) can become narrowed. This is
often due to a combination of changes - ligament thickening,
disc bulging and degenerative bony changes.
Symptoms: Pain,
often worse after exercise. Leg pain. Stiffness.
MRI: The space for the spinal nerves
in the spinal canal is narrowed. Saggital image of spinal stenosis.
|
|
|
|
|
|
|
| |
Spinal Infection
MRI can help diagnose spinal infection - the clinical
symptoms of spinal infection can mimic other causes of back pain. An early
diagnosis is important as the treatment for this condition requires antibiotics
and often hospital admission. Infection commonly affects the disc and
is therefore called “discitis”.
Symptoms: Pain. Non
specific symptoms of infection – fever, sweats,
unwell.
MRI: Different sequences can be used
such as T1 ,STIR (a sensitive but non specific marker of abnormality)
and contrast enhanced images.
The case shows spinal infection in the L1-L2 intervertebral disc.
Picture 1 - T1 weighted image. Infection in
the L1-L2 disc space
Picture 2 - Gadolinium contrast enhanced image.
Enhancement of the L1-L2 disc and surrounding tissues.
Picture 3 - STIR image. Disc narrowing &
fluid next to the disc. The STIR sequence is a very sensitive but non
specific indicator of abnormality.
|
|
| |
|
|
|
| |
Spinal Fractures
Spinal fractures are clearly
identified with MRI. In addition to the fracture, complications
from the fracture will be spotted, such as pressure
on the spinal cord or spinal nerves. Spinal fractures
can follow road traffic accidents or other trauma. Patients
with osteoporosis are at increased risk when trauma
may be minimal.
Symptoms: Pain localized
to the fracture unless there is pressure on the spinal
nerves.
MRI: Wedging of the vertebral
body. Thoracic spine wedge fracture.
|
|
|
|
 |
|
 |
|
