MRI LS Spine

Indications
Low back pain
Spinal trauma
Spinal tumors and/or vertebral metastasis
Infections
Inflamatory/autoimmune conditions
Suspected complications of spinal surgery
Congenital spinal malformations
 Imaging
Sagittal:
T1W
T2W
STIR
Axial:
T2
Coronal:
T2W
STIR
 Normal anatomy
Anterior column:
• Anterior portion of the vertebral body
• Anterior portion of the IV disc
• Anterior longitudinal ligament
Middle column:
• Posterior half of the vertebral body
• Posterior half of the IV disc
• Posterior longitudinal ligament
Posterior column:
• Pedicles
• Facet joints
• Laminae
• Spinous processes
• Ligamentum flavum
• Interspinous ligaments
Lumbar vertebrae
 Vertebral end plate changes
• Modic classification:
Type I: Edematous changes related to
subchondral end plate fractures,
formation of vascularized fibrous
tissue and an acute reparative
response.

Type II: Fatty replacement of normal

marrow and more chronic and stable.

Type III: Chronic end plate sclerosis

and development of dense woven
bone
Osteophytes
 Anterolisthesis
Anterior displacement of a vertebral body relative to the one below.
Usually associated with spondylolysis.
Spondylolysis: Defect in the pars interarticularis of the neural arch.
 Intervertebral discs
2 components:
Peripheral annulus fibrosis
Central nucleus pulposus
A normal disc is fully and normally developed, free of disease,
trauma or aging.
 Degeneration
Intervertebral discs:
3 phases:
Growth
Maturation
Degeneration
 Bulging disc
Presence of disc tissue
beyond the edges of the ring
apophyses.
 Disc desiccation
Replacement of the hydrophilic glycosaminoglycans within the
nucleus pulposus with fibrocartilage.
 Annular fissure

Loss of integrity of the

annulus with a radial,
transverse or concentric
pattern.
 Disc herniations
Intra-vertebral disc herniations
(Schmorl nodes):
Protrusions of the cartilage of the
intervertebral disc through the
vertebral body endplate and into the
adjacent vertebra.
May contact the marrow of the
vertebra, leading to inflammation.
 Disc herniations
Focal displacement of disc
material (<25% of the disc
circumference) beyond the
limits of the intervertebral disc
space.
Types:
Contained
Uncontained
 Protrusion vs Extrusion
Protrusion: The greatest distance, in
any direction, between the edges of the
disc material beyond the disc space is
less than the distance between the
edges of the base.
Extrusion: When any one distance
between the edges of the material
beyond the disc space is greater than
the distance between the edges of the
base
 Localization of herniated discs
Central
Subarticular
Foraminal
Extraforaminal
Spectrum of disc
lesions
 Sequestration

Displaced disc material loses

continuity with the parent disc.
 Migration

Displacement of disc material

away from the site of
extrusion, whether
sequestrated or not.
 Facet joint osteoarthritis
Forms the posterior articulation of vertebral bodies.
Facet joint osteoarthritis: secondary process associated with disc
degeneration and loss of disc space height.
May result in narrowing of central canal, lateral recesses and foramina.
 Ligamentum flavum hypertrophy
Paired ligaments
Extend between the lamina of
adjacent vertebral bodies.
Hypertophy with degeneration
of elastic fibers and
proliferation of Type II
collagen.
May cause secondary canal
stenosis.
 Structural sequelae
Spinal stenosis
Neural foraminal stenosis
Spinal canal
stenosis
Levels of nerve compression
Thank You