Lumbar Spinal Imaging in Radicular Pain and Related Conditions (eBook)

Preface 4
Acknowledgements 6
Contents 7
Chapter 1 9
The Nature of Radicular Pain and Related Conditions 9
1.1 Introduction 9
1.2 Radicular Pain: Nomenclature and Pathogenesis 9
1.3 Neurogenic Claudication 12
1.4 Cauda Equina Syndrome 13
1.5 Conclusion 14
References 14
Chapter 2 16
Imaging Techniques for the Lumbar Spine: Conventional Radiology, Computed Tomography Magnetic Resonance Imaging
2.1 Introduction 16
2.2 Conventional X-ray Studies 16
2.2.1 Contrast Studies: 17
2.3 X-Ray Computed Tomography 19
2.3.1 CT Myelography 21
2.4 Magnetic Resonance Imaging (MRI) 22
2.4.1 T1-Weighted (T1-W) Images 25
2.4.2 T2-Weighted (T2-W) and T2*-Weighted (T2*-W) Images 25
2.4.3 Proton Density-Weighted (PD-W) Images 28
2.4.4 Fat-Suppressed Images 28
2.4.5 MR Myelography: 28
2.4.6 Imaging Planes 34
2.4.7 Upright Imaging 35
2.4.8 Considerations of Field Strength 35
2.4.9 Abbreviated Scanning Protocols 35
References 36
Chapter 3 38
Normal Anatomy 38
3.1 Topographic Anatomy 38
3.2 Sectional Anatomy 49
3.2.1 Transverse Sectional Anatomy 49
3.2.2 Sagittal and Coronal Sectional Anatomy 54
3.3 Functional Anatomy 55
References 63
Chapter 4 65
Pathologic Anatomy and Mechanisms of Nerve Root Compression 65
4.1 Herniated Disc 65
4.1.1 Why Are Disc Herniations Diagnosed So Rarely in the Upper Lumbar Region? 85
4.1.2 Other Focal Mass Conditions Causing Intraspinal Compression of Nerve Roots 93
4.1.2.1 Tumours 93
4.1.2.2 Synovial (Juxta-Articular) Cysts 93
4.1.2.3 Hypertrophic Callus Formation in Spondylolysis 93
4.2 Narrowing of Spinal Canal General or Regional
4.2.1 Why Is Narrowing of the Spinal Canal Seen So Rarely at L5-S1? 99
4.2.2 Factors Further Contributing to Reduction of Space in the Spinal Canal 99
4.3 Regional Spinal Narrowing 101
Appendix : Morphometrics of Lumbar Intraspinal Structures, A Literature Review 116
Measurements in Normals and Patients, Static 116
Measurements in Normals and Patients, Dynamic 116
Imaging Features of Compression of Individual Nerve Roots and Cauda Equina 117
References 117
Chapter 5 120
Spinal Imaging in Relation to Surgical Therapy: Pre- and Post-Operative 120
5.1 Introduction 120
5.2 Pre-Operative Imaging 120
5.2.1 Is the Lesion Responsible for the Presenting Symptoms? 120
5.2.1.1 Radiologic Features of a Disc Lesion Related to Clinical Significance: Shape and Size 121
5.2.1.2 Assessment of Relative Size of the Herniation with Respect to Dimensions of the Canal 122
5.2.1.3 Imaging of Nerve Root Compression: MR Myelography 124
5.2.1.4 Intravenous Contrast Studies of Nerve Root Enhancement 128
5.2.1.5 Conclusion 128
5.2.2 Is the Condition Likely to Follow a Favourable Early Natural Course, or Is Conservative Management Likely to Fail in the Long Run, and Is Early Surgery Preferable? 131
5.2.2.1 Shape and Size of the Herniation, Nerve Root Compression, Concomitant Pathology 136
5.2.2.2 Gadolinium Enhancement of the Herniated Disc 137
5.2.3 Conclusion 137
5.3 Post-Operative Imaging 137
5.3.1 Introduction 137
5.3.2 Normal Post-Operative Findings 140
5.3.3 Residual or Recurrent Disc Herniation and Epidural Scarring 140
5.3.4 Spondylodiscitis 142
5.3.5 Hematoma, Pseudomeningocele 147
5.3.6 Arachnoiditis 149
Appendix 159
References 160
Index 163