Imaging in Spine Surgery

Jeffrey S. Ross, MD is a Consultant for the Neuroradiology Division of the Department of Radiology at the Mayo Clinic Arizona, and Professor of Radiology at the Mayo Clinic College of Medicine, in Phoenix, AZ

SECTION 1: NORMAL ANATOMY AND TECHNIQUES

Normal Anatomy Overview Craniovertebral Junction Cervical Spine Thoracic Spine Lumbar Spine Measurement Techniques Normal Postoperative Change: Disc Space Normal Postoperative Change: Epidural Space Metal Artifact

SECTION 2: DEVICES AND INSTRUMENTATION

Devices and Instrumentation Overview Plates and Screws Cages Subaxial Posterior Instrumentation Transpedicular Screw Fixation Cervical Artificial Disc Lumbar Artificial Disc Interspinous Spacing Devices Scoliosis and Devices Instrumentation Pumps and Catheters

SECTION 3: CONGENITAL AND GENETIC DISORDERS

BONY VARIATIONS C2-C3 Fusion C1 Assimilation Ponticulus Posticus Ossiculum Terminale Paracondylar Process Condylus Tertius Posterior Arch Rachischisis Split Atlas

DIAGNOSES

Odontoid Hypoplasia/Aplasia C1 Dysmorphism/Hypoplastic Arch Chiari 1 Complex Chiari Chiari 2 Chiari 3 Myelomeningocele Lipomyelomeningocele Lipoma Dorsal Dermal Sinus Simple Coccygeal Dimple Dermoid Cysts Epidermoid Cysts Tethered Spinal Cord Segmental Spinal Dysgenesis Caudal Regression Syndrome Terminal Myelocystocele Anterior Sacral Meningocele Occult Intrasacral Meningocele Sacrococcygeal Teratoma Klippel-Feil Spectrum Failure of Vertebral Formation Vertebral Segmentation Failure Diastematomyelia Neurenteric Cyst Os Odontoideum Lateral Meningocele

GENETIC

Neurofibromatosis Type 1 Neurofibromatosis Type 2 Down Syndrome Mucopolysaccharidoses Achondroplasia Osteogenesis Imperfecta Spondyloepiphyseal Dysplasia

SECTION 4: DISORDERS OF ALIGNMENT

Introduction to Scoliosis Scoliosis Kyphosis Degenerative Scoliosis Scoliosis Instrumentation Spondylolisthesis Instability

SECTION 5: TRAUMA

VERTEBRAL COLUMN, DISCS Fracture Classification Atlantooccipital Dislocation Ligamentous Injury Occipital Condyle Fracture Jefferson C1 Fracture Atlantoaxial Rotatory Fixation Odontoid C2 Fracture Burst C2 Fracture Hangman's C2 Fracture Apophyseal Ring Fracture Cervical Hyperflexion Injury Cervical Hyperextension Injury Cervical Burst Fracture Traumatic Disc Herniation Thoracic and Lumbar Burst Fracture Fracture Dislocation Chance Fracture Anterior Compression Fracture Sacral Insufficiency Fracture

CORD, DURA, AND VESSELS

Posttraumatic Syrinx Presyrinx Edema Spinal Cord Contusion-Hematoma Idiopathic Spinal Cord Herniation Traumatic Epidural Hematoma Traumatic Subdural Hematoma

SECTION 6: DEGENERATIVE DISEASES AND ARTHRITIDES

DEGENERATIVE DISEASE

Nomenclature of Degenerative Disc Disease Degenerative Disc Disease Degenerative Endplate Changes Disc Bulge Anular Fissure, Intervertebral Disc Cervical Intervertebral Disc Herniation Thoracic Intervertebral Disc Herniation Lumbar Intervertebral Disc Herniation Intervertebral Disc Extrusion, Foraminal Cervical Facet Arthropathy Lumbar Facet Arthropathy Facet Joint Synovial Cyst Baastrup Disease Bertolotti Syndrome Schmorl Node Scheuermann Disease Acquired Lumbar Central Stenosis Congenital Spinal Stenosis Cervical Spondylosis DISH OPLL Ossification Ligamentum Flavum Periodontoid Pseudotumor Spondylolysis

INFLAMMATORY, CRYSTALLINE, AND MISCELLANEOUS ARTHRITIDES

Adult Rheumatoid Arthritis Juvenile Idiopathic Arthritis Neurogenic (Charcot) Arthropathy Hemodialysis Spondyloarthropathy Ankylosing Spondylitis CPPD Gout

SECTION 7: INFECTION AND INFLAMMATORY DISORDERS

INFECTION

Pathways of Spread Pyogenic Osteomyelitis Tuberculous Osteomyelitis Fungal and Miscellaneous Osteomyelitis Osteomyelitis, C1-C2 Septic Facet Joint Arthritis Paraspinal Abscess Epidural Abscess Abscess, Spinal Cord

INFLAMMATORY AND AUTOIMMUNE

Acute Transverse Myelopathy Multiple Sclerosis Neuromyelitis Optica ADEM Sarcoidosis Grisel Syndrome IgG4-Related Disease/Hypertrophic Pachymeningitis

SECTION 8: NEOPLASMS, CYSTS, AND OTHER MASSES

EXTRADURAL NEOPLASMS

Spread of Neoplasms Blastic Osseous Metastases Lytic Osseous Metastases Hemangioma Osteoid Osteoma Osteoblastoma Aneurysmal Bone Cyst Giant Cell Tumor Osteochondroma Chondrosarcoma Osteosarcoma Chordoma Ewing Sarcoma Lymphoma Leukemia Plasmacytoma Multiple Myeloma Neuroblastic Tumor

INTRADURAL EXTRAMEDULLARY

Schwannoma Meningioma Solitary Fibrous Tumor/Hemangiopericytoma Neurofibroma Malignant Nerve Sheath Tumors Metastases, CSF Disseminated Paraganglioma

INTRAMEDULLARY

Astrocytoma Cellular Ependymoma Myxopapillary Ependymoma Hemangioblastoma Spinal Cord Metastases Primary Melanocytic Neoplasms/Melanocytoma

NONNEOPLASTIC CYSTS AND TUMOR MIMICS

CYSTS CSF Flow Artifact Meningeal Cyst Perineural Root Sleeve Cyst Syringomyelia

TUMOR MIMICS Fibrous Dysplasia Kümmell Disease Hirayama Disease Paget Disease Bone Infarction Extramedullary Hematopoiesis Tumoral Calcinosis

SECTION 9: VASCULAR DISORDERS

Vascular Anatomy Approach to Vascular Conditions Type 1 Vascular Malformation (Dural Arteriovenous Fistula) Type 2 Arteriovenous Malformation Type 3 Arteriovenous Malformation Type 4 Vascular Malformation (Arteriovenous Fistula) Posterior Fossa Dural Fistula With Intraspinal Drainage Cavernous Malformation Spinal Artery Aneurysm Spinal Cord Infarction Subarachnoid Hemorrhage Spontaneous Epidural Hematoma Subdural Hematoma Bow Hunter Syndrome Vertebral Dissection Carotid Dissection Fibromuscular Dysplasia

SECTION 10: COMPLICATIONS

Complications Overview Myelography Complications Vertebroplasty Complications Failed Back Surgery Syndrome Epidural Abscess, Postop Disc Space Infection Meningitis CSF Leakage Syndrome Pseudomeningocele Direct Cord Trauma Vascular Injury Epidural Hematoma, Spine Instrumentation Failure Bone Graft Complications rhBMP-2 Complications Heterotopic Bone Formation Recurrent Disc Herniation Peridural Fibrosis Arachnoiditis/Adhesions Arachnoiditis Ossificans Accelerated Degeneration Postsurgical Deformity Radiation Myelopathy

SECTION 11: REMOTE COMPLICATIONS

Remote Complications Overview Donor Site Complications Deep Venous Thrombosis Pulmonary Embolism Aspiration Pneumonia Acute Myocardial Infarction Cerebral Infarction Cerebellar Hemorrhage Intracranial Hypotension Extraaxial Hematoma, Brain Retroperitoneal Hemorrhage Retroperitoneal Lymphocele Ophthalmic Complications Esophageal Perforation Acute Pancreatitis Pseudomembranous Colitis (Clostridium difficile) Rhabdomyolysis Bowel Perforation Ureteral Trauma

SECTION 12: DIFFERENTIAL DIAGNOSIS

Basilar Invagination Basilar Impression Cranial Settling Platybasia Intrinsic Skull Base Lesion Foramen Magnum Mass

SECTION 13: PERIPHERAL NERVE AND PLEXUS

Normal Plexus and Nerve Anatomy Superior Sulcus Tumor Thoracic Outlet Syndrome Muscle Denervation Brachial Plexus Traction Injury Idiopathic Brachial Plexus Neuritis Traumatic Neuroma Radiation Plexopathy Peripheral Nerve Sheath Tumor Peripheral Neurolymphomatosis Hypertrophic Neuropathy Femoral Neuropathy Ulnar Neuropathy Suprascapular Neuropathy Median Neuropathy Common Peroneal Neuropathy Tibial Neuropathy

SECTION 14: IMAGE-GUIDED PROCEDURES

CERVICAL SPINE

Medial Branch Block, Cervical Spine Facet Joint Injection, Cervical Spine Selective Nerve Root Block, Cervical Spine Epidural Steroid Injection, Cervical Spine

THORACIC SPINE

Medial Branch Block, Thoracic Spine Facet Joint Injection, Thoracic Spine Selective Nerve Root Block, Thoracic Spine Epidural Steroid Injection, Thoracic Spine

LUMBAR SPINE

Medial Branch Block, Lumbar Spine Facet Joint Injection, Lumbar Spine Selective Nerve Root Block, Lumbar Spine Epidural Steroid Injection, Lumbar Spine

VERTEBRAL BODY

Vertebroplasty Kyphoplasty Sacroplasty Vertebral Biopsy

INTERVERTEBRAL DISC

Percutaneous Discectomy Intradiscal Electrothermal Therapy Nucleoplasty Disc Aspiration/Biopsy

PELVIS

Pelvis Anatomy Sacroiliac Joint Injection Sacral Nerve Root Block Piriformis Steroid Injection