Anatomic Considerations

Interventional Radiology Techniques

Cervical Spine Biopsy Anterolateral and postero-lateral approaches are used in cervical vertebral biopsy. Fluoroscopic, CT, and MRI guidance has been used with cervical biopsy 29,32,33,77 . Fluoroscopic guidance requires adequate knowledge of cervical anatomy to be performed safety. CT and MRI allow visualization of the soft tissue structures of the neck during needle placement Fig. 11. Biopsy techniques. CT-guided direct posterolateral approach. Fig. 11. Biopsy techniques. CT-guided direct...

Discogenic Back Pain

Back pain arising from the disc may be acute or slow in onset but become chronic, persistent, intractable, and disabling. The pain may be caused by inflammatory substances from the nucleus pulposis leaking into the surrounding tissues and inflaming the meninges. Disruption of the concentric collagenous fibers of the annulus fibrosus can also create pain. Innervation of the annulus from the recurrent meningeal nerve and ventral ramus of the somatic spinal nerves are sources of the pain. Disc...

Disc Herniation

Annulus Vertebrae

Findings of disc disease on MRI examination must be carefully correlated with clinical symptoms 6 . Jensen et al. performed lumbar spine MRI on 98 patients without back pain and found a 64 prevalence of either a bulge, protrusion, or extrusion 7 . Thirty-eight percent had abnormalities at more than one level. A similar study noted extrusions in 24 of asymptomatic people 8 . Furthermore, discogenic pain, caused by a small annular tear with an inflammatory reaction, can often produce severe...

Benign Tumors

Paraspinal Soft Tissue Structures

On the benign end of the tumor spectrum, there are several lesions whose appearance is usually diagnostic, including enostosis, osteoid osteoma, hemangioma, and osteochondroma. Enostoses, or bone islands, are benign incidental lesions detected on imaging, which occasionally are mistaken for sclerotic metastases. They are classically round to oval in shape, sharply defined, and have characteristic spiculated margins. Most lesions do not demonstrate activity on bone scintigraphy although giant...

Extradural Spinal Masses

Lumbar Vertebrae Masses

These lesions are found outside the dural sac involving the epidural space, paravertebral soft tissues, and spinal skeleton. The most common extradural masses are metastases from primary breast, lung, prostate, myeloma, and lymphoma. MRI is the preferred imaging modality to detect these lesions. Primary bone tumors rarely involve the lumbar spine. Nerve sheath tumors may present as extradural lesions but this is less common than their presentation in the intradural compartment. Chordomas...