Spinal Stenosis

Reflek Meningeal Sign

The spinal cord is surrounded by ligaments and bones that provide support and protection. The central canal containing the cord is constructed from bones of the spine, ligaments, and fat. Depending on the patient's body habi Fig. 4. A Ankle reflex S1. B Knee reflex L2, 3, Fig. 4. A Ankle reflex S1. B Knee reflex L2, 3, tus, a central canal anteroposterior AP diameter of lt 14 mm in the cervical region and lt 15 mm in the lumbar region could be diagnostic 14 . Neural compression may be...

The Pathophysiology Of Lumbar Disc Disruption

Lumbar Spinal Fusion

Understanding the pathophysiology of discogenic pain is critical for understanding the treatment options. Discogenic pain represents a complex interaction of multiple pathologies. The intervertebral disc is an innervated structure capable of producing severe pain 7 . In addition, pain fibers nociceptors are present in the outer posterolateral portion of the disc. Nociceptor afferent pain transmissions are relayed through the dorsal root ganglion 8 . Ingrowth of granulation tissue and small...

Anatomic Considerations

Spine Biopsy

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...

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...