Compression Fractures

Thoracic Vertebral Compression Fracture

Compression fractures in the cervical and upper thoracic regions are most often traumatic in origin. In the middle, lower thoracic, and lumbar regions, the fractures are related to axial loading as has been seen in elderly and osteoporotic patients. Commonly the patient is an elderly post-menopausal woman aged 60 or older 23 . Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue that leads to pronounced bone fragility and increased...

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...

The Pathophysiology Of Pain Production

The sensation of pain represents a complex series of events designed to protect the central nervous system CNS . The integration of multiple components of the neuroaxis begins with activation of specific nociceptors, signaling potential injury to sensory fibers and potential damage to the CNS. This type of neuropathic pain is considered maladaptive, yielding harmful sequelae. Nocice-ptive pain is, however, more of a warning to the rest of the body, indicating some form of injury, signifying...

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...