Adults
Indication
- When lower extremity pain is present
- For adult spinal deformity
- Neurological symptoms reported in 59–85% of patients with ASD
- Severe symptoms (VAS > 5) present in > 40% of patients
- Most common are isolated radiculopathy followed by claudication, neurological deficit, and myelopathy
Can identify
Disc degeneration
- Pfirrmann grading
- A complete evaluation of disc status (especially at LSJ) is critical to define whether to extend the fusion to the Sacrum/pelvis
Modic endplate changes;
- Oh I See; Oedema I both bright, See Shadow)
- Modic type I:
- Pathology
- bone marrow oedema and inflammation
- T1: low signal
- T2: high signal
- T1 C+ (Gd): enhancement
- Clinical significance
- associated with low back pain
- ? infection being a potential aetiological factor for lower back pain.
- Albert et al. 2013: double blind RCT
- co- amoxiclav for 100 days
- back pain + Modic type 1 changes
- Findings were encouraging and demonstrated a statistically significant improvement in disability indices in the antibiotic group versus the placebo group.
- This has been disproven by other external studies (Need to find these studies)
- Modic type II:
- Pathology
- Marrow ischaemia → Normal red haemopoietic bone marrow conversion into yellow fatty marrow
- T1: high signal
- T2: iso to high signal
- Clinical significance
- associated with low back pain
- Modic type III:
- Pathology
- Subchondral bony sclerosis
- T1: low signal
- T2: low signal
Central canal stenosis
- Canal stenosis occurs in ~8% of patients with ASD
- Most common symptom is neurological claudication
- Schizas grading
- Grade A: No or minor stenosis
- A1: the rootlets lie dorsally and occupy less than half of the dural sac area.
- A2: the rootlets lie dorsally, in contact with the dura but in a horseshoe configuration.
- A3: the rootlets lie dorsally and occupy more than half of the dural sac area.
- A4: the rootlets lie centrally and occupy the majority of the dural sac area.
- Grade B stenosis: Moderate stenosis
- the rootlets occupy the whole of the dural sac, but they can still be individualized. Some CSF is still present giving a grainy appearance to the sac.
- Grade C stenosis: Severe stenosis
- no rootlets can be recognized, the dural sac demonstrating a homogeneous gray signal with no CSF signal visible. There is epidural fat present posteriorly.
- Grade D stenosis: Extreme stenosis
- in addition to no rootlets being recognizable there is no epidural fat posteriorly.
Synovial cyst
- Originates from the joint
- Capsulated, iso/hyperintense in T2
- Can be aspirated
Paraspinal muscle health (Goutallier classification)
- Evaluation of fatty infiltration in paraspinal muscles
- Jun 2016
- Fatty degeneration (FD) of paraspinal muscles was significantly correlated with:
- Higher age (r = 0.393)
- Increased pelvic tilt (r = 0.430)
- Increased sagittal vertical axis (SVA) (r = 0.488)
- Greater PI–LL mismatch (r = 0.479)
- More kyphotic thoracic alignment (r = −0.559; negative correlation)
- Less lumbar lordosis (LL) (r = −0.505)
- Muscle mass (LM) was positively correlated with LL (r = 0.342), and negatively with PI–LL mismatch (r = −0.283).
- Facet hypertrophy
- Pedicle enlargement
- Foraminal encroachment
Paediatric (EOIS, LOIS)
- MRI spine including craniocervical junction to sacrum is required
- Indication
- Rapid progression
- Excessive kyphosis
- Structural abnormalities
- Neurologic symptoms or pain
- Atypical curve pattern (left thoracic curve, short angular curve, apical kyphosis)
- Foot deformities
- Asymmetric abdominal reflexes
- A syrinx is associated with abnormal abdominal reflexes and a curve without significant rotation
- Identify CNS causes (e.g. syrinx, Chiari malformation, tethered cord).
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