E³ 919 - Degenerative cervical spine
The degenerative process targeting the intervertebral discs and synovial joints can affect single or multiple levels in the cervical spine with variable severity. The changes are usually progressive and proliferative promoting instability and encroachment on the cord and exiting nerve roots. However, imaging evidence of these changes even when severe is not always related to symptoms. The objective of this session is to specifically focus on the relevant imaging features that a) are likely to be clinically relevant, b) require treatment and c) aid in treatment planning.
1. To understand normal ageing process.
2. To describe biomechanical spinal changes with ageing.
3. To learn MR age-related findings.
Ageing of the spine is a normal process, occurring in any subject. The prevalence of neck problems accounts for 1% of all health issues. Normal ageing; however, is not necessarily linked to symptoms. Ageing of the cervical intervertebral disc involves several processes, such as decrease of proteoglycan content and decrease of water content. Ageing of the disc starts with adolescence. The prevalence is around 16% in adolescence and close to 90% in subjects over 60 years. Already at 40 years of age, at least one finding representing a degenerative phenomenon is seen on two thirds of MR images of the spine. Cross-sectional studies have shown that all factors but age, such as physical activity, gender, smoking, body mass index are not significantly linked to the progression of degeneration. About one third of previously asymptomatic subject develops symptoms over a 10-year period. The most common MR imaging findings in the 10-year follow-up of an asymptomatic cohort are drop in signal of the nucleus pulposus, narrowing of the interspace, compression of the dural sac or the spinal cord and formational stenosis.
1. To summarise typical MRI patterns of degenerative cervical spine disease.
2. To identify which imaging findings explain pain and are useful in planning treatment.
3. To discuss the role of the different modalities, MR vs CT.
This lecture will summarise typical MRI patterns of degenerative cervical spine disease, will explain which imaging findings may explain pain and are useful in planning treatment and will also include a discussion of the role of the different modalities, especially MRI vs. CT. Modern CT and MRI techniques provide excellent anatomical images of the cervical spine. MRI is best suitable for evaluation of the soft tissues, including the intervertebral discs, ligaments, bone marrow and spinal cord, whereas CT offers delineation of osseous components with high spatial resolution. MR imaging has a key role for exploration of spine degenerative disease. Intervertebral disc fissures are optimally depicted on T2-weighted imaging. Disc herniation and neural foraminal stenosis are common changes seen associated with neck pain with or without radiculopathy. Questions concerning pathologies of the neuroforamina, multiplanar reconstructions and/or additional angulated imaging sequences of the spine should particularly be included in routine examinations for improved delineation and depiction of neuroforaminal pathologies, especially if there is a need to evaluate surgical therapy. Whenever possible, a 3D sequence is preferred and thus post-imaging reconstructions can be compiled that not merely reduce examination time but also offers advantages for multiple planar reconstructions as well as simplifying the MR exam. Kinematic MRI might be beneficial for revealing disc bulges, which are not shown by traditional neutral views and should be considered in dedicated cases for the evaluation of the cervical spine. Cervical spine MRI should systematically be performed for cases of neck pain associated with neurologic deficit.
1. To learn the most frequent causes of spinal stenosis.
2. To learn how to make a correct diagnosis of spinal stenosis using different imaging modalities.
3. To identify imaging features of spinal stenosis that determine outcome and treatment strategies.
Spinal canal stenosis represents a frequent cause of pain with relevant impact on the quality of life and daily activities. Spondylosis, trauma and malignancies are the most frequent causes and their incidence depends on patient age. Radiology has a crucial role in the diagnosis of spinal stenosis as well as in the recognition of the aetiologies using different imaging modalities: x-ray, CT, MR and dynamic studies. Furthermore, mini-invasive image-guided treatments are nowadays commonly included in the clinical practice dedicated to this category of patients. This presentation aims to describe the most frequent causes of spinal stenosis, to propose a correct diagnostic approach and planning the treatment strategies.