1. To learn about the physiological and pathophysiological degeneration of the cervical spine.
2. To understand the role of imaging in the diagnosis and clinical decision making in the degenerative cervical spine.
3. To appreciate the clinical relevance of imaging findings in the degenerative cervical spine.
Neck pain is a common problem with many possible causes. The facet joint and the uncovertebral joint are frequently involved in degenerative cervical spine disease. It is important to learn how to differentiate normal and asymptomatic changes that occur with age from abnormal findings that are causing neck and/or arm pain. I will demonstrate the use of plain film, CT, SPECT, and MRI in diagnosing an offending uncovertebral or facet joint. Many of these offending joints can be targeted specifically, leading to easy and fast pain reduction in many patients with aspecific neck pain.
1. To learn about the pathophysiology and imaging findings in spinal stenosis and cervical spondylotic myelopathy.
2. To understand the relation between imaging findings and clinical presentation.
3. To appreciate the importance of imaging findings and the clinical presentation with respect to possible treatment options.
Degenerative changes of the cervical spine occur during the aging process or are caused by segmental mechanical overload. Among the degenerative processes leading to spinal stenosis are marginal osteophytes of the vertebral bodies and joints, intervertebral disc degeneration with herniation and hypertrophy of the ligaments. CT, CT-myelography, and MR imaging are essential in assessing the extent and severity of spinal canal stenosis, especially with a view to guiding conservative or surgical treatment. Next to the assessment of the osseous and soft tissue structures of the vertebral column as well as spinal canal stenoses, T2-weighted MRI imaging is crucial for the assessment of signal changes within the myelon. The differentiation between signs of an acute myelopathy and myelomalacia, caused by an irreversible damage of the spinal cord, is essential to select the appropriate treatment option. Moreover, patients present with a broad spectrum of clinical symptoms ranging from neck pain to spastic paraparesis; therefore, it is crucial to put imaging findings in context with clinical symptoms to assess the potential benefit of different conservative and surgical treatment options.
1. To learn about the imaging findings and pitfalls of postoperative cervical spine imaging.
2. To understand the heterogeneity of imaging findings and their clinical relevance.
3. To appreciate the importance of standardised imaging, interpretation and reporting of postoperative imaging findings in the cervical spine.
Cervical spine surgery is common, so it is important for radiologists to know what the normal imaging findings are to avoid pitfalls. This is not easy as there are substantial imaging overlaps between normal early postoperative findings and surgical complications. Because there are a vast variety of surgical approaches and hardware that can be applied to the spine, it is a challenge for the radiologists to know their anatomical implications and possible complications. The use of a particular imaging technique is dictated by multiple factors including the underlying pathology, surgical approach, device or instrumentation used, and suspected complications. The postoperative imaging should be able to assess progression of osseous fusion, confirm correct positioning and integrity of instrumentation, and detect suspected complications such as new disease or disease progression. Radiographs are most commonly used for assessment of fusion. CT is the modality of choice for the evaluation of graft position, hardware, bone integrity, and fractures. It also provides imaging of bone detail to accurately assess the degree of osseous fusion. MRI is the best option for evaluation of endplates, paraspinal soft tissues, epidural spaces, and intrathecal structures, making it useful for detecting and monitoring infection or postoperative collections.