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The Radiology Assistant : Spine - Lumbar Disc Herniation

Degenerative spine disease is a major cause of chronic disability in the adult working populationand a common reason for referral to an MR imaging center. Spinal degeneration is a normal part ofaging, and neck and back pain are one of life's most common infirmities. There are many potentialsources of pain, and finding the specific cause is often a confounding problem for both patient anddoctor. Pain can originate from bone, joints, ligaments, muscles, nerves and intervertebral disks, aswell as other paravertebral tissues. The landmark article by Mixter and Barr in 1934 on the rupturedintervertebral disk provided an anatomic basis for selected cases of back pain and neurologicdysfunction. Most neck and back pain responds to conservative therapy, but if the pain is unrelenting,severe, or associated with a radiculopathy or myelopathy, imaging is indicated to look for a treatablecause.

Spondylolisthesis is the actual slipping forward of the vertebral body (the term "listhesis" means "to slip forward") (Fig. 3). It occurs when the pars interarticularis separates and allows the vertebral body to move forward out of position causing pinched nerves and pain. Spondylolisthesis usually occurs between the fourth and fifth lumber vertebra or at the last lumbar vertebra and the sacrum. This is where your spine curves into its most pronounced "S" shape and where the stress is heaviest.

Many Mayfield patients have the option of same-day, outpatient surgery at our spine surgery center.

Spondylolisthesis (Spondylolysis) – Spine Slippage | Spine

Indentation or compression of the cord is common with larger disks and is seen best on T2-weighted or gradient-echo sagittal images. When either herniated disks or osteophytes impinge onthe spinal cord, cord injury can result, which points out the importance of prompt, accurate diagnosisand definitive therapy. As with any contusion, cord edema and swelling develop that may be seen asfocal high-signal intensity on T2-weighted scans. There is also disruption of the blood-cord barrier,so enhancement may be observed with Gadolinium.

Symptomatic thoracic disks are uncommon, accounting for about 1% of alldisk herniations. The rib cage, small intervertebral disks, and coronalorientation of the facets joints all contribute to limited mobility of thethoracic spine, and consequently, a lower risk of disk herniation. The mostcommon level is T11-T12, where the spine is relatively less rigid. SagittalT2-weighted FSE sequences are excellent for displaying indentation of ventralthecal sac and impingement of the spinal cord by thoracic disks. Axial imageshelp delineate lateralization to either side. Disk morphology is similarto the cervical region. Calcification is more common in thoracic disk fragmentsand parent disks than in cervical or lumbar region.

Lumbar spine listhesis in older African American …

Cervical disk disease occurs most commonly at the levels of C5-6 and C6-7. A central diskherniation will most likely cause a myelopathy due to cord compression, along with neck pain andstiffness. If the disk extends laterally to compress nerve roots, the pain may radiate to the shoulder,arm, or hand.

The determination of clinically significant disk disease is an important radiologic and clinicaldecision because the possible consequences of back surgery are not insignificant. Identification ofnerve root compression or severe effacement of the thecal sac, especially ventrolaterally, thatcorrelates with radicular pain or a muscle weakness pattern supports the operative approach whenconservative medical therapy has failed. But beyond that, things are less certain. Annular tears andfocal disk protrusions are frequently found in asymptomatic populations. The annuloligamentouscomplex is richly innervated by the recurrent meningeal nerve. Annular tears involving this complexmay be a source of diskogenic pain due to exposure of the nerve endings to the acid metabolites ofthe protruding nucleus pulposus.

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This is basically another term for spondylolisthesis


Listhesis Treatment - The Ultimate Chiropractic …

Nearly 80 percent of our spine patients are able to recover with nonsurgical treatment. But when physical therapy, medications, and spinal injections fail to relieve neck or back pain, we help patients with surgery.

Spondylolisthesis Overview | Grades, Causes, and …

Nearly 80 percent of our spine patients are able to recover with nonsurgical treatment. But when physical therapy, medications, and spinal injections fail to relieve neck or back pain, we help patients with surgery.

Spondylolisthesis Causes, Symptoms, Treatments

Marginal osteophytes form around the periphery of the vertebral body end plates of the lumbarspine. The larger ones generally project anteriorly or directly lateral and do not compress neuralstructures. Posterior and posterolateral osteophytes are more likely to cause problems.

Spondylolisthesis Center - Exercises Treatments Surgery

The neural foramina are visualized on parasagittal images of the lumbar spine, and disk herniationcan be detected by obliteration of foraminal fat. Nevertheless, axial MR is better for visualizinglateral disk herniations. Lateral disks compress the nerve root within the foramen or just beyond itslateral margin distal to the nerve root sheath.

Anterolisthesis - Grading, Causes, Treatment and …

Osteophytes are hypointense on all pulse sequences. Identification of central osteophytes requiresgradient-echo or T2-weighted images to achieve good contrast between the osteophytes and thehyperintense CSF within the thecal sac. On T1-weighted scans, osteophytes may be silhouetted bythe low-signal CSF Posterior ridging osteophytes produce broad ventral impressions on the thecalsac. In the cervical spine, if the posterior bony ridges are large, they can cause repeated trauma tothe spinal cord with neck motion, eventually resulting in cord deformity, atrophy, and a myelopathy.

Spondylolysis and spondylolisthesis - Mayfield Clinic

Most disk herniations occur in a posterolateral direction into the spinal canal because the toughposterior longitudinal ligament is thicker and tougher in the middle and resists posterior extensionnear the midline. A herniated disk usually impinges on the nerve root as it courses inferiorly towardthe foramen at the next lower level. For example, an L4-L5 herniated disk impinges on the L5 root. The L4 root is likely unaffected unless there is lateral and cephalad migration of a free fragment intothe neural foramen.

Laminectomy plus Fusion versus Laminectomy Alone …

degenerative arthritis: the wearing away of cartilage that cushions joints in the hands, feet and spine. Bone spurs can develop where the joints rub together resulting in limited motion.

12/01/2006 · Original Article

Some degree of spondylosis is invariably associated with degenerative disk disease. Decrease inheight of the intervertebral disk places more stress on the facet joints and unco-vertebral joints,leading to degenerative joint disease. Moreover, with the loss of structural strength at the disk level,exaggerated motion occurs at these joints, accelerating the degenerative changes and placing stressupon the posterior supporting ligaments as well.

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