Classification of Lumbar Disc

Question 1

purpose of lumbar disc classification

Answer 1

develop a clear system to avoid

confusion between the radiologist and clinician

Question 2

T/F: These classifications are based on anatomy and pathology, and DO
NOT define or imply cause, symptomatology, or treatment

Answer 2

TRUE

Question 3

̜ Scoliosis
̜ Spondylolisthesis
̜ Hypoplastic intervertebral disc

Answer 3

Congenital / Developmental Variation

Question 4

what type of scoliosis is most common

Answer 4

right sided

left has to get MRI ASAP

Question 5

spondylolisthesis creates a ____buldge

Answer 5

pseudo buldge

Question 6

what are the 3 types of disc degenerations

Answer 6

̜ Degeneration
̜ Herniation
̜ Annular fissure

Question 7

Separations between the annular fibers or separations of the annular fibers from their attachments to the vertebral bone • aka high intensity zone (HIZ)
̜ Fluid and/or granulation tissue
̜ T2-weighted MRI
Separations between the annular fibers or separations of the annular

Answer 7

Subtype I: annular fissure

Question 8

“Tear” or fissure

• REMEMBER – it is a ________ term; does NOT imply a traumatic origin

Answer 8

descriptive

Question 9

• Dessication • Fibrosis • Narrowing of the disc space • Diffuse bulging of the annulus beyond the disc space • Fissuring (i.e., annular fissures)

Answer 9

Subtypes II and III: degeneration

Question 10

• Mucinous degeneration of the annulus • Intradiscal gas • Osteophytes of the vertebral apophyses • Defects • Inflammatory changes • Sclerosis of the endplates

Answer 10

Subtypes II and III: degeneration

Question 11

is it normal to see gas in the intervertebral disc?

Answer 11

NO, means degenerative

Question 12

̜ Affects mainly the annulus fibrosus and adjacent apophyses
̜ Mild to moderate disc height loss
̜ Exuberant spondylophyte formation (i.e., apophyseal osteophytes)

Answer 12

Spondylosis deformans

Question 13

̜ Dramatic disc height loss
̜ Minimal spondylosis
̜ Possible vacuum (intradiscal gas)
̜ Endplate cartilage erosion

Answer 13

Intervertebral osteochondrosis

Question 14

• Localized or focal displacement of disc material beyond the limits
of the intervertebral disc space
• Extension of disc material less than 25% (90o) of the periphery of
the disc as viewed in the axial plane

Answer 14

Subtypes II and III: herniation

Question 15

how are disc herniations classified

Answer 15

• Protrusion • Extrusion

Question 16

̜ Disruption of the disc associated with physical and/or imaging
evidence of violent fracture and/or dislocation

Answer 16

trauma

Question 17

does trauma include: Repetitive injury

Answer 17

NO

Question 18

does trauma include: Contribution of less than violent trauma to the degenerative process

Answer 18

NO

Question 19

does trauma include: herniation Fragmentation of the ring apophysis in conjunction with disc

Answer 19

NO

Question 20

does trauma include: Disc abnormalities associated with degenerative subluxations

Answer 20

NO

Question 21

Infection

Modic disease

Inflammatory response to a spondyloarthropathy

Answer 21

inflammatory change to the

intervertebral disc

Question 22

Inflammatory spondylitis of the subchondral endplate and bone marrow associated with degenerative pathologic changes to the disc

Answer 22

Modic disease

Question 23

Vertebral:
• Loss of vertebral endplate cortex • Vertebral marrow signal abnormality abutting the disc • Hypointense on T1, hyperintense on fat-sat T2 or STIR • Avid enhancement with gad

Answer 23

Infectious spondylitis and discitis

Question 24

Disc:
• Disc space narrowing
• Hypointense on T1, hyperintense T2
• Diffuse post-gad enhancement

Answer 24

Infectious spondylitis and discitis

Question 25

when you see an infection of the spine w/ an xray... how long has the pt had to be infected

Answer 25

2 weeks

Question 26

Acute, with disruption and fissuring of the endplates with adjacent fibrous tissue • Marrow edema and inflammation • Low on T1, high on T2

Answer 26

type I changes of Modic endplate

Question 27

* More chronic process * Fatty degeneration of adjacent marrow * High on T1, iso- to slightly high on T2

Answer 27

type II changes of Modic endplate

Question 28

* Consistent with endplate sclerosis on x-ray | * Low on both T1 and T2

Answer 28

type III changes of Modic endplate

Question 29

``` ̜ First involves the SI joints ̜ Second involves T/L junction ̜ MRI: • Low signal intensity bone marrow at corner on T1 • High signal intensity bone marrow at early corner on T2 and STIR ```

Answer 29

Seronegative | spondyloarthropathy

Question 30

Anytime a neoplasm, benign or malignant, primary or metastatic, is present within the osseous spine, it may have a morphological effect on the

Answer 30

adjacent disc

Question 31

beyond the edges of the ring apophyses, throughout the circumference of the disc Presence of disc tissue extending

Answer 31

Disc Bulge

Question 32

asymmetric bulging disc tissue is greater than _____ of the disc circumference

Answer 32

25%

Question 33

generalized disc bulge:

Answer 33

greater than 50%

Question 34

circumferential disc bulge:

Answer 34

100%

Question 35

what is a contained disc bulge

Answer 35

If the displaced portion of the disc is covered by outer annulus fibers and/or the PLL

Question 36

When the base of the herniated disc material is larger than the most distal portion

Answer 36

Protrusion

Question 37

̜ When the distal portion of disc material is larger than the base of the herniation ̜ The material, while attached to the parent disc, may migrate in the cephalad or caudal direction

Answer 37

Extrusion

Question 38

no continuity exists between the disc material | that is beyond the disc space and that which is within the disc space

Answer 38

Sequestration

Question 39

When a portion of disc material separates from the parent disc and migrates away, either cephalad, caudal, lateral, or posterior

Answer 39

Sequestration

Question 40

Intravertebral Herniation

Answer 40

“Schmorl’s node”

Question 41

Disc material herniates in the vertical direction through a defect in the vertebral endplate

Answer 41

Intravertebral Herniation

Question 42

̜ _____ means to rub or wipe out | ̜ To obliterate or make indistinct; the obliteration of features

Answer 42

Effacement