Spinal degenerative diseae

Question 1

Do annular tears enhance?

Answer 1

Yes, indicates granulation tissue

Question 2

What is meant by the term disc dessication

Answer 2

loss of proteoglycans “dries” out the disc

Question 3

Why are disc bulges eccentric in the L4-L5 and L5-S1 level?

Answer 3

Centrally are blocked by the median ligament

Question 4

What levels do far lateral disc bulges occur?

Answer 4

L2/3 and L3/4

Question 5

What is torn with a free disc fragment?

Answer 5

PLL and anulus fibrosus

Question 6

What is a sequestered free fragment?

Answer 6

Move into lateral recess or posterior to thecal sac

Question 7

What is a schmorls node?

Do they enhance?

Answer 7

Herniation of nucleus pulposus into the endplate

They can enhance

Question 8

What is the difference between postsurgical disc herniation and scar? When should patient be imaged after recieving contrast?

Answer 8

Disc will not enhance

scar will enhance

IMMEDIATELY! Delay images may show enhancement of the postsurgical disc

Question 9

What is the most common cause for failed back syndrome?

Answer 9

Residual/recurrent herniation

Scar isnt symptomatic and will enhance on immediate postcon imaging

Question 10

What are the causes of arachnoiditis?

Answer 10

Postsurgical

Infection
Intrathecal steroid administration
Trauma
SAH

Question 11

What are the imaging appearances of arachnoiditis?

Answer 11

Featureless thecal sac
Multiple localized filling defects, nerve roots adhere to thecal wall
Soft tissue mass filling spinal canal WITHOUT enhancement

Question 12

What is associated with enhancing lumbar nerve root?

Answer 12

Epidural fibrosis, but also with postop or arachnoiditis

Question 13

What are the 3 types of facet cysts?

Answer 13

True synovial: fluid filled, communicates with joint space

Pseudosynovial: fluid filled, communicates with joint space but lined by fibrous capsule

Ganglion cyst: fluid filled, doesnt communicate with joint space, lined by fibrous capsule

Question 14

Do facet cysts erode bone/enhance?

Answer 14

they can

Question 15

How can one tell between spondylolisthesis secondary to spondylolysis vs degenerative disease?

Answer 15

Lysis will have a widened AP diameter in the thecal sac: the posterior and anterior elements arent connected, so when the anterior elements migrate anteriorly the posterior elements are left behind

Degen will have a shorter AP thecal diameter

Question 16

who gets OPLL? What level is most commonly affected?

Answer 16

Asian men

C4-C6

Question 17

What are the imaging features of pagets in the spine?

Answer 17

Osteolytic: fibrous conversion of marrow with multiple enlarged vessels

Mixed: loss of changes

Osteoblastic: marrow returns to normal, thickened cortices

Squared vertebra with “picture frame” sign: sclerosis around the endplates and a/p margins

Question 18

New or acute pain in the setting of pagets should prompt suspicion for what?

Answer 18

Sarcomatous degeneration

Question 19

What is the general progression of pagets?

Answer 19

Lytic lesion -> coarse/thickened trabeculae with bony enlargement -> sclerosis