ABSTRACT
Magnetic resonance imaging (MRI) has become a valuable noninvasive, cost-effective
tool for accurately evaluating spine disorders. This article affords a comprehensive
review of normal anatomy as it relates to MRI interpretation with specific attention
to accurately defining nerve root abnormalities. It gives in-depth detail on disc
herniation nomenclature with specific examples of disc bulge, disc protrusion, disc
extrusion, and disc sequestration. In addition, there are illustrations of various
forms of degenerative spine disease, including intradiscal degenerative disease, reactive
end plate changes, spinal stenosis, synovial cyst formation, and spinal instability.
Differentiating features for separating osteoporotic spine fracture from underlying
neoplastic pathologic fracture are illustrated. Finally, examples of both benign and
malignant disease are illustrated in the spine with corresponding clinical and MRI
examples.
KEYWORDS
Spine MRI - normal anatomy - disc disease - degenerative disease - neoplastic disease
REFERENCES
1
Frymoyer J W.
Back pain and sciatica.
N Engl J Med.
1988;
318
291-300
2
Jensen M C, Brant-Zawadzki M N, Obuchowski N, Modic M T, Malkasian D, Ross J S.
Magnetic resonance imaging of the lumbar spine in people without back pain.
N Engl J Med.
1994;
331
69-73
3
Boden S D, Davis D O, Dina T S et al..
Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A
prospective investigation.
J Bone Joint Surg Am.
1990;
72
403-408
4
Chin C T.
Spine imaging.
Semin Neurol.
2002;
22
205-220
5
Haijiao W, Koti M, Smith F W, Wardlaw D.
Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging.
J Spinal Disord.
2001;
14
143-149
6 Ross J, Brant-Zawadzki M, Moore K. Diagnostic Imaging Spine. Salt Lake City, UT;
Amirsys 2004
7
Breton G.
Is that a bulging disk, a small herniation or a moderate protrusion?.
Can Assoc Radiol J.
1991;
42
318
8
Milette P C.
Reporting lumbar disk abnormalities: at last, consensus!.
AJNR Am J Neuroradiol.
2001;
22
428-429
9 Levin K. Neck and low back pain. Neurologic Clinics. Philadelphia, PA; WB Saunders
2007 25: 450
10
Deyo R A.
Back surgery—who needs it?.
N Engl J Med.
2007;
356
2239-2243
11
Lejeune J P, Hladky J P, Cotton A et al..
Foraminal lumbar disc herniation. Experience with 83 patients.
Spine.
1994;
19
1905-1908
12
Epstein N E.
Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome
measures.
Spinal Cord.
2002;
40
491-500
13
Modic M T, Steinberg P M, Ross J S et al..
Degenerative disk disease: assessment of changes in vertebral body marrow with MR
imaging.
Radiology.
1988;
166
193-199
14
Blumenthal S L, Roach J, Herring J A.
Lumbar Scheuermann's: a clinical series and classification.
Spine.
1987;
12
929-932
15
Kirkaldy-Willis W H, Farfan H E.
Instability of the lumbar spine.
Clin Orthop Relat Res.
1982;
165
110-123
16
Butler D, Trafimow J H, Andersson G BJ, McNeill T W, Huckman M S.
Discs degenerate before facets.
Spine.
1990;
15
111-113
17
Wiltse L L, Widell E H, Jackson D W.
Fatigue fracture: the basic lesion in isthmic spondylolisthesis.
J Bone Joint Surg Am.
1975;
57
17-22
18
Rossi F.
Spondylolysis, spondylolisthesis, and sports.
J Sports Med Phys Fitness.
1978;
18
317-340
19
Fredrickson B E, Baker D, McHolick W J, Yuan H A, Lubicky J P.
The natural history of spondylolysis and spondylolisthesis.
J Bone Joint Surg Am.
1984;
66
699-707
20
Cavalier R, Herman M J, Cheung E V et al..
Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural
history, and nonsurgical management.
J Am Acad Orthop Surg.
2006;
14
417-424
21
Chad D A.
Lumbar spinal stenosis.
Neurol Clin.
2007;
25
407-418
22 Kasdan R. Degenerative diseases and related conditions of the spine. Presented
and published for the Annual Meeting of American Academy of Neurology May 1, 2007
Boston, MA;
23
Qasho R, Raymundo O E, Maraglino C et al..
Epidural lipomatosis with lumbar radiculopathy in one obese patient. Case report and
review of the literature.
Neurosurg Rev.
1997;
20
206-209
24
Ohta Y, Hayashi T, Sasaki C et al..
Cauda equina syndrome caused by idiopathic sacral epidural lipomatosis.
Intern Med.
2002;
41
593-594
25
Apostolaki E, Davies A M, Evans N, Cassar-Pullicino V N.
MR imaging of lumbar facet joint synovial cysts.
Eur Radiol.
2000;
10
615-623
26 St. Amour T E, Hodges S C, Laakman R W, Tamas D E.
Arachnoid (meningeal) cysts . In: St. Amour TE, Hodges SC, Laakman RW, Tamas DE MRI of the Spine. New York, NY;
Raven Press 1994
27
Boden S D, Davis D O, Dina T S et al..
Contrast-enhanced MR imaging performed after successful lumbar disk surgery: prospective
study.
Radiology.
1992;
182
59-64
28
Bundschuh C V, Stein L, Slusser J H et al..
Distinguishing between scar and recurrent herniated disk in postoperative patients:
value of contrast-enhanced CT and MR imaging.
AJNR Am J Neuroradiol.
1990;
11
949-958
29
Ledermann H P, Schweitzer M E, Morrison W B et al..
MR imaging findings in spinal infections: rules or myths?.
Radiology.
2003;
228
506-514
30
Etchepare F, Roche B, Rozenberg S, Dion E, Bourgeois P, Fautrel B.
Post-lumbar puncture arachnoiditis. The need for directed questioning.
Joint Bone Spine.
2005;
72
180-182
31
Sather M D, Gibson M D, Treves J S.
Spinal subarachnoid hematoma resulting from lumbar myelography.
AJNR Am J Neuroradiol.
2007;
28
220-221
32
Shih T T, Huang K M, Li Y W.
Solitary vertebral collapse: distinction between benign and malignant causes using
MR patterns.
J Magn Reson Imaging.
1999;
9
635-642
33
Yuh W T, Zachar C K, Barloon T J et al..
Vertebral compression fractures: distinction between benign and malignant causes with
MR imaging.
Radiology.
1989;
172
215-218
34
Fu T S, Chen L H, Liao J C et al..
Magnetic resonance imaging characteristics of benign and malignant vertebral fractures.
Chang Gung Med J.
2004;
27
808-815
35
Cuénod C A, Laredo J D, Chevret S.
Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced
and gadolinium-enhanced MR images.
Radiology.
1996;
199
541-549
36
Moore K R, Tsuruda J S, Dailey A T.
The value of MR neurography for evaluating extraspinal neuropathic leg pain: a pictorial
essay.
AJNR Am J Neuroradiol.
2001;
22
786-794
37 Hansen J T, Koeppen J M, Netter F, Perkins J, Craig J. Atlas of Neuroanatomy and
Neurophysiology: Selections from the Netter Collection of Medical Illustrations. Teterboro,
NJ; Icon Custom Communications 2002
38 Banna M. Clinical Radiology of the Spine and Spinal Cord. Rockville, MD; Aspen
Systems Corp 1985
39 Rao K CVG, Williams J P, Lee B CP, Sherman J L. MRI and CT of the Spine. Baltimore,
MD; Williams & Wilkins 1994
Richard B KasdanM.D.
Associates in Neurology of Pittsburgh
5750 Centre Avenue, Suite 100, Pittsburgh, PA
eMail: jhoward@presgar.com