tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 28

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 28. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Imaging Studies Chapter 9 251 The appearance of spinal cord lesions on MR imaging provides prognostic information regarding the likely extent of recovery of neurologic function 11 19 . Magnetic resonance angiography can reliably demonstrate vertebral artery injuries not uncommonly associated with cervical spine subluxation or dislocation and fractures crossing the transverse foramen 45 . Chronic Low Back Pain Standard radiographs in the anteroposterior and lateral planes are typically obtained initially although they are usually not very helpful. However they can occasionally demonstrate unexpected lesions such as spinal deformities previous fractures previous infection or other inflammatory diseases tumors later stage For additional imaging in most instances MRI is preferable to CT. It is superior to CT for evaluation of In chronic low back pain standard radiographsand MR imaging are the most useful imaging methods disc degeneration endplate changes disc herniation annular tears spinal canal and foraminal stenosis Endplate changes are classified according to Modic 23 into three grades Fig. 8 Grade I decreased signal on T1 W images and increased signal on T2 W images Grade II increased signal on T1 W and T2 W images Grade III decreased signal on T1 W and T2 W images Even for evaluation of the facet joints MR imaging does not provide less information than CT 49 . In suspected osteoporotic fractures MR imaging is preferable to CT because signal alterations within the fractured vertebral body allow the determination of whether a fracture is acute up to a few weeks old or old Fig. 16 . Such information for instance is important in a medicolegal context and it represents a predictor for the success of percutaneous vertebroplasty 1 . MRI is not inferior to CT for the evaluation of facet joint alterations Postoperative Imaging Standard radiography demonstrates spinal deformity the position and signs of loosening of implants as well as degeneration in segments adjacent to