Hemangioma

Vertebral body hemangiomas are the most common tumors of the spinal axis and in most circumstances are incidental findings. Most hemangiomas are diagnosed based on their characteristic imaging findings, though the diagnosis can be challenging in cases of atypical or aggressive hemangiomas. In such cases, the recognition of vertically oriented coarse bony trabeculae surrounded by fatty stroma, resulting in the "salt and pepper" appearance on axial images and a striated appearance on coronal or sagittal images, is the key to the correct diagnosis. Though rare, aggressive hemangiomas can be symptomatic and pathologic fractures can lead to myelopathy and cord compression. In such patients, MR accurately displays the extraosseous extension of the hemangioma and its effect upon the spinal canal and cord.

Atypical hemangioma

The T1-weighted sagittal image demonstrates an atypical hemangioma within the L1 vertebral body (arrow) with coarse trabeculae, but with relatively little typical fat signal within the lesion.

The T2-weighted sagittal image shows a typical appearance with increased signal intensity, well-circumscribed margins and coarsened trabeculae (arrow).

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Typical hemangioma

The T2-weighted sagittal image shows a lesion of increased signal intensity replacing the entire L2 vertebral body. Coarse vertically oriented trabeculae are present (arrows).

The T1-weighted sagittal image reveals that the L2 vertebral body lesion (arrow) is of increased signal intensity, similar to that seen on the T2-weighted image.

The T1-weighted axial image demonstrates the coarse trabeculae on end surrounded by fat signal, resulting in a 'salt and pepper" appearance (arrow).

On plain radiographs, hemangiomas often have a vertically striated appearance due to thickening of bony trabeculae. This appearance has been described as "corduroy cloth" or "jail bar" and the overall density of the vertebral body is decreased due to the presence of fatty marrow.

With CT, vertebral body hemangiomas have low attenuation interspersed with thickened bony trabeculae, causing a characteristic "salt and pepper" or "polka dot" appearance on axial images.

With MR imaging, the intralesional fat of the hemangioma causes increased signal intensity on T1 weighted MR images.4 On T2-weighted images, the signal intensity of the hemangiomas also increases because of high water content,4 and the T2-hyperintensity is typically greater than that of fat, thereby differentiating hemangiomas from focal fat deposition.
These signal characteristics also differ from those of metastatic lesions, which have decreased signal intensity on T1 weighted images and increased signal intensity on T2 weighted images.

vertebral hemangioma

Lumbar spine trauma. The structures of the lumbar spine can be considered as 3 columns. Trauma to the lumbar spine may result in injury limited to the anterior, middle, or posterior column, or it may involve multiple spinal columns, resulting in gross instability.

Lumbar spine trauma. Lateral drawing of the 3 spinal columns of the thoracolumbar junction. The anterior column (black dotted line) includes the anterior spinal ligament, the anterior annulus fibrosis, the intervertebral disc, and the anterior two thirds of the vertebral bodies. The middle column (red dotted line) includes the posterior aspect of the vertebral bodies, the posterior annulus fibrosis, and the posterior longitudinal ligament. The posterior column (thick blue dotted line) includes all of the spine posterior to the longitudinal ligament (thick blue dotted line).

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Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Axial CT image demonstrates a compression fracture of the upper lumbar spine. Note the comminuted fracture pattern.

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Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Sagittal reformatted CT image demonstrates fracture of the anterior L1 vertebral body with a posterior fragment displaced into the spinal canal (black arrow). The fracture extended into the spinous process (yellow arrow). A second fracture in the L3 vertebral body is noted in the posterior aspect of the inferior endplate of the L3 (white arrow).

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Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Sagittal reformatted CT image demonstrates fracture of the anterior L1 vertebral body with a posterior fragment displaced into the spinal canal (black arrow). The fracture extended into the spinous process (yellow arrow). A second fracture in the L3 vertebral body is noted in the posterior aspect of the inferior endplate of the L3 (white arrow).

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Lumbar spine trauma. Drawing of the mechanism of injury of the lumbar spine burst injury is compared with an axial CT image. The centrally applied vertical force results in radial expansion of the vertebral body endplate. The posterior margin of the endplate may be displaced into the spinal canal (arrow).

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Lumbar spine trauma. Coronal view of a multiplanar reformatted image of the lumbar spine. Spinal compression fractures are identified at the L2 and L5 levels. The vertical forces (yellow arrows) have resulted in posterior displacement of a bone fragment into the spinal canal at the L2 vertebral body. As a result of a single traumatic event, compression fractures of the L2 and L5 have occurred. The coronal multiplanar reformatted image demonstrates more completely the vertical nature of the fracture patterns of the L2 and L5 (yellow arrows).

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Lumbar spine trauma. Axial CT (right) and axial MRI (left) images of an upper lumbar spine burst injury. While the CT image presents better detail concerning the bone injury, the MRI image fully illustrates the position of the conus.

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Lumbar spine trauma. Sagittal T1-weighted MRI of the lumbar spine demonstrates a severe degree of compression of the L1 vertebral body (arrow). More than 60% of the vertical height of the L1 has been lost due to a compression failure of the L1 body.

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Lumbar spine trauma. Two contiguous sagittal T2-weighted MRIs of the lumbar spine demonstrate a compression fracture of the L1 vertebral body. The anterior aspect of the L1 is compressed more than 60%. The posterior margin of the fracture encroaches into the spinal canal at the L1 level.

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Lumbar spine trauma. Two contiguous sagittal T2-weighted MRIs of the lumbar spine demonstrate a compression fracture of the L1 vertebral body. The anterior aspect of the L1 is compressed more than 60%. The posterior margin of the fracture encroaches into the spinal canal at the L1 level.

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Lumbar spine trauma. Sagittal T1-weighted MRI of the lumbar spine. A 40-year-old man without any preceding event presented with sudden severe low back pain after lifting at work. He underwent chiropractic manipulation without relief of pain. The pain radiated into his right thigh. Lumbar spine findings were abnormal, and additional studies were performed.

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Lumbar spine trauma. Axial CT images of an L2 compression burst fracture after posterior fusion with pedicle screws (yellow arrow) joined by a posterior bar (white arrow). The pedicle screws should be entirely within the bone of the body and pedicle of the vertebral bodies.

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Lumbar spine trauma. Lateral view of the lumbar spine demonstrates a compression fracture (arrow). Because the patient's pain was of recent onset, the fracture was considered to be acute. The loss of vertebral body height is less than 50%. The patient was considered to be a good candidate for treatment with vertebroplasty.

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MRI of a 31-year-old man with tuberculosis of the spine. Images show the thoracic spine before and after an infusion of intravenous gadolinium contrast. The abscess and subsequent destruction of the T11-T12 disc interspace is marked with arrowheads. Vertebral body alignment is normal. Courtesy of Mark C. Diamond, MD, and J. Antonio Bouffard, MD, Detroit, Mich.

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grading of vertebral wedge fracture

1) A line ① is drawn along the top of the vertebral body of the lower spinal segment.
2) Then at the top-back most portion of the lower vertebral body, draw line ② at 90 degrees to line ①, till it projects well into the body of the vertebra above.
3) Then draw another line ③ parallel to the line just drawn ② this time at the posterior most lower portion of the upper vertebral body.
4) The distance between the upright lines ② and ③ is measured. Any distance of 2mm or greater is a retrolisthesis. This measurement represents the degree of translation (slippage) of the upper of the two segments. See Photo.

http:// headbacktohealth.com/Retrolisthesis.html