Showing posts with label vertebral lesions. Show all posts
Showing posts with label vertebral lesions. Show all posts
Friday, June 11, 2010
Thursday, June 10, 2010
vertebral osteomyelitis
Figure 1a: 65-year-old man with vertebral osteomyelitis due to Mycobacterium avium-intracellulare. Sagittal T1-weighted image shows hypointense lesion from L4 to L5, extending to the prevertabral region (arrows).
Figure 1b: 65-year-old man with vertebral osteomyelitis due to Mycobacterium avium-intracellulare. Sagittal T2-weighted image obtained at the same level as A shows very hyperintense areas in the extended region and in the L4-5 intervertebral disc. (arrows).
Figure 1c: 65-year-old man with vertebral osteomyelitis due to Mycobacterium avium-intracellulare. Sagittal T1-weighted image obtained after gadolinium injection at the same level as A shows Rim-like enhancement in the lesion (arrows).
Figure 1d: 65-year-old man with vertebral osteomyelitis due to Mycobacterium avium-intracellulare. Axial T1-weighted image obtained after gadolinium injection at the level of L4-5 shows Rim-like enhancement (arrows). http://www.google.com.eg/imgres?imgurl=http://www.ispub.com/ispub/ijra/volume_5_number_1_35/spinal_osteomyelitis_due_to_mycobacterium_avium_intracellulare_mr_findings/mr-fig1a.jpg&imgrefurl=http://www.ispub.com/journal/the_internet_journal_of_radiology/volume_5_number_1_35/article_printable/spinal_osteomyelitis_due_to_mycobacterium_avium_intracellulare_mr_findings.html&usg=__hY1KRxYmHDUvaR5cpFp0YaPN6ow=&h=708&w=356&sz=39&hl=en&start=1&sig2=SZXF1AKu5xi-IlsCKlZHUA&itbs=1&tbnid=7w3LCfOoM6nlBM:&tbnh=140&tbnw=70&prev=/images%3Fq%3Dvertebral%2Bosteomyelitis%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1&ei=PLIQTNOXN9WK_Abs06WtBA
-Osteomyelitis most often occurs as a result of trauma producing open wounds that allows the entry of bacteria into the body, as a result of surgical procedures, or as a result of bacteria circulating in the bloodstream—a condition known as bacteremia. Osteomyelitis of joints can affect their function by means of bone destruction and joint deformity.
http://www.jamesdisabilitylaw.com/back-injuries.htm
http://www.jamesdisabilitylaw.com/back-injuries.htm
kyphosis
T2 weighted sagittal MRI image demonstrating kyphosis of the lower thoracic spine.
Kyphosis is an abnormal degree of curvature of the thoracic spine (upper back) in the forward direction (flexion). Kyphosis may be congenital or may occur in post-menopausal osteoporosis with collapse of the anterior (front) part of vertebral bodies in the upper back.
In kyphosis, forward curvature of the spine up to 20 degrees is considered normal, and mild up to 40 degrees. Bracing is prescribed for angles over 40 degrees and balance can be impaired by kyphotic curves greater than 40 degrees. Curves of 50 degrees or greater can produce a significant restrictive breathing deficit and should have vital capacity tested with spirometry. As with scoliosis, extremely abnormal curves of 100 - 110 degrees or more can compromise cardiac function.
http://www.jamesdisabilitylaw.com/back-injuries.htm
In kyphosis, forward curvature of the spine up to 20 degrees is considered normal, and mild up to 40 degrees. Bracing is prescribed for angles over 40 degrees and balance can be impaired by kyphotic curves greater than 40 degrees. Curves of 50 degrees or greater can produce a significant restrictive breathing deficit and should have vital capacity tested with spirometry. As with scoliosis, extremely abnormal curves of 100 - 110 degrees or more can compromise cardiac function.
http://www.jamesdisabilitylaw.com/back-injuries.htm
scoliosis
http://www.google.com.eg/imgres?imgurl=http://www.hoei.com/caden/blog/pics/MRI2.jpg&imgrefurl=http://www.hoei.com/caden/blog/2009/02/01/mri-results.htm&usg=__Ae_AsGimDP-JBeQBBciSJF47_NA=&h=605&w=605&sz=57&hl=en&start=2&sig2=XGEEt4DzAkPbREGSIErMpg&um=1&itbs=1&tbnid=UoB1tcKhXJy4CM:&tbnh=135&tbnw=135&prev=/images%3Fq%3Dscoliosis,mri%26um%3D1%26hl%3Den%26sa%3DG%26rlz%3D1T4RNTN_enEG364EG364%26tbs%3Disch:1&ei=orYQTKPSLYyf_QbR7cjJBA
http://scoliosisworld.ning.com/profiles/profile/show?id=AndyMcCall-Scoliosis is a sideways curvature to the spine (see Figure 9 below), associated with pain but not neurological impairment.
-Scoliosis should be suspected with leg length discrepancies of 2.2 cm or greater.
-The abnormal spinal curve of scoliosis is measured on plain X-rays. The measurement is called a Cobb angle. Scoliosis may be considered present with abnormal curves greater than 10 degrees. Mild cases have angles less than 30 degrees.
-Angles of 20 degrees or less are usually produce no symptoms. Bracing is prescribed for angles over 20 degrees. Curves over 40 degrees may produce neurological abnormalities such as sensory loss and weakness. Small curves of less than 30 degrees in childhood are not likely to get worse during adulthood, while more severe curves may continue to progress. Surgery with permanent rod implantation and fusion is indicated with curves greater than 45 degrees.
-Claimants with curves 60 degrees or more require spirometry for restrictive lung disease (decreased vital capacity).
-Heart failure may occur from scoliosis when abnormal curves are markedly severe at 100 degrees or more.
-Scoliosis should be suspected with leg length discrepancies of 2.2 cm or greater.
-The abnormal spinal curve of scoliosis is measured on plain X-rays. The measurement is called a Cobb angle. Scoliosis may be considered present with abnormal curves greater than 10 degrees. Mild cases have angles less than 30 degrees.
-Angles of 20 degrees or less are usually produce no symptoms. Bracing is prescribed for angles over 20 degrees. Curves over 40 degrees may produce neurological abnormalities such as sensory loss and weakness. Small curves of less than 30 degrees in childhood are not likely to get worse during adulthood, while more severe curves may continue to progress. Surgery with permanent rod implantation and fusion is indicated with curves greater than 45 degrees.
-Claimants with curves 60 degrees or more require spirometry for restrictive lung disease (decreased vital capacity).
-Heart failure may occur from scoliosis when abnormal curves are markedly severe at 100 degrees or more.
spinal stenosis
Spinal stenosis is a narrowing of the space inside the bony spine (see Figure 7 below), which sometimes results in pressure on the spinal cord and peripheral nerve roots from the spinal cord. The Social Security Administration most commonly sees such cases in claimants who have severe osteoarthritis of the lower spine. Spinal stenosis can be worsened by bulging or herniated disks (HNPs) (see Figure 8 below) and spondylolisthesis.
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Figure 7: Spinal stenosis with a narrowing of the spinal canal.
Figure 8: Spinal stenosis caused by a herniated disk and osteoarthritis.
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Figure 7: Spinal stenosis with a narrowing of the spinal canal.
Figure 8: Spinal stenosis caused by a herniated disk and osteoarthritis.-Spinal stenosis most commonly involves the lower back, specifically the area somewhere between the 3rd lumbar vertebra and the beginning of the sacrum (L3-4, L4-5, and L5-S1 levels). Less frequently, the neck (cervical spine) may be involved with spinal stenosis; its presence in the upper back (thoracic spine) is rare.
-Spinal stenosis is one of many possible causes of damage to the spinal cord (myelopathy). Myelopathy may be irreversible. Surgical decompression of the spinal cord may be necessary for severe cases, but even after surgery symptoms may not improve.
-In addition to osteoarthritis, causes of spinal stenosis include congenital spinal deformities (scoliosis, kyphosis, or congenital skeletal dysplasias like achondroplastic dwarfism); acquired deformities such as post-traumatic spinal fractures; inflammatory spinal diseases like ankylosing spondylitis; or stenosis may be of unknown cause. Tumors or infection present possible reversible causes of lumbar stenosis.
-Spinal stenosis can be seen on imaging studies such as myelography, CT, and MRI scans. But myelography and CT scans can miss some types of stenosis.
spondylolisthesis
Spondylolisthesis is a slippage of vertebral bodies out of their normal position, usually a forward slippage of the 5th lumbar vertebra over the 1st sacral vertebra (L5-S1). More rarely, a type of spondylolisthesis called retrolisthesis involving the backward displacement of a vertebral body occurs. Most spondylolisthesis is seen in the lumbar spine (L1-L5/S1). This disorder can been seen on plain X-rays. It is significantly more likely to be seen on X-rays taken in the standing position than in those taken in lying position—with weight on the spine, slippage is more likely.
However, severe or even significant neurological abnormalities (sensory changes, reflex changes, muscle weakness or atrophy) are not to be expected in spondylolisthesis
Studies have shown that most individuals with spondylolisthesis, lead active lives with little, if any, adjustment for having this type of spinal abnormality. Spondylolisthesis is most likely to become limiting as a contributing factor for spinal stenosis in combination with other spinal disorders, such as severe osteoarthritis and severely bulging intervertebral discs.
http://www.jamesdisabilitylaw.com/back-injuries.htm#Degenerative_Disc_Disease_(DDD)
However, severe or even significant neurological abnormalities (sensory changes, reflex changes, muscle weakness or atrophy) are not to be expected in spondylolisthesis
Studies have shown that most individuals with spondylolisthesis, lead active lives with little, if any, adjustment for having this type of spinal abnormality. Spondylolisthesis is most likely to become limiting as a contributing factor for spinal stenosis in combination with other spinal disorders, such as severe osteoarthritis and severely bulging intervertebral discs.
http://www.jamesdisabilitylaw.com/back-injuries.htm#Degenerative_Disc_Disease_(DDD)
Lumbar strain refers to stress on the ligaments, muscles, and other soft tissues near the spine with resultant pain. There may or may not be underlying arthritis or DDD. Acute strain, associated with a particular lifting event, will almost always resolve in several months. If the pain is marked, there is associated muscle spasm and difficulty bending the back. When back pain continues for a prolonged period, orthopedists and other doctors tend to apply the diagnosis of “chronic lumbar strain,” if there is no other underlying identifiable abnormality that can be seen on imaging studies.
MRI is the study of choice for the diagnostic evaluation of arachnoiditis. T1-weighted MRIs may reveal an indistinct or absent cord outline due to the increase in the signal intensity of the surrounding CSF. T2-weighted MRIs may demonstrate CSF loculation and obliteration of the subarachnoid space or irregularly thickened, clumped nerve roots, which occasionally may be misinterpreted as a tethered cord or a thickened filum terminale. With more severe arachnoiditis, progression of nerve root clumping and leptomeningeal adhesions may lead to angular defects in the dural sac. Peripheral adherence of the nerve roots to the walls of the thecal sac produces the so-called featureless, or empty, sac.
Arachnoiditis is inflammation of some part of the arachnoid membrane that covers the spinal cord. It can produce severe chronic pain. Arachnoiditis may occur as a result of infection, but most commonly is seen after surgical procedures and use of contrast material to enhance visualization of structures with X-rays during myelography. Some people are more sensitive than others to contrast material. An MRI scan has about a 90% chance of showing this abnormality if it is present. A negative MRI scan for arachnoiditis is a strong argument that it is not present.
The most serious tumors of the spine arise from cancer that has spread to the spine from breast, colon, prostate, or other origin. Tumors can not only cause chronic pain, but result in spinal fractures as they destroy bone. The spread of cancer of any kind to the spine is a serious development that must also be considered under the listings dealing with cancer.
Wedge fractures are the most common fractures and occur most frequently at the midthoracic and thoracolumbar regions in both men and women. Crush fractures also have a higher tendency to occur in the midthoracic and thoracolumbar regions. Unlike other types of fractures, biconcave fractures are equally as likely to occur in lower lumbar vertebrae as at other spinal locations.http://www.google.com.eg/imgres?imgurl=http://www.osseon.com/media/images/Vertebral-Fracture-Variations3.0.jpg&imgrefurl=http://www.osseon.com/patient-education/vertebral-compression-fractures/&usg=__VBKQEcYm5Z0voYuy75MmsbPgzxg=&h=233&w=429&sz=26&hl=en&start=13&sig2=nffz1kCLgXT2wEnyjvwuhA&um=1&itbs=1&tbnid=S-Wzj-yIQ5BWcM:&tbnh=68&tbnw=126&prev=/images%3Fq%3Dvertebral%2Bfracture%26um%3D1%26hl%3Den%26sa%3DG%26rlz%3D1T4RNTN_enEG364EG364%26tbs%3Disch:1&ei=-ioQTIr0CY6g4Qai6tTtDA
figure:Lumbar spine radiograph (two projections): A compressed fracture can be seen in the the second lumbal vertebra (arrows), which is anteriorly narrowed in a wedge shape. Corresponding to the fractured lumbal vertebra, a gibbus can be observed.http://www.google.com.eg/imgres?imgurl=http://www.szote.u-szeged.hu/radio/trauma2/traum1c.gif&imgrefurl=http://www.szote.u-szeged.hu/radio/trauma2/a2trau1c.htm&usg=__HUujda7IJMPb9Eqv7ZDE3cSnoEY=&h=400&w=368&sz=77&hl=en&start=3&sig2=Xz4lK1numwMuX2-y1Srt9Q&um=1&itbs=1&tbnid=bZ-F0zykprtzUM:&tbnh=124&tbnw=114&prev=/images%3Fq%3Dvertebral%2Bfracture%26um%3D1%26hl%3Den%26sa%3DG%26rlz%3D1T4RNTN_enEG364EG364%26tbs%3Disch:1&ei=CSoQTPOPOdCI4QbF0tH_DA
Fractures of the bony spine are most commonly related to automobile or motorcycle accidents. There may be associated spinal cord injury. Traumatically fractured vertebrae are treated with a combination of surgical fusion and sometimes stabilization with metal rods.
figure:showed osteoporosis vertebral compression fracturehttp://www.google.com.eg/imgres?imgurl=http://www.pharmaweblog.com/wp-content/uploads/2008/09/vertebral-fracture.jpg&imgrefurl=http://www.pharmaweblog.com/%3Fattachment_id%3D518&usg=__UtM9aBSMFgnd1wCzjaxdAU18k_k=&h=925&w=617&sz=43&hl=en&start=3&sig2=WLsfYQXD4h75WvH2xXZrgA&um=1&itbs=1&tbnid=812x2OKpqU8IYM:&tbnh=147&tbnw=98&prev=/images%3Fq%3Dvertebral%2Bosteoporosis%26um%3D1%26hl%3Den%26sa%3DN%26rlz%3D1T4RNTN_enEG364EG364%26tbs%3Disch:1&ei=dicQTMO4MemP4gaDioT0DA
Osteoporosis
Osteoporosis is a metabolic disorder associated with decrease in the mass of bone. By far, most of the instances of osteoporosis seen by the Social Security Administration are in post-menopausal women. Osteoporosis may be confined to the spine, but other bones may be involved in those who have used corticosteroids. A collapse of vertebral bodies, especially in the upper back, is known as a compression fracture. Compression fractures are visible on plain X-ray or other imaging studies. If the fracture involves the anterior (front) part of a vertebral body more than the rest of the vertebra, the spine will tend to curve forward and result in the popularly known dowager’s hump.
Compression fractures are graded in regard to the percent of the vertebra that is compressed, compared to the normal height of the vertebra. Normal height is judged from adjacent vertebrae. Pain, loss of motion, and muscle spasm are most likely to be present at the time of fracture and in the healing period. Marked or multiple compression fractures are more likely to produce chronic pain.
Plain X-rays are much less sensitive than bone densitometry in determining the severity of osteoporosis. A normal appearance of bone on plain X-rays only rules out the most advanced osteoporosis. Plain X-rays are fine for determining the percentage of vertebral body collapse in compression fractures.
http://www.jamesdisabilitylaw.com/back-injuries.htm#Degenerative_Disc_Disease_(DDD)
Osteoporosis is a metabolic disorder associated with decrease in the mass of bone. By far, most of the instances of osteoporosis seen by the Social Security Administration are in post-menopausal women. Osteoporosis may be confined to the spine, but other bones may be involved in those who have used corticosteroids. A collapse of vertebral bodies, especially in the upper back, is known as a compression fracture. Compression fractures are visible on plain X-ray or other imaging studies. If the fracture involves the anterior (front) part of a vertebral body more than the rest of the vertebra, the spine will tend to curve forward and result in the popularly known dowager’s hump.
Compression fractures are graded in regard to the percent of the vertebra that is compressed, compared to the normal height of the vertebra. Normal height is judged from adjacent vertebrae. Pain, loss of motion, and muscle spasm are most likely to be present at the time of fracture and in the healing period. Marked or multiple compression fractures are more likely to produce chronic pain.
Plain X-rays are much less sensitive than bone densitometry in determining the severity of osteoporosis. A normal appearance of bone on plain X-rays only rules out the most advanced osteoporosis. Plain X-rays are fine for determining the percentage of vertebral body collapse in compression fractures.
http://www.jamesdisabilitylaw.com/back-injuries.htm#Degenerative_Disc_Disease_(DDD)
A herniated nucleus pulposus is the protrusion of the hard, cartilaginous center (nucleus) of an intervertebral disk through the outer fibrous tissue (annulus fibrosa) (see Figures 5 and 6 below). Many small HNPs will produce acute symptoms that improve with time. Injection of corticosteroid drugs in the area of the HNP can also help relieve inflammation and pain. Some claimants have a large HNP that presses on a spinal nerve root, and must have part of the HNP removed (discectomy, diskectomy).
figure 5
figure 6
figure 5
figure 6
Degenerative disc disease refers to dehydration and shrinkage of the intervertebral discs that cushion the vertebral bodies of the spine. DDD is common and causes no symptoms in many older individuals. Everyone over about the age of 50 has some degree of DDD, which may or may not be symptomatic and functionally limiting. Osteoarthritis of the spine is frequently accompanied by DDD, while DDD without associated OA is also common. DDD can be seen on X-rays, MRI, and CT scans of the spine. It appears as narrowing of the space between vertebral bodies. Symptomatic DDD occurs between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1).
Sometimes a combination of OA and DDD produces enough symptoms that surgical fusion is performed in the lumbar spine (lumbar fusion) or cervical spine (neck). This procedure is done in an attempt to stabilize the spine and decrease pain. The surgery requires taking strips of bone from the posterior (back) upper part of the pelvic bone and laying them over the vertebral bodies that need to be stabilized (see Figure 4 below). Bone is living tissue and will incorporate the vertebral bodies into one solid mass. Sometimes, the bone strips do not incorporate well and the surgical fusion partially or wholly fails. Some fusions involve only two vertebrae, but multiple vertebrae may also be fused.
http://www.google.com.eg/imgres?imgurl=http://wiki.cns.org/wiki/images/0/03/Degenerative_disc_disease.jpg&imgrefurl=http://wiki.cns.org/wiki/index.php/Degenerative_Disc_Disease&usg=__fc681vAyEjRSyV3xOL2_RWtQVJA=&h=384&w=250&sz=23&hl=en&start=2&sig2=eNZJ3d6V4k_7UAPLw7BM4Q&itbs=1&tbnid=nCqP2wdJCQgcsM:&tbnh=123&tbnw=80&prev=/images%3Fq%3Ddegenerative%2Bdisc%2Bdisease%26hl%3Den%26gbv%3D2%26tbs%3Disch:1&ei=xB8QTJPAGYuu4QbgjLnzDA
Sometimes a combination of OA and DDD produces enough symptoms that surgical fusion is performed in the lumbar spine (lumbar fusion) or cervical spine (neck). This procedure is done in an attempt to stabilize the spine and decrease pain. The surgery requires taking strips of bone from the posterior (back) upper part of the pelvic bone and laying them over the vertebral bodies that need to be stabilized (see Figure 4 below). Bone is living tissue and will incorporate the vertebral bodies into one solid mass. Sometimes, the bone strips do not incorporate well and the surgical fusion partially or wholly fails. Some fusions involve only two vertebrae, but multiple vertebrae may also be fused.
figure 4
http://www.jamesdisabilitylaw.com/back-injuries.htm#Degenerative_Disc_Disease_(DDD)
http://www.google.com.eg/imgres?imgurl=http://wiki.cns.org/wiki/images/0/03/Degenerative_disc_disease.jpg&imgrefurl=http://wiki.cns.org/wiki/index.php/Degenerative_Disc_Disease&usg=__fc681vAyEjRSyV3xOL2_RWtQVJA=&h=384&w=250&sz=23&hl=en&start=2&sig2=eNZJ3d6V4k_7UAPLw7BM4Q&itbs=1&tbnid=nCqP2wdJCQgcsM:&tbnh=123&tbnw=80&prev=/images%3Fq%3Ddegenerative%2Bdisc%2Bdisease%26hl%3Den%26gbv%3D2%26tbs%3Disch:1&ei=xB8QTJPAGYuu4QbgjLnzDA
http://www.google.com.eg/imgres?imgurl=http://boneandspine.com/wp-content/uploads/2009/08/lumbar-spondylosis-straightening-spine.JPG&imgrefurl=http://boneandspine.com/category/spine/back-pain-spine/&usg=__p2jiMTUwCXEi9IPhFpdnWDAT_vA=&h=406&w=528&sz=40&hl=en&start=10&sig2=vZk0bOotdF0nyfEplIx1Fg&itbs=1&tbnid=hoEUEnG1VYm3rM:&tbnh=102&tbnw=132&prev=/images%3Fq%3Dspondylotic%2Bspinal%2Bchanges%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1&ei=IhwQTKz8C-WL4ga10tD4DASome degree of osteoarthritis of the spine is common in middle-aged people, even if they are not aware of it. OA of the spine can take several forms. In ankylosis, parts of the spine are abnormally fused together as a result of bony overgrowth. For example, bony spurs can fuse vertebral bodies together. The peripheral nerves formed from the spinal cord exit the bony spine through recesses in vertebrae called intervertebral foramina (see Figure 2 below). Some of these foramina can become encroached by osteoarthritis and require surgical decompression. Vertebrae have contact points with other vertebra called facet joints (see Figure 3 below). Arthritis affecting these facet joints can be painful and limit the motion of the spine.
Sunday, May 16, 2010
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