ANATOMY OF THE SPINE

Reported By

MARIA THERESA M. NAVARRO, M.D.

OVERVIEW
THREE MAJOR COMPONENTS

THE SPINAL COLUMN (bones and discs) NEURAL ELEMENTS (spinal cord and nerve roots) SUPPORTING STRUCTURES (muscles and ligaments)

VERTEBRAE
CORTICAL BONE

CANCELLOUS

Typ ic al VER TE BRA

1. VERTEBRAL BODY 2. SPINOUS PROCESS 3. TRANSVERSE FACET 4. PEDICLE 5. CENTRAL SPINAL CANAL 6. LAMINA 7. COSTOVERTEBRAL FACET

ATL AS AND AXI S

Cervical Spine X-ray

1 VERTEBRAL BODY 2 SPINOUS PROCESS 3 SUPERIOR ARTICULAR PROCESS 4 INFERIOR ARTICULAR PROCESS 5 PEDICLE 6 TRANSVERSE PROCESS

3 4

2 5 6

Cervical Spine (Lateral view)

VERTEBRAL BODY SPINOUS PROCESS FACET JOINT INTERVERTEBRAL DISC FORAMEN TRANSVERSARIUM SUPERIOR ARTICULAR FACET INFERIOR ARTICULAR FACET

THO RAC IC VER TE BRA

Thoracic Spine

Thoracic Spine Lateral View

Thoracic CT scan (axial view)

LUMBAR VER TEB RA

LUMBAR SPINE X RAY

LUMBAR SPINE (LATERAL VIEW)

SCOTTIE DOG
PEDICLE SUPERIOR ARTICULAR PROCESS INFERIOR ARTICULAR PROCESS FACET JOINT PARS INTERARTICULARIS TRANSVERSE PROCESS

SACRUM AND COCCYX

SPI NAL CU RVES

CERVICAL 20-40 degrees THORACIC 20-40 degrees LUMBAR 40-60 degrees SACRAL sacrum fused in a kyphotic curve

FUNCTIONS OF THE VERTEBRAL COLUMN

PROTECTION BASE FOR ATTACHMENT STRUCTURAL SUPPORT FLEXIBILITY AND MOBILITY OTHERS production of red blood cells mineral storage

INTERVERTEBRAL DISCS
THREE COMPONENTS
1. CARTILAGINOUS ENDPLATE - attaches firmly to the osseous endplate by means of numerous collagenous fibers (Sharpeys fibers) - strengthens the osseous endplate, which contains multiple perforations - within the pores of the vertebral endplate are numerous vascular channels (major source of nutrients) 2. ANNULUS FIBROSUS - complex fibrous and fibrocartilaginous structure that consists of 12 to 15 layers, each with well developed dense parallel fibrous bands. - composed of collagen and proteoglycans

INTERVERTEBRAL DISCS
THREE COMPONENTS
3. NUCLEUS PULPOSUS - composed of fibrocartilage - mucopolysaccharide gel gives the disc its high intrinsic pressure, which allows it to resist compressive forces. - contains realtively more proteoglycans giving it a looser gelatinous texture.

BASIC PRINCIPLES IN MRI IMAGING

T1 WI - water is black fat is white bone is black T2 WI water is white fat is white bone is black

color is referred to as increased or decreased signal or hypo or hyperintense

MRI IN FOR MAT ION

Spinal alignment Disc height and hydration Vertebral body configuration Evaluation of intervertebral disc Spinal canal size Nerves Abnormalities

T1 FAST SPIN ECHO OF THE LUMBAR SPINE

T2 FAST SPIN ECHO OF THE LUMBAR SPINE

DEGENERATIVE DISEASES
OF THE SPINE

DISC DISEASE

DISC DEGENERATION
DEGENERATION
CRACKS OR FISSURES IN THE INNER LAYERS OF THE ANNULUS FIBROSUS LOSS OF BOUND WATER MOLECULES DECREASED CAPACITY FOR SHOCK ABSORPTION

LOSS OF DISC HEIGHT

ALTERATIONS IN THE PROTEOGLYCAN MATRIX

DIMINISHED TURGOR AND ELASTICITY

GREATER FORCES TRANSMITTED INTO ADJACENT VERTEBRAL BODIES

OSTEOPHYTES SCLEROSIS

MRI OF DEGENERATIVE DISC DISEASE

decrease in disc space vertical height decrease signal intensity on T2 weighted images diffuse disc bulging may or may not be present

MARR OW CHA NG ES (I NTERV ERT EB RAL OS TEOC HON DROS IS)

alterations of the adjacent vertebral body architecture

Edema pattern (TYPE I)

decreased signal on T1WI increased signal on T2WI

Infiltration by fat (TYPE II)

increased signal on T1WI Isointense or slightly hyperintense signal on

T2WI

Degenerative discogenic sclerosis (TYPE III) dense bone devoid of marrow

decreased signal on T1WI decreased signal on T2WI

DISC HERNIATION

CHRONIC REPETITIVE STRESS OR ACUTE INJURY MAY RESULT IN MARGINAL DISPLACEMENTS OF DISC MATERIAL

DISC BULGE
CIRCUMFERENTIAL EXTENSION OF THE DISC MARGIN BEYOND THE VERTEBRAL BODY MARGINS

DISC HERNIATION
FOCAL DISPLACEMENT OF DISC MATERIAL (NUCLEUS PULPOSUS AN/OR ANNULUS) BEYOND THE MARGINS OF THE DISC SPACE A BULGING DISC THAT IS ECCENTRIC TO ONE SIDE BUT > 3 mm BEYOND VERTEBRAL MARGIN

DISC HERNIATION
DISC PROTRUSION
A DISC HERNIATION THAT EXTENDS BEYOND THE VERTEBRAL MARGINS BUT RETAINS A BASE AGAINST THE INTERVERTEBRAL DISC MARGIN THAT IS WIDER THAN THE MAXIMUM DIAMETER OF THE PROTRUDING DISC A BULGING DISC THAT IS ECCENTRIC TO ONE SIDE BUT < 3 mm BEYOND VERTEBRAL MARGIN

DISC EXTRUSION
FOCAL HERNIATION ASSOCIATED WITH EXTENSION OF THE NUCLEAR MATERIAL COMPLETELY THROUGH THE OUTER ANNULUS INTO THE EPIDURAL SPACE

DISC HERNIATION
DESSICATION
LOSS OF DISC WATER

FREE FRAGMENT
EPIDURAL FRAGMENT OF DISC NO LONGER ATTACHED TO THE PARENT DISC

DISC HERNIATION
LUMBAR SPINE 90% L4-L5 or L5-S1 the rest L3-L4 disc annulus most frequently falls posterolaterally where it is weakest (PARACENTRAL HERNIATION)

DISC HERNIATION
CERVICAL SPINE disc herniation and degeneration most common at C5-C6 and C6-C7.

SPONDYLOSIS OSTEOARTHRITIS SPINAL STENOSIS

SPONDYLOSIS DEFORMANS
Most COMMON degenerative process of the spine Osteophytes arise secondary to degenerative disc disease
When Sharpeys fibers are torn from their attachments along the vertebral body margins, stress is placed on bone as the disc moves and osteophytes form in reaction to stress

SPONDYLOSIS DEFORMANS
can take the form of marginal end plate osteophytes, enlarged uncinate processes, or facet arthrosis. Osteophytes are hypointense on all pulse sequences

OSTEOARTHRITIS
Degenerative arthritis involving synovial joints In the spine, affected is the apophyseal or facet joints
Spondylosis and osteoarthritis are terms used synonymously because often coexist

OSTEOARTHRITIS
not all back pain or sciatica is due to intervertebral disc disease
degeneration of the facet joint can cause facet arthrosis syndrome

Facet joint hypertrphy + osteophyte formation along the posterior lateral margins of the vertebral body can encroach upon the lateral recesses of the spinal canal and neural foramina.

SPINAL STENOSIS
REFERS TO BONY OR SOFT TISSUE NARROWING OF THE SPINAL CANAL OR NEURAL FORAMINA can compress neural structures within the spine and cause neurological symptoms can involve the spinal canal, the lateral recesses or the neuroforamina.

CAUSES
DEGENERATIVE DISEASE OF THE DISC SPACE AND FACET JOINTS SPONDYLISTHESIS TRAUMA PAGETS DISEASE POST SURGICAL COMPLICATION

LATERAL RECESS STENOSIS

MOST COMMON CAUSE is Hypertrophy of the superior articular processes of facet joints Disc protrusions Post operative scars

NEURAL FORAMINAL STENOSIS

MOST COMMON CAUSE is Degenerative hypertrophy of the uncinate process and posterior facet joints in the cervical spine Hypertrophic osteophytes from facet joints and bulging discs in the lumbar spine

SPONDYLOLISTHESIS
Displacement of a vertebra with respect to the subjacent vertebra DEGENERATIVE SPONDYLISTHESIS

Most common type Degenerative changes of both the facet joints and intervertebral disc. Most common in the lumbar spine

SPONDYLOLYSIS
Bilateral pars defect Most frequently seen in the neural arch of the 5th lumbar vertebra C6 is the most common cervical site of spondylolytic spondylolisthesis Seen in the oblique views LUCENCY ACROSS THE NECK OF THE SCOTTIE DOG

DISC HERNIATION

SPONDYLISTHESIS
Traumatic subluxation of the cervical spine in a 51-yearold man with quadriparesis following an automobile crash. Spin-density weighted MRIs show anterior subluxation of C4 (top arrow) on C5 (bottom arrow), associated with marked narrowing of the spinal canal and compression of the thecal sac and spinal cord. The hyperintensity of the disc and adjacent prevertebral and ventral epidural soft tissues likely represents a combination of edema and hemorrhage.

COLLAPSE L5 WITH SPINAL STENOSIS

DEGENERATIVE SPINAL STENOSIS

SPINAL STENOSIS DUE TO TUMOR

POSTEROLATERAL DISC HERNIATION

MULTILEVEL SPINAL STENOSIS

SEVERE LUMBAR SPINAL STENOSIS AND FACET DISEASE

LUMBAR SPINAL STENOSIS AND SYNOVIAL CYST

LATERAL RECESS STENOSIS