Spinal Pathology

Objective: You will learn

• Common conditions presenting as back pain that need imaging investigation.
• Optimal imaging procedures.
• Imaging findings of spinal-intraspinal lesions.
• Systematic evaluation of imaging studies.

What are the common conditions presenting as back pain?

• Vertebral body pathology (metastasis, fracture, osteoporosis)
• Disc disease (herniation)
• Spinal cord tumor
• Retroperitoneal structures when diseased (abdominal aortic aneurysm (AAA), renal pathology, retroperitoneal lymphadenopathy)

What are the available imaging procedures for lower backache? What is the utility of each of these procedures?

CT or MRI is typically ordered for patients with severe or prolonged pain, focal neurologic deficits or history of cancer or febrile illness.

• MRI and CT scans are commonly used to identify an abnormality of the disc or vertebral body pathology.
  • MRI is more accurate and allows visualization of vertebral body pathology, spinal cord and nerve roots.
• X-rays are widely available to rule out gross fractures or spinal instability.
• Radio nuclide bone scanning is the preferred method for evaluating the entire skeleton for the presence of multiple metastatic lesions.
• A DEXA test measures bone mineral density and compares it to that of an established norm or standard to give you a score.