Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1:
a central core consisting of necrotic inflammatory cells and local tissue
peripheral halo of viable neutrophils
surrounded by a 'capsule' with dilated blood vessel...
Anterior vertebral body beaking occurs in a number of conditions and may eminate from the central portion or the lower third of the vertebral body.
Morquio syndrome 1 (middle for Morquio)
Hurler syndrome 2
The atlantodental interval (ADI), as the name suggests, is the horizontal distance between the anterior arch of the atlas and the dens of the axis, used in the diagnosis of atlanto-occipital dissociation injuries and injuries of the atlas and axis.
It is the distance (in mm) between the posteri...
Basilar invagination, also called basilar impression, is a congenital or acquired craniocervical junction abnormality where the tip of the odontoid process projects above the foramen magnum.
The terms basilar invagination and basilar impression are often used interchangeably becau...
The basion-axial interval (BAI), as the name suggests, is the horizontal distance between the basion and the posterior cortex of the axis, used in the diagnosis of atlanto-occipital dissociation injuries.
It is the distance (in mm) between the basion and the superior extension of the posterior ...
The basion-dens interval (BDI), as the name suggests, is the distance between the basion and the tip of the dens, used in the diagnosis of atlanto-occipital dissociation injuries.
It is the distance from the most inferior portion of the basion to the closest point of the superior aspect of the ...
Bone within a bone is a descriptive term applied to bones that appear to have another bone within them. There are numerous causes including:
thoracic and lumbar vertebrae (neonates and infants)
growth recovery lines (after infancy)
cortical splitting and new periostitis
sickle cell d...
Boogards angle is measured by drawing a line from basion to opisthion and another line along the plane of the clivus to the basion intersecting the first line - the angle between these two lines is measured .
The normal angle is 126+/- 6°. If the angle measures more than 136° it is indicative o...
Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.
The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and...
Chalk stick or carrot stick fractures are fractures of a fused spine, classically seen in ankylosing spondylitis.
Some authors define the chalk stick fracture as a fracture through a Pagetoid long bone (see Paget disease).
They usually occur through the disco-vertebral ...
Chamberlain line is a line joining the back of hard palate with the opisthion on a lateral view of the craniocervical junction.
It helps to recognise basilar invagination which is said to be present if the tip of the dens is >3 mm above this line.
McGregor developed a modificatio...
Chance fractures, also referred as seatbelt fractures, are flexion-distraction type injuries of the spine that extend to involve all three spinal columns. These are unstable injuries and have a high association with intra-abdominal injuries.
They tend to occur from a flexi...
Coronal vertebral cleft refers to the presence of a radiolucent vertical defect on a lateral radiograph.
It is most often seen in premature male infants 1,3. As they can occur as part of normal variation (especially in the lower thoracic-upper lumbar spine of premature infants) ...
Craniovertebral junction (CVJ) anomalies can be congenital, developmental or due to malformation secondary to any acquired disease process. These anomalies can lead to cranial nerve compression, vertebral artery compression and obstructive hydrocephalus.
The cranio-vertebral junctio...
Diffuse T1 vertebral bone marrow signal loss has a number of causes. T1-weighted imaging without fat suppression is one of the most important sequences for distinguishing between normal and abnormal bone marrow. Given the homogeneity, this appearance can often be difficult to spot as abnormal. ...
A diffuse homogeneous bone marrow FDG uptake usually reflects hyperplastic bone marrow which can be seen in the following conditions:
granulocyte colony stimulating factor (G-CSF)
Dural ectasia refers to ballooning or widening of the dural sac which can result in posterior vertebral scalloping and is associated with herniation of nerve root sleeves.
Patients with dural ectasia may present with low back pain or radicular pain in the buttocks or legs...
Erosion of the odontoid peg can result from a number of pathological entities:
rheumatoid arthritis: classic 1-2
systemic lupus erythematosus
calcium pyrophosphate arthropathy (CPPD): relatively common
non-inflammatory arthropathy: osteoar...
Extension tear drop fracture typically occurs due to forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body. Extension teardrop fractures are stable in flexion, and unstable in extension as the anterior longitudinal ligament is disrupted. Extensio...
Facet dislocation refers to anterior displacement of one vertebral body on another. Without a fracture, the only way anterior displacement can occur is by dislocation of the facets.
Facet dislocation can occur to varying degrees:
The injury usua...
Flexion tear drop fractures are the most severe fracture of the cervical spine, often causing anterior cervical cord syndrome and quadriplegia.
It typically occurs from severe flexion and compression forces, most commonly at C5-6 (e.g. diving head first, motor vehicle coll...
Gibbus deformity is a short-segment structural thoracolumbar kyphosis resulting in sharp angulation.
There are a number of causes which can be divided into congenital and acquired.
cretinism (congenital hypothyroidism)
Haematomyelia refers to the presence of intramedullary haemorrhage or haematoma within the spinal cord. This is distinct from extramedullary haemorrhage, such as that seen in epidural haematomas.
Although this can occur in the setting of trauma, the term is generally used to signify non-traumat...
Hangman fracture, also known as traumatic spondylolisthesis of the axis, is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.
Post-traumatic neck pain after a high-velocity hyperextension injury is ...
Intervertebral disc calcification is seen with numerous conditions.
degenerative: relatively common and may occur in up to 6% in routine abdominal radiographs in adults
ochronosis: very dense central (nucleus pulposus) calcification associated with osteopaenia; begins ...
Intradural extramedullary neoplasms are located outside the spinal cord but within the dural sheath.
The most common presenting symptoms include weakness, back pain and radicular pain.
Schwannomas are the most common intradural extramedullary spinal lesions (...
Intramedullary spinal metastases are rare, occurring in ~1% of autopsied cancer patients, and are less common than leptomeningeal metastases.
Intramedullary lesions may result from:
growth along the Virchow-Robin spaces
direct extension from leptomeninges
Locked facet joint is a type of facet joint dislocation that results from jumping of the inferior articular process over the superior articular process of the vertebra below and becomes locked in the position.
It can be unilateral or bilateral.
The tip ...
Longitudinally extensive spinal cord lesions (LESCL), also known as longitudinally extensive transverse myelitis (LETM), represent extensive involvement of the spinal cord, with abnormal T2 signal traversing at least three vertebral body segments in length.
They are typi...
Loss of intervertebral disc space can be due to a variety of causes:
degenerative disc disease of the spine: most common cause
dialysis related spondyloarthropathy
crystal deposition diseases
McRae line is a radiographic line drawn on a lateral skull radiograph or midsagittal section of CT or MRI, joining the basion and opisthion.
Normal position of the tip of dens is 5mm below this line. If the tip of the dens migrates above this line it indicates the presence of basilar invaginati...
Meningoceles are protrusions of the meninges through a defect or weak point in the skull or spine, usually involving the soft tissues beneath the surface of the skin. They are typically categorized into congenital, iatrogenic (e.g. following a craniotomy, sinus surgery, or as a laminectomy compl...
The differential diagnosis for masses of the cauda equina region is often considered separately to the remainder of the spinal cord. It is often difficult to determine whether masses in this region are intramedullary or intradural-extramedullary.
Most common tumours
Osteoarthritis of the vertebral column, also known as spondylosis deformans, is common and usually merely referred to as spinal "degenerative change". Complications such as spinal stenosis are important to recognise.
The hallmark of osteoarthritis in the spine, as is the...
Parasyndesmophytes or floating syndesmophytes are, as the name suggests, paravertebral dystrophic soft tissue calcifications or heterotopic ossifications.
They are known to be seen in psoriatic arthritis and reactive arthritis 4.
Initially they begin at a dist...
Powers ratio is a measurement of the relationship of the foramen magnum to the atlas, used in the diagnosis of atlanto-occipital dissociation injuries.
The ratio, AB/CD, is measured as the ratio of the distance in the median (midsagittal) plane between the:
basion (A) and the posterior spinola...
The most common tumour of the spine is metastatic deposits. A number of both benign and malignant tumours may arise primarily from the spine.
giant cell tumour (GCT)
aneurysmal bone cyst (ABC)
eosinophilic granuloma (EG)
Pseudosubluxation of the cervical spine is the physiological anterior displacement of C2 on C3 in children. It is common in children <7 years, and less often present in older children. Less often it is seen at C3 on C4. It is more pronounced in flexion and is of clinical significance as it can b...
Radiation induced MRI signal changes in bone are the earliest detectable changes in bone. They increase with increase in the radiation dose.
1st week: decreased marrow cellularity with oedema and haemorrhage
2nd week: increased marrow cellularity due to influx from unirradiated area...
A retropulsed fragment is any vertebral fracture fragment that is displaced into the spinal canal, thereby potentially causing spinal cord injury.
They usually arise from the vertebral body with or without a portion of the pedicle, and are displaced posteriorly, hence the prefix 'retro'.
Scheuermann disease, also known as juvenile kyphosis, juvenile discogenic disease 11 or vertebral epiphysitis, is a common condition which results in kyphosis of the thoracic or thoracolumbar spine. The diagnosis is usually made on plain film.
occurs in ~5% (range 0.4-8%) of the g...
Scoliosis is defined as an abnormal lateral curvature of the spine. It is quite common in young individuals and is often idiopathic and asymptomatic. In some cases, however, it is the result of underlying structural or neurological abnormalities.
By definition, a scoliosis is any lateral spina...
Spinal cord compression is a surgical emergency, usually requiring prompt surgical decompression to prevent permanent neurological impairment.
There are numerous causes of cord compression. These can be divided according to the location of the compressing mass:
Spinal dysraphism is a broad term given to a group of anomalies where there are malformations in the dorsum of the embryo. Neural tube defects come under this group as well.
There is often abnormal fusion of the midline embryonic neural, vertebral and mesenchymal structures.
The differential diagnosis for a spinal epidural mass includes:
herniated nucleus pulposus
epidural arteriovenous malformation
Spinal fractures are usually the result of significant trauma to a normally formed skeleton, or the result of trauma to a weakened spinal column. Examples include:
Jefferson fracture: ring fracture of C1
hangman fracture: bilateral pedicle or pars fracture of C2
Spinal metastases is a vague term which can be variably taken to refer to metastatic disease to any of the following:
vertebral metastases (94%)
may have epidural extension
intradural extramedullary metastases (5%)
intramedually metastases (1%)
Each of these are discussed separately. Below...
Synovial cysts of the spine are cystic formations connected to the facet joint and containing synovial fluid lined by a cuboid or pseudostratified columnar epithelium. They may be result in lumbar radiculopathy in a significant number of cases.
They may be asymptomatic an...
Spinal vascular malformations (SVM) are rare but knowledge of them is important as if undiagnosed and untreated they can lead to serious complications.
There are two main types of SVMs 1,2:
spinal arteriovenous fistula (AVF): 70% of SVMs
pial: small, large, or giant
dural AVF (DA...
Subluxed facet joint is the mildest form of facet dislocation in which the ligamentous injury leads to partial uncovering of facet joint (c.f. complete uncovering in perched facet). This results in mild anterior displacement of one vertebral body on another (anterolisthesis).
Syndesmophytes are calcifications or heterotopic ossifications inside a spinal ligament or of the annulus fibrosus. They are seen in only a limited number of conditions including:
Appearance on plain radiographs comprises v...
Torticollis (wryneck) is a clinical finding of head tilt with or without rotational spinal malalignment. It is not a diagnosis in itself and there are a wide range of underlying conditions. It is most common in the paediatric age group.
Torticollis can be acute (<1 week) or chronic ...
Traumatic spinal cord injury (SCI) can manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures. It can result from minor injury if the spine is weakened from disease such as ankylosing spondylitis or if there is pre-existing spinal ...
Unilateral facet dislocation is a relatively stable type of facet dislocation.
Flexion/distraction associated with rotation. The inferior articular facet of vertebral above moves over the superior facet of the vertebral below and becomes locked. It usually affects C4-C5 or...
Vertebra plana or pancake vertebra is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced crush fracture. It can occur with a variety of settings, including:
Langerhans cell histiocytosis (LCH)
The differential diagnosis for a vertebral body mass is broad and may range from a completely benign, sclerotic enostosis (bone island) to a malignant primary bone tumour.
Broadly, these lesions can be separated into:
primary bone tumours
Vertebral scalloping is a concavity to the posterior (or less commonly anterior) aspect of the vertebral body when viewed in a lateral projection. A small amount of concavity is normal, as is concavity of the anterior vertebral body (see vertebral body squaring).
The (absent) pedicle sign, also called the winking owl sign, occurs on plain film when a pedicle is absent.
The term, winking owl sign, where the missing pedicle corresponds to the closed eye, the contralateral pedicle to the other open eye, and the spinous process to the beak of the animal on ...