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Posted by on Wednesday, September 8, 2010, 0:38
This news item was posted in Back, D, Pain, Spinal category and has 1 Comment so far.

Degenerative spine disease is a major cause of chronic disability in the adult working population and a common reason for referral to an MR imaging center. Spinal degeneration is a normal part of aging, and neck and back pain are one of life’s most common infirmities. There are many potential sources of pain, and finding the specific cause is often a confounding problem for both patient and doctor. Pain can originate from bone, joints, ligaments, muscles, nerves and intervertebral disks, as well as other paravertebral tissues.

The landmark article by Mixter and Barr in 1934   on the ruptured intervertebral disk provided an anatomic basis for selected cases of back pain and neurologic dysfunction. Most neck and back pain responds to conservative therapy, but if the pain is unrelenting, severe, or associated with a radiculopathy or myelopathy, imaging is indicated to look for a treatable cause.


In the evaluation of degenerative spine disease, multiple anatomic sites need to be imaged, including the intervertebral disk, spinal canal, spinal cord, nerve roots, neuroforamina, facet joints, and the soft tissues within and surrounding the spine. Many pulse sequences are available, and specific protocols vary among different MR sites. There



is general agreement that the spine needs to be imaged in at least two planes, and surface coils are used almost exclusively. In the cervical and thoracic regions a T2-weighted sequence is mandatory to assess damage to the spinal cord. Thin sections are required to visualize the neuroforamina, and pulse sequences must be tailored to counteract CSF flow and physiologic motion. The imaging requirements for the lumbar spine are less strenuous because the anatomical parts are larger. Most protocols include a T1-weighted sequence and some type of T2-weighted sequence to give a myelographic effect.   Fast spin-echo (FSE) techniques allow enormous time savings, and if available, they have replaced conventional spin-echo for T2-weighted imaging of the spine. Three-dimensional gradient-echo (GRE) methods can achieve slice thicknesses less than one millimeter, an advantage for displaying cervical neuroforamina.
In the postoperative spine, gadolinium injection with T1-weighted imaging is essential to evaluate enhancing lesions. Fat-suppression is helpful to eliminate competing fat signal from bone marrow and other soft tissues

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