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Percutaneous Intradiskal Therapies

Abstract Percutaneous intradiskal therapies are currently used in the treatment of two distinct medical problems: chronic low back pain and the herniated nucleus pulposus–related radicular syndrome (sciatica). Both conditions lead to substantial medical and economic losses, with low back pain being the major cause of disability in the United States for patients less than 45 years of age. The prevalence of low back pain in the…

Vertebroplasty and Kyphoplasty

Abstract Vertebroplasty was first described by Herve Deramond and his colleagues from Amiens, France, in 1987. They were faced with a patient with an aggressive, destructive, but otherwise benign hemangioma of a C2 vertebral body. There seemed to be no surgical option, and they elected to perform an experimental procedure placing a needle via a transoral route and injecting methylmethacrylate under image-intensifier control. It became apparent…

Discography

Abstract Indications Discography is a diagnostic tool for the diagnosis of cervical, thoracic, or lumbar radicular or referral pain. Although the use of discography as the first-line diagnostic examination is not indicated, it is usually recommended when conservative treatment or noninvasive diagnostic tools fail to establish a reasonable outcome. It is reserved for suspicious abnormalities seen on other tests and when severe symptoms are propelling the…

Spinal Injections

Indications Epidural pain injections are useful in the patient with a wide variety of disorders that could generate back pain, including extruded and bulging disks; foraminal and lateral recess stenoses with nerve compression from facet osteoarthritis, capsular hypertrophy, synovial cyst formation, and scar production; spondylolysis with spondylolisthesis; and congenital and/or acquired central canal stenosis. In addition to these mechanical abnormalities, chemical irritation of the nerves can…

Tumor Ablation

Techniques Chemical Ablation with Sclerosing Agents Sclerosing agents act by diffusion into cells and cause immediate dehydration of cytoplasm with subsequent necrosis followed by fibrosis. By entering into the circulation, these agents induce necrosis of endothelial cells and platelet aggregation, causing thrombosis. Radiofrequency Ablation In radiofrequency ablation (RFA), an RF probe is positioned in the patient. The probe is usually monopolar, and large grounding pads are…

Percutaneous Biopsy of the Spine

Percutaneous biopsy of the spine is an effective, reliable, safe, and rapid procedure that can be easily performed in comparison with open biopsy. It may be performed at a lower cost than surgery. This procedure has become routine and is indicated in many cases. Indications Bone Metastases A suspicion of bone metastasis represents the principal indication for percutaneous biopsy of the spine. It is especially helpful…

Percutaneous Biopsy of the Appendicular Skeleton

Percutaneous biopsy of the appendicular skeletal lesion is a minimally invasive, safe, and inexpensive procedure compared with open biopsy. Therefore, this procedure is indicated in many cases. Indications Bone Metastases A suspicion of bone metastasis is the main indication for percutaneous biopsy of skeletal lesions. This procedure is particularly helpful in patients with no known primary bone tumor who present with multiple lesions consistent with metastases…

Biopsy: Soft Tissue

Abstract Indications The incidence of soft tissue sarcomas in the general population is very low, 1.4 to 2.7 per 100,000, increasing for patients 80 years of age and older to 8 per 100,000. The majority (59%) of soft tissue sarcomas occur in the extremities, with the most common types reported to be undifferentiated pleomorphic sarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor. Although…

Normal Variants

Abstract Normal variants in the skeleton are commonly encountered in the practice of radiology. Kohler was the first to seriously address this subject in his book, Borderlands of the Normal and Early Pathologic Findings in Skeletal Radiology, which was published in 1968 and was limited to the skeletal system. Theodore E. Keats expanded the concept of normal variation to all of the subspecialties of imaging with…

Dental Imaging

Diagnosis of Mandibular and Maxillary Lesions The mandible and maxilla are unique bones in that they both contain teeth and tooth-forming tissues. This fact is responsible for the high rate of inflammatory diseases, such as osteomyelitis and of lesions of odontogenic origin and other possible bone-related diseases. Because of this wide spectrum of disease, the interpretation of diagnostic images of the maxilla and mandible can be…

Temporomandibular Joint

Pathophysiology Anatomy The temporomandibular joint (TMJ) is a diarthrodial joint bounded by the glenoid fossa and articular eminence of the temporal bone above and the mandibular condyle below (see Video 114-1 ). A joint capsule extends from the posterior portion of the temporal bone, glenoid fossa, and the articular eminence superiorly to the neck of the mandibular condyle inferiorly in the form of an inverted pyramid.…

Postoperative Infections

Etiology Postoperative infection of the hip and knee may occur in a myriad of clinical settings, including systemic infection or illness, blunt or penetrating trauma, or following medical intervention. Infection is both a primary complication and a medium through which deleterious effects may impact bone, muscle, neurovascular, and soft tissue as well as implanted materials. Complications may occur if there is delayed diagnosis of an infection,…

Imaging of the Residual Limb after Amputation

Amputation surgery is an ancient procedure dating back to prehistoric times. Although there have been numerous advances in limb salvage techniques, amputation is still performed today and may be the treatment of choice in cases of severe vascular disease, severe trauma, and some malignant neoplasms. In the United States, most amputations are performed in patients with diabetes mellitus and peripheral vascular disease, with amputations in this…

Postoperative Ankle and Foot

More than 200 distinct operations are performed in the ankle and foot. Indications for operative intervention include traumatic, overuse, degenerative, arthritic, congenital, neoplastic, and inflammatory conditions. Procedures unique to the foot and ankle are reviewed here, with emphasis on the imaging techniques used to evaluate successful and complicated operations. Osteosynthesis Description The most commonly performed operations in the foot and ankle—fracture treatment, osteotomies, and arthrodeses—are designed…

Postoperative Knee

Imaging the postoperative knee can be challenging. The postoperative knee can have all of the pathologic processes of the preoperative knee, in addition to specific issues related to the surgery performed, general problems with surgery, and specific postoperative complications. The imaging is often confounded by artifact produced from instrumentation or surgical scar, so that, often, special imaging technique is required, especially for CT and MRI. Because…

Postoperative Hip

Postoperative Imaging in Arthroscopic Hip Surgery In recent years, there has been considerable growth in arthroscopic hip surgery as a modality for both investigation and treatment of hip pathology. In this chapter, the postoperative imaging appearances of the hip are described following arthroscopic surgery. Postoperative Imaging of the Labrum Postoperative MR arthrography in patients who have undergone traditional labral débridement portray the normal triangular labrum as…

Postoperative Elbow, Wrist, and Hand

Elbow, wrist, and hand surgery are frequently done to repair bone and soft tissues, such as fractures and disruptions of ligaments and tendons. Nerves also traverse the area and are released from various tunnels. In this chapter, common indications are discussed for surgery on various bone and soft tissue structures in and around these joints, and some of the procedures with their postoperative imaging appearances are…

Postoperative Shoulder

Recurrent or persistent pain is a common complaint after shoulder surgery. MRI and ultrasonography (US) are often performed in the postoperative setting as a noninvasive means of determining the etiology of postoperative pain. Numerous surgical and arthroscopic techniques are available to the surgeon, and many of these procedures result in a change to the normal anatomy of the shoulder. An accurate interpretation of a postoperative shoulder…

Principles and Complications of Orthopedic Hardware

Evaluating the postoperative patient is integral to the practice of musculoskeletal radiology. Most of the subsets of musculoskeletal pathology, including trauma, neoplasia, arthritis, sports medicine, and congenital and developmental maladies, encompass many diagnoses and entities that lead to surgical intervention. The radiologist must combine knowledge of normal and abnormal reparative processes with understanding of the pathology, surgical procedures, and various implants and devices to render adequate…

Spinal Deformity

Classification and Definitions Many different classification systems have been described for spinal deformities. Over the years, some of these classifications have fallen out of favor while new descriptive terms have been applied. To accurately diagnose a spinal deformity, it is important to understand the definitions of the terms used. Spinal deformities are described in relation to the position of the deformity within the spine, the characteristics…