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Infections of the Spinal Column

Spinal infection frequently injures the vertebral bodies, intervertebral discs, paraspinal soft tissues, epidural space, meninges, and spinal cord. Clinically, it is notoriously difficult to differentiate spinal infection from degenerative processes, noninfective inflammatory disorders, and spinal neoplasms. Spinal infections are a common cause of morbidity and mortality, especially in immunocompromised patients. Epidural and intradural extramedullary infections are most often caused by pyrogens. Intramedullary infections are usually caused…

Metabolic Conditions Affecting the Spinal Cord

Metabolic disorders of the spinal cord are less common than metabolic disorders of the brain and peripheral nerves. Such metabolic myelopathies can be secondary to nutritional deficiencies, especially vitamin B 12 deficiency, or to systemic metabolic disorders. VITAMIN B 12 DEFICIENCY Subacute combined degeneration (SCD) of the spinal cord is a symmetric spongy vacuolation and degeneration of myelin that results from deficiency of vitamin B 12…

Metabolic Conditions Affecting the Spinal Column

The skeletal manifestations of metabolic disease are a heterogeneous group of conditions resulting from endocrinopathy, vitamin deficiency, renal tubular dysfunction, and disorders of endogenous metabolism. As a group, they are characterized by altered function of the osteoblasts and osteoclasts or abnormal rates of mineralization. Consequently, there are pathologic changes in the bone mass, the collagen framework of the bone, the degree of bone mineralization, and the…

Spinal Tumors

Spinal tumors comprise a large spectrum of distinct histologic entities that may arise primarily from the spinal cord (intra-axial or intramedullary space), the surrounding leptomeninges (intradural extramedullary space), or the extradural soft tissues and bony structures (extradural space). All three anatomic compartments may also be secondarily affected by metastatic disease from a known or unknown distant primary neoplasm. The same category also includes primary and metastatic…

Spinal Cysts

Cystic lesions of the spine are a diverse group of infectious, post-traumatic, postinterventional, and degenerative abnormalities with the common feature of a fluid collection with a wall. The cellular linings of the walls may be squamous epithelium, columnar epithelium, arachnoid cap cells, ependymal cells, or collagenous fibrous tissue. The cyst may contain simple low protein fluid similar to cerebrospinal fluid (CSF), highly proteinaceous fluid, hemorrhagic fluid,…

Spinal Vascular Malformations

Spinal vascular malformations are developmental derangements of the interconnections between arteries and veins, with secondary features of vascular enlargement, aneurysm and varix formation, mass effect from the enlarged vessels, excessively high flow with vascular steal and potential cardiac failure, and/or elevated venous pressure with low blood flow and backpressure ischemia due to venous congestion. Multiple schemes have been proposed to classify spinal vascular malformations. Genetically, spinal…

Trauma to the Spinal Cord

Spinal cord trauma is the application of excess force to the spinal cord and the consequences of that force for the cord. Traumatic spinal cord injury (SCI) may result from an acute blow to the spine, resulting in fracture or dislocation of the vertebrae, rupture of intervertebral discs and ligaments, occlusion or rupture of blood vessels of the spine or the spinal cord, and/or formation of…

Trauma to the Spinal Column

Traumatic injuries of the spinal column reflect the mechanisms that produced them. The patterns of these injuries on imaging studies, therefore, help to predict the underlying mechanisms of trauma and lead, in turn, to more complete description of the pathologic process, more thorough search for associated abnormalities, and better patient prognostication. Differences in the anatomy and mobility of each spinal segment influence the pathologic process suffered.…

Extra-axial Hemorrhages

Spinal epidural hematoma and spinal subdural hematoma are accumulations of blood within the epidural or subdural spaces of the spinal canal or both. They may appear “spontaneously,” result from trauma, or arise secondary to coagulopathy, vascular malformation, neoplasm, or another cause. The clinical symptoms are similar in both spinal epidural and spinal subdural hematomas and include local pain, extremity weakness, sensory loss, and bladder or bowel…

Spinal Cord Arterial Ischemia

Spinal cord ischemia is caused by deficient spinal arterial blood flow secondary to occlusion of intercostal/lumbar arteries or to involvement of the intrinsic arteries of the cord. It is also referred to as ischemic myelomalacia of the spinal cord. Epidemiology The precise epidemiology of spinal cord arterial ischemia is unknown. In our experience, men and women are affected equally and age range is highly variable: 0.5…

Spinal Vascular Anatomy

The normal vascular anatomy of the spine and spinal cord is described in this chapter as it follows the blood flow from large arteries to smaller arterial trunks and through the capillaries to venous drainage channels of progressively larger size. The application of this anatomy to the imaging of spinal cord pathology is reviewed elsewhere. ARTERIES Segmental Arteries and Their Anastomoses In the segmented spine, the…

Degenerative Disorders of the Spine

Degeneration of the spine should be distinguished from normal aging of the spine. Normal aging retains the biomechanical and biochemical functions of the spine, whereas degeneration does not. The claim that disc degeneration begins in the first decade of life and affects many children suggests misconceptions in the use of the term degeneration . In this chapter a description is provided of the biochemical and biomechanical…

Age-Related Changes in the Spine

The spines of older individuals have both the changes of normal aging and the changes of “degeneration.” In the absence of accepted criteria to distinguish aging and degeneration, the features that characterize the majority of individuals at a specified age can be taken to represent normal aging rather than degeneration. The anatomic, chemical, and imaging features of the aging spine are discussed here, and the degenerative…

The Normal Spinal Cord and Meninges

I. THE SPINAL CORD The spinal cord is the segment of the central nervous system that lies within the spinal canal caudal to the foramen magnum ( Figs. 5-1 to 5-3 ). The top of the spinal cord is taken to be the plane immediately rostral to the emergence of the C1 nerve roots. The bottom of the spinal cord merges into the filum terminale at…

The Normal Spinal Column: Thoracic, Lumbar, Sacral, and Coccygeal Segments

The spinal column consists of multiple segmented osseous vertebrae, the intervertebral discs interposed between these segments, and the ligaments and joints that bind the segments together. The spine has 32 to 35 vertebral segments, traditionally considered as 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 to 5 coccygeal segments. The relative lengths of the cervical, thoracic, lumbar, and sacral spines are in proportion as…

The Normal Spinal Column: Overview and Cervical Spine

The spinal column consists of multiple segmented osseous vertebrae, the intervertebral discs interposed between these segments, and the ligaments and joints that bind the segments together. The spine has 32 to 35 vertebral segments, traditionally considered as 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 to 5 coccygeal segments. The relative lengths of the cervical, thoracic, lumbar, and sacral spines are in proportion as…