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Pathways of Spread

Anatomy-Based Imaging Issues Spread of infection may occur along one of many different tracts, including direct extension , lymphatic spread , hematogenous spread , and along the cerebrospinal fluid pathways . Direct extension , as its name implies, occurs when bone or soft tissue comes into contact with a directly adjacent infection leading to a soft tissue abscess or osteomyelitis. For the spine, this route is…

Ankylosing Spondylitis

KEY FACTS Imaging Location Discs and synovial joints of spine Joints of axial skeleton, less commonly peripheral joints Tendon and ligament attachments (entheses) Sacroiliac joints: Bilaterally symmetric erosive arthropathy → fusion Facet, uncovertebral joints: Erosions → fusion Squaring of vertebral bodies → corner erosions → shiny corner (corner sclerosis) → ankylosis Erosions, new bone formation at tendon and ligament attachments Trauma Often hyperextension injury involving all…

Hemodialysis Spondyloarthropathy

KEY FACTS Terminology Destructive spondyloarthropathy Discocentric destructive arthritis in patient on long-term hemodialysis Imaging Vertebral and endplate destruction in patient on long-term hemodialysis, ± vertebral collapse Cervical, thoracic, or lumbar spine Often involves multiple levels Endplate destruction with sharply marginated erosions Amorphous material in disc, spinal canal, &/or prevertebral soft tissues Usually lower signal intensity than infection on T2WI, STIR Top Differential Diagnoses Infection Neuropathic joint Gout…

Adult Rheumatoid Arthritis

KEY FACTS Imaging Erosions of dens, uncovertebral joints, facet joints Atlantoaxial instability in 20-86% patients with rheumatoid arthritis (RA) Atlantoaxial subluxation in 5% of cervical RA Cranial settling occurs in 5-8% of RA patients Lower cervical spine: Facet and uncovertebral joint erosions, instability Neutral, flexion, and extension lateral radiographs performed for evaluation of instability Normal: 2 mm between inner margin anterior ring of C1 and dens…

Spondylolysis

KEY FACTS Terminology Defects in pars interarticularis thought to result from repetitive stress injury Pars is junction of pedicle, lamina, and facet Imaging Most common at L5: 80-90% Discontinuity in neck of “Scotty dog” on oblique plain films Elongation of spinal canal at level of pars defects on axial imaging Incomplete ring sign on axial imaging Top Differential Diagnoses Acute traumatic fracture of posterior elements Facet…

Periodontoid Pseudotumor

KEY FACTS Terminology Calcium pyrophosphate dihydrate deposition disease (CPPD); articular chondrocalcinosis Crowned dens syndrome: Fever with cervicooccipital junction pain, stiffness with associated calcification of transverse ligament and nonenhancing retroodontoid soft tissue; associated with CPPD or hydroxyapatite deposition Pseudogout: Arthritis caused by CPPD crystal inflammation with symptoms like gout You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

Scheuermann Disease

KEY FACTS Terminology Juvenile kyphosis, Scheuermann kyphosis Kyphosis secondary to multiple Schmorl nodes → vertebral body wedging You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here