Spine infection/inflammation

This article discusses the imaging of infectious and other inflammatory conditions that affect the spinal cord, spinal column, intradural spinal nerve roots, and spinal meninges with emphasis on magnetic resonance (MR) imaging. Inflammatory lesions of the spine are often indistinguishable on imaging and even on pathologic examination. However, infectious causes are treatable so it is important for the radiologist to make the diagnosis. The most common inflammatory and infectious conditions affecting the anatomic compartments of the spine are described, following an external to internal anatomic approach. Subsequently, several infectious pathogenic agents are discussed individually as they affect the spinal column and its contents.     

MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS

Our purpose was to describe the range of MRI findings in infectious and neoplastic involvement of the spine and spinal cord in symptomatic patients with the acquired immunodeficiency syndrome (AIDS). MRI studies in 55 patients with AIDS and neurological signs and symptoms thought to be related to the spine or spinal cord were reviewed. We categorized the findings according to the spinal compartment involved. There were 29 patients with extradural, 11 with intradural-extramedullary and 9 with intramedullary disease. In 6 patients more than one compartment was involved simultaneously, and patients presented with multiple lesions in the same compartment. The most common causes of extradural disease were bone lesions (28); an epidural mass was seen in 14 and spondylodiscitis in 4 patients. Cytomegalovirus polyradiculitis was the most common cause of intradural-extramedullary disease (in 10 cases); herpes radiculitis was seen in two, and tuberculous infection in another two. In three cases leptomeningeal contrast enhancement was due to lymphoma. Human immunodeficiency virus (HIV) myelitis was seen in two patients, presumed vacuolar myelopathy in two, toxoplasma myelitis in four, intramedullary lymphoma in one, and herpes myelitis in one. Familiarity with the various potential pathological entities that can affect the spine and spinal cord in the AIDS population and their imaging characteristics is crucial for initiation of further diagnostic tests and appropriate medical or surgical treatment. Received: 2 July 1999 Accepted: 3 September 1999     

Exercise induced compartment syndrome in a professional footballer

Recurrent pain in the lower leg caused by exercise is a common problem in athletes. The main causes are exercise induced compartment syndrome, periostitis of the tibia, stress fracture, venous diseases, obliterative arterial diseases, and shin splints. Exercise induced compartment syndrome is the least common. A recurrent tightening or tense sensation and aching in anatomically defined compartments is pathognomonic. The symptoms are caused by abnormally high pressure in compartments of the leg during and after exercise. In this report, a case of exercise induced compartment syndrome in a professional footballer is described.     

Spontaneous spinal subarachnoid hemorrhage associated with subdural hematoma at different spinal levels

We describe the clinical features and MR-imaging findings of spontaneous spinal subarachnoid hemorrhage located in the lumbar spine associated with subdural hematoma at a higher, thoracic level in a 66-year-old man without neurological deficit. The sequential MR-imaging changes of hemorrhage at various stages in its evolution are portrayed. The possible pathogenetic mechanism for these very unusual, combined hemorrhages in both spinal compartments is discussed.     

Chronic exertional compartment syndrome

Chronic exertional compartment syndrome is a relatively common, but often overlooked cause of leg pain in athletes. A careful history and physical examination is essential in the diagnosis of CECS. Affected individuals have recurrent, activity-related leg pain that recurs at a consistent duration or intensity and is only relieved by rest. Measurement of baseline and postexercise compartment pressures confirms the diagnosis and helps in the planning of treatment. Surgical treatment with fasciotomy of the involved compartments is successful in allowing patients to return to full activity levels. With surgical treatment, it is critical to address all affected compartments as well as releasing any fascial defects, both of which may cause recurrent symptoms if neglected. With appropriate diagnosis and treatment, excellent outcomes can be achieved and allow athletes to return to full, unrestricted activity levels.     

Combined spinal subdural tuberculous empyema and intramedullary tuberculoma in an HIV-positive patient

Tuberculous involvement of the spinal subdural and intramedullary compartments is extremely uncommon. Simultaneous involvement of both compartments has never been reported, to our knowledge. We present an HIV-positive patient with such kind of combined involvement. Diagnosis was made on the basis of a prior history of pulmonary tuberculous infection and a positive therapeutic response to antituberculous chemotherapy. Magnetic resonance imaging is the diagnostic procedure of choice in order to determine the exact level, site, and size of the disease. Tuberculosis of the spine should always be considered in the differential diagnosis of spinal cord compression if the patient lives in or comes from a region where tuberculosis is endemic or if the patient is immunocompromised.     

A prospective blinded evaluation of exercise thallium-201 SPET in patients with suspected chronic exertional compartment syndrome of the leg.

This study compared the quantitative and qualitative results of leg thallium-201 single-photon emission tomography (SPET) imaging in patients with and without raised intracompartmental pressure associated with exercise-related leg pain. The purpose of this study was to clarify the aetiology of chronic exertional compartment syndrome (CECS), and to investigate the diagnostic applications of 201Tl SPET in CECS. Thirty-four study participants underwent compartment pressure testing (CPT) between March and August 2000. There were 25 positive CPT results (patient group), and nine negative CPT results (control group). All 34 participants underwent scintigraphy. Quantitative and qualitative assessments were performed for the anterolateral and deep posterior compartments of the lower leg. There was no significant difference in either quantitative or qualitative assessments of perfusion between those compartments with and those without CECS. In contrast, a marked effect of exercise type upon compartment perfusion pattern was noted. Results of this study indicate that there is no compartment perfusion deficit in those patients with raised intracompartmental pressure associated with CECS, and suggest a non-ischaemic basis for the pain associated with CECS. They also suggest no role for exercise perfusion scintigraphy in the diagnosis of this syndrome.     

CT and MR imaging in atypical teratoid/rhabdoid tumors of the central nervous system

Introduction Atypical teratoid/rhabdoid tumors (ATRT) are rare aggressive neoplasms of the CNS affecting predominantly very young children. Methods We retrospectively reviewed the imaging findings of 9 CT and 32 MR examinations of the brain and spine of 33 children. Results Of the 33 tumors, 11 were located in the infratentorial compartment, 16 in the supratentorial compartment, 5 in both cranial compartments, and 1 in the lower thoracic spinal cord. The mean age of the children with infratentorial or infra- and supratentorial tumors was significantly lower than the mean age of the children with purely supratentorial tumors. Heterogeneity on imaging, large size and high tumor stages are striking features reflecting the aggressive nature of this histopathological entity. Although not present in the majority of children, a distinct and unusual pattern of a wavy band-like enhancement surrounding a central hypointensity was present in 12 of 32 children (38%) in whom contrast medium was used. Conclusion To the best of our knowledge this is the largest number of imaging examinations of ATRTs so far reported. A rather unusual pattern of contrast enhancement may be typical of ATRTs. This work was funded by the German Children’s Cancer Foundation (Deutsche Kinderkrebsstiftung).     

Sectional neuroanatomy of the lumbosacral spine (L1-S5)

This paper will review the lumbosacral spine (L1-S5). Procedures performed in the lumbosacral spine include electromyography, spinal stimulator implants, spinal infusion implants for spasticity or pain medications, sacroiliac spine injections, facet blocks, and steroid injections. Complications from these procedures include iatrogenic paraplegia or paraplegia due to transverse myelitis, intravascular penetration, dural puncture, increased pain at the injection site, increased radicular pain, increased spine pain, lightheadedness, nausea, nonspecific headache, and vomiting. Long-term complications include implant infection, implant or catheter dislodgment/kinking, and device failure. This paper provides anatomically accurate schematics of innervations of the lumbosacral spine (L1-S5) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the lumbosacral spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the lumbosacral spine allows the physician to increase the accuracy and efficacy of interventional procedures. This anatomical map could also assist the electromyographer in correlating the clinical and electrophysiological findings on magnetic resonance images.     

“十三五”期间我国脊柱脊髓损伤临床诊疗研究亮点与进展

随着我国经济社会的飞速发展,以高处坠落伤及交通伤等高能量损伤为主要病因的脊柱脊髓损伤仍是当前我国脊柱创伤领域关注的焦点问题.脊柱脊髓损伤具有致残率高、并发症多、治疗棘手等特点,给个人、家庭和社会带来沉重负担.“十三五”期间,我国学者围绕脊柱脊髓损伤的精准化、微创化治疗,在分型诊断及治疗技术上进行了大量探索,创造性地提出...     

腰椎退行性病变CT分型(附1180例分析)

目的综合分析腰椎退行性病变的CT表现。方法分析1180例退变性腰腿痛患者的腰椎CT表现,按腰椎相关结构对其表现分类,结合临床表现,对腰椎退变的影像表现进行分型诊断。结果腰椎退变存在6种类型,即:椎间盘退变型,退变率65.3%;骨质退变型,退变率48.1%;椎小关节退变型,退变率36.0%;韧带退变型,退变率25.4%;退变性腰椎管狭窄,退变率44.0%;退变性腰椎失稳,退变率25%。前4种为原发性腰椎退变型,后2种为继发性腰椎退变型。结论腰椎退行性病变的CT分型有利于临床治疗。     

Chronic leg pain in athletes due to a recurrent compartment syndrome

A series of 29 patients, all engaged in sports activity on a regular basis, suffering from recurrent compartmental syndrome, is reported. The syndrome is not restricted only to long distance runners but to athletes involved in a variety of sports activities (soccer, volleyball, cycle racing, gymnastics, judo, physical education, and long distance running). Although most patients presented activity-related leg pain, some patients mainly complained of ankle weakness and recurrent ankle distortions at fatigue. The wick catheter technique proved to be most useful to determine which compartments were involved. The severity of clinical symptoms correlated highly with the anomalies of the tissue pressure measurements. The predominance of deep posterior compartment and multiple compartment involvement are in contrast with most previous reports. Conservative treatment was unsuccessful in every patient, whereas surgical decompression of the involved compartments yielded favorable results in those cases where all the involved compartments were released.     

Biomechanical considerations for clinical application in athletes with low back pain

Biomechanical concepts of the effects of lumbar spine load transmission, flexion and extension stresses, contact pressure in facet joints, and load transmissibility function of intervertebral discs are presented. These concepts serve as a basis for discussion of some innovative approaches to treatment of low back pain in the athlete. In addition, explanations of extremes of spinal extension and flexion related to back pain, coupling mechanisms as a basis for spinal motion, and discogenic pain as the primary etiology for back pain in athletes are offered.     

Intramuscular pressure recording in the assessment of patients with suspected chronic compartment syndrome

This report presents results from intramuscular pressure recordings in 181 consecutive patients. All patients were suspected on clinical grounds of suffering from chronic compartment syndrome (CCS). The diagnostic criterion used in this study was an intramuscular pressure exceeding 30 mmHg immediately postexercise. Most of the pressure studies were made with the micro-capillary infusion technique. CCS in the anterior tibial compartment was diagnosed in 36 of 165 patients with anterior or anterolateral exercise-induced pain. Regarding measurements in other lower-leg compartments, CCS was diagnosed in only one patient in the superficial posterior compartment. CCS was more commonly found in men than in women. It is concluded that, even in highly selected cases, CCS is a rather uncommon cause of exercise-induced pain, predominantly found in the anterior tibial compartment     

脊柱动态测量仪对正常人和腰痛患者脊柱运动能力的量化测量

目的：量化测量脊柱各个椎体椎间角度变化,评估腰痛患者运动能力下降程度。方法：使用脊柱动态测量仪测量112例正常人和60例腰痛患者不同姿势下的脊柱形态,得出量化脊柱各个椎体之间椎间角角度,并进行独立样本t检验和配对样本t检验。结果：腰痛患者脊柱前屈运动能力比正常人下降80%,后伸要比正常人要下降60%,P〈0.05。前屈时腰痛患者的胸段脊柱（T1～7）后凸增加不明显,没有显著差异,但是下胸段与腰段前凸转为后凸,椎间角度变化存在显著差异,P〈0.05。正常人的下腰段后伸能力变化最大的L4～5、L5～S1、L3～4椎间隙,在腰痛患者则表现为此3个节段的脊柱僵硬,后伸位与伸直位时椎间角比较没有显著差异。结论：脊柱动态测量仪可以直接、方便的测量出胸、腰椎各个椎间角变化,并且存在很好的可靠性、重复性和可信性,是脊柱各个节段运动能力评定的良好工具。     

Lumbar spine disc heights and curvature: upright posture vs. supine compression harness

INTRODUCTION: Spinal lengthening in microgravity is thought to cause back pain in astronauts. A spinal compression harness can compress the spine to eliminate lengthening but the loading condition with harness is different than physiologic conditions. Our purpose was to compare the effect of spine compression with a harness in supine position on disk height and spinal curvature in the lumbar spine to that of upright position as measured using a vertically open magnetic resonance imaging system. METHODS: Fifteen healthy subjects volunteered. On day 1, each subject lay supine for an hour and a baseline scan of the lumbar spine was performed. After applying a load of fifty percent of body weight with the harness for thirty minutes, the lumbar spine was scanned again. On day 2, after a baseline scan, a follow up scan was performed after kneeling for thirty minutes within the gap between two vertically oriented magnetic coils. Anterior and posterior disk heights, posterior disk bulging, and spinal curvature were measured from the baseline and follow up scans. RESULTS: Anterior disk heights increased and posterior disk heights decreased compared with baseline scans both after spinal compression with harness and upright posture. The spinal curvature increased by both loading conditions of the spine. DISCUSSION: The spinal compression with specially designed harness has the same effect as the physiologic loading of the spine in the kneeling upright position. The harness shows some promise as a tool to increase the diagnostic capabilities of a conventional MR system.     

Diffusion-weighted imaging distinguishes recurrent epidermoid neoplasm from postoperative arachnoid cyst in the lumbosacral spine

Diffusion-weighted imaging can be used to distinguish epidermoid tumor from arachnoid cyst in the intracranial compartment. We report the use of diffusion-weighted imaging in a postoperative spine to successfully distinguish a recurrent epidermoid tumor from arachnoid cyst in a noninvasive manner. Our case illustrates the value of this readily available sequence presently not generally used in the clinical evaluation of spinal pathology.     

Long-term results of fasciotomy of the anterior compartment in patients with exercise-induced pain in the lower leg

This prospective study aims to describe the results of fasciotomy in patients with exercise-induced pain in the lower leg with suspected (chronic) exertional compartment syndrome. The diagnosis of (chronic) exertional compartment syndrome was made if pain in the lateral side of the lower leg after a standard physical load was accompanied by elevated tissue pressures in the anterior muscle compartment. Tissue measurements were performed in 114 patients. In 56 patients (106 compartments) increased tissue pressure was found (> 50 mmHg measured immediately after exercise, or > 30 mmHg if the pressure before exercise > 20 mmHg, or if the pressure five minutes after exercise is still > 30 mmHg). Two years after fasciotomy, (remaining) complaints were evaluated on the basis of a questionnaire: 87 % of the patients had significant reduction in complaints. Patients who were not found to have increased tissue pressure were also asked to report developments through the questionnaire. In 18 patients a fasciotomy was performed on the basis of the typical history, despite normal or slightly increased intramuscular pressures. Twelve of these patients (24 compartments) were asymptomatic after surgery. Fasciotomy in patients with a (chronic) exercise-induced compartment syndrome in the anterior compartment of the lower leg, based on our criteria, gave a marked reduction in symptoms in 87 % of the patients. Further research has to be done for the minimum tissue pressures above which fasciotomy may be successful in terms of reducing complaints.     

重症脊柱结核的手术治疗

目的探讨重症脊柱结核手术治疗的方法和临床效果。方法110例病变累及1—3个椎节的胸腰椎结核患者,伴有不同程度结核中毒症状,32例患者有不同程度后凸畸形。一期行前路病灶切除减压,自体髂骨肋骨和同种异体骨椎体间植骨,“K”钢板内固定重建脊柱稳定性,术后给予12～18个月抗痨治疗,观察术后腰背部疼痛缓解、脊髓神经功能恢复、植骨融合及内固定稳定情况。结果术后患者腰背部疼痛缓解,下肢疼痛麻木消失,术前伴有脊髓功能障碍的27例患者术后神经功能均有不同程度恢复。术后影像学检查示植骨块及内固定钢板位置良好,椎体序列及高度恢复良好。随访1～7年,平均4．2年,复发8例,经处理后痊愈。结论采用前路一期病变椎体切除椎体间植骨钢板内固定的手术方式有利于病变切除彻底,椎管减压彻底,脊柱稳定性重建可靠。     

Lap-belt injuries of the lumbar spine in children: a pitfall in CT diagnosis

A retrospective review of 365 consecutive CT studies in children assessed for intraabdominal trauma yielded five children in whom lap-belt-associated injuries of the lumbar spine were missed on CT. Facet subluxation and anterior dislocation of the third lumbar vertebra were present in four patients and multiple compression fractures were present in one. Clinical presentations included acute abdominal symptoms; two had acute back pain, and three experienced delayed onset of back pain. Although the injuries to the spine were visible retrospectively on anteroposterior radiographs, the findings were subtle and their extent was best appreciated on lateral lumbar spine views. Five of 365 patients with blunt abdominal trauma were identified as having sustained midlumbar spinal injury that was clearly visible only on a lateral radiograph of the spine.