Diagnostic imaging spine 3e pdf. Diagnostic Imaging: Spine, 3e Jeffrey S. Ross MD, Kevin R. Moore Publisher: Elsevier Release Date: With. PDF | The high prevalence of neck and low back pain in the rapidly aging While spinal imaging can be useful to identify less common causes of neck and back. Request PDF on ResearchGate | Spinal Imaging: Diagnostic Imaging of the Spine and Spinal Cord | This is a richly illustrated and.
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Diagnostic Imaging: Spineis the fourth volume in the formulaic series fol-. lowingDiagnostic Imaging: Orthope- dics, Diagnostic Imaging: Brain. PDF Download Diagnostic Imaging: Spine, 1e, Download PDF Diagnostic Imaging: Spine, 1e, Free PDF Download Diagnostic Imaging: Spine, 1e, Free Ebook. This book aims to provide an overview of diagnostic spinal imaging. Available at ronaldweinland.info Warder DE, Oakes WJ.
Secondary neurulation. The terminal ventricle is the sole remnant of the secondary neural canal From Tortori-Donati et al. Catala, pers. The conus medullaris contains a focal expansion of the ependymal canal called terminal ventricle, representing the remnant of the lumen of the secondary neural tube. As development proceeds, epithelial spheres, called somites, are formed in a cephalo-caudal gradient. These somites mature during development according to a cephalo-caudal gradient.
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Terminal myelocystocele in a 5-month-old girl. External to it, the meningocele M also is displayed. VB vertebral body. The overall picture is extremely complex, due to the markedly distorted anatomy.
On initial imaging analysis, we were unable to recognize the real nature of the syringocele; therefore, our presumptive diagnosis was lipomyelomeningocele. Only on surgery, displaying continuity of the syringocele with the interior of the spinal cord, was the diagnosis of terminal myelocystocele eventually established.
The contents of the sac may be represented by an expanded hydromyelic cavity lined by the posterior wall of the spinal cord i.
Neurological deterioration may ensue after surgical repair without release of the intraspinal tethering structures or due to associated diastematomyelia or hydrocephalus.
On MRI, full-blown nonterminal myelocystoceles show hydromyelia ballooning into a cyst that protrudes out of the spinal canal and into a meningocele Fig.
In abortive myelocystoceles, a thin stalk emanating from the dorsal aspect of an otherwise normal spinal cord and fanning out into a posterior meningocele is detected. In both cases, the dome of the meningocele is covered by thick, squamous epi- 1. Intradural and Intramedullary Lipoma Intradural and intramedullary lipomas differ from lipomas with dural defects in that they are contained within an intact dural sac but are otherwise similar to them both pathologically and embryologically.
Intradural lipomas are located along the midline in the groove formed by the dorsal surface of the unapposed folds of the placode, and may bulge posteriorly in the subarachnoid spaces elevating the pia mater. In rare instances, lipomas are completely intramedullary.
Intradural lipomas commonly involve the lumbosacral spine and usually present with TSC, whereas cervicothoracic lipomas generally produce insidious signs of spinal cord compression. On MRI, lipomas are detected as masses that are isointense with subcutaneous fat on all sequences, including those acquired with fat suppression Tortori-Donati et al.
In 17 A. Tortori-Donati a b Fig. Thoracic nonterminal myelocystocele, 2-day-old male newborn. The stretched walls of the spinal cord are visible arrowhead, a,b as they separate the hydromyelic cavity from external, slightly dilated subarachnoid spaces thick arrow, b. Note localized hydromyelia just above the origin of the posterior stalk arrow, a , a quite common occurrence with nonterminal myelocystoceles. Case courtesy of J. Van Goethem c a b Fig. Intradural lipoma in a 4-month-old girl.
Note that there also is overgrowing subcutaneous tissue. On MRI Fig. Different from what is commonly believed, isolated cases are extremely uncommon, while the abnormality is more frequent in patients with diastematomyelia or dermal sinuses Tortori-Donati et al.
A low-lying conus medullaris is frequently, albeit not necessarily, associated. The tip of the conus medullaris lies inferior to L2 in the vast majority of cases Warder The lumbosacral region is the most common location, although cervical, thoracic, and occipital locations are also described Scotti and Harwood-Nash ; Barkovich et al. Clinical examination reveals a midline dimple or pinpoint ostium, often associated with a b a Fig. Filar lipoma in a year-old girl with tethered cord syndrome.
The spinal cord is not low-lying conus terminus at L1 but does show an excessive taper and contains slender hydromyelic cavity arrowhead. The spinal canal is abnormally large. Because the latter are anatomically located below the level of the bottom of the thecal sac, dysraphic abnormalities are typically not associated, and imaging studies are usually not required Weprin and Oakes Although the ostium is usually evident at birth, some children are not brought to medical attention until complications such as local infection or meningitis ensue.
Embryologically, dermal sinus tracts are traditionally believed to result from focal incomplete disjunction of the neuroectoderm from the cutaneous ectoderm Elton and Oakes They are easily recognized on sagittal MR images as thin hypointense stripes that course obliquely within the subcutaneous fat, more often in a caudally oblique direction Fig. In a considerable amount of cases, dermal sinuses are associated with dermoids, generally located at the level of the cauda equina or near the conus medullaris and probably resulting from an encasement of part of the dermal sinus tract Fig.
Such an association was found in Dermoids show variable MRI features depending on their content. Infected dermoids display intense contrast enhancement that may become ring-like with abscessation. It is embryologically related to preservation of the continuity of the terminal ventricle of secondary neurulation with the central canal of the spinal cord.
By itself, the persistent terminal ventricle is asymptomatic, but cases have been reported in which a huge cystic dilation was associated with low-back pain, sciatica, and bladder disorders Sigal et al. Intramedullary tumors are easily excluded by morphology, isointensity with CSF, and absence of gadolinium enhancement. The size of the cavity usually does not change on follow-up exams. Sagittal T2-weighted image shows dermal sinus coursing obliquely through the subcutaneous fat arrows.
Hyperintense dermoid D apparently originating from bottom of the dermal sinus open arrow connects with a low-lying conus medullaris. A fatty stripe along the posterior aspect of the cord generates chemical shift artifact arrowheads Gastrulation is characterized by the development of the notochord, a potent inductor that is involved in the formation of not only the spine and spinal cord, but also of several other organs and structures in the human body; therefore, spinal dysraphisms originating during this period will characteristically show a complex picture in which not only the spinal cord, but also other organs are impaired.
Due to this complex picture, disorders of gastrulation are also called complex dysraphic states Dias and Walker In the vast majority of cases, these abnormalities are covered by skin, and no telltale subcutaneous masses are present. The only exceptions are hemimyelocele and hemimyelomeningocele see section 1.
While the former results in longitudinal spinal cord splitting, the latter results in the absence of a notochordal Fig.
Sagittal T2-weighted image shows dilatation of the ependymal canal that slightly expands the conus medullaris 21 22 A. Tortori-Donati segment and, therefore, of the corresponding spine and spinal cord segment.
Midline integration is the process by which the two paired notochordal anlagen fuse in the midline to form a single notochordal process. The cause of failed midline notochordal integration has been the source of continuing debate among authors, and several possible explanations have been proposed Faris and Crowe ; Pang et al.
The eventual malformation depends on the severity of the abnormality and the outcome of the repair efforts of the embryo.
Several malformations belong to this broad group. This condition is extremely rare and has only exceptionally been described Hoffman et al.
Disorders of Segmental Notochordal Formation Programmed cell death, or apoptosis, is a process of cell elimination that occurs during normal development and represents a crucial phenomenon in various steps of embryogenesis. According to one theory Tortori-Donati et al. The consequences of such a segmental notochordal paucity are manifold and affect the development of the spinal column and spinal cord as well as of other notochord-induced organs. If the prospective notochord is depleted, a wide array of segmental ver- tebral malformations, including segmentation defects, indeterminate or block vertebrae, or absence of several vertebrae, will result.
In the vast majority of cases, the abnormality involves the caudal extremity of the embryo, resulting in caudal agenesis. Much less frequently, the abnormality involves an intermediate notochordal segment, thereby resulting in segmental spinal dysgenesis Tortori-Donati et al.
Diastematomyelia Diastematomyelia is the most frequent form of abnormal midline notochordal integration. Whether this diastematomyelia represents true cord splitting or, rather, incomplete cord duplication has been the subject of enduring debate. Observations indicate that there is in fact a continuous spectrum of abnormality ranging all the way between a partially cleft cord contained in a single dural tube at one end, and a completely duplicated spinal cord contained within dual dural tubes with an intervening bony spur at the other end.
We therefore encourage retaining the traditional denomination, which has the advantage of being widely recognized and accepted in the literature.
Embryologically, abnormal midline notochordal integration results into a variably elongated segment in which the midline notochord is replaced by two paired notochordal processes separated by intervening primitive streak cells. Congenital Malformations of the Spine, Spinal Cord, and Cranio-Cervical Junction The resulting malformation essentially depends on the developmental fate of the intervening primitive streak tissue, which is a totipotential tissue capable of differentiating into ecto-, meso-, and endodermal lineages.
If this intervening tissue differentiates into cartilage and bone, the two hemicords eventually will be contained into two individual dural sacs separated by an osteocartilaginous spur.
Diastematomyelia Type I Diastematomyelia type I consists of two hemicords contained within individual dural tubes, separated by a bony or osteocartilaginous septum that extends from the vertebral body to the neural arches Pang et al. This rigid septum is entirely extradural. Clinically, patients often display a hairy tuft lying high relatively cephalad along the back, which is considered to be a very reliable clinical marker of diastematomyelia Tortori-Donati et al.
Affected children usually present with scoliosis and a tethered cord syndrome TCS.
Radiological abnormalities involve both the spine and spinal cord. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
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