Scoliosis Classification: 

  Idiopathic: 80%   Infantile <3; Juvenile 4-10; Adolescent: 10-18

  Or:   Early onset <5; Late onset >5

  Congenital: Osteogenic: hemivertebra, fused vertebra

  Neurogenic: tethered cord, syringomyelia, Chiari

  Developmental: Achondroplasia

  NF   OI

  Neuromuscular:   Cerebral palsy

Tumour:   Osteoid osteoma

  BPNST

Xray report- there is a mild thoracic scoliosis convex to the left centered at T10.

Adolescent gymnast

  16 F

  Fit & well

  Curve noticed 12 yrs of age

  Left thoracic and right T/L curve

  O/E Absent abdominal reflex ,

  Brisk lower limb reflexes,? Up going plantars

Scheuermann's Disease

  Thoracic pain

  Kyphosis of greater than 40 degrees

  Vertebral end plate abnormality

  Variable wedging of at least 3 consecutive thoracic vertebra

16 yr M

  Chronic cough

  No pain

  CXR report- Scheuermann's disease of the thoracic spine is noted.

22 yr M

  Chronic Thoracic Pain

  Increasing kyphosis

Nomenclature of disc herniations and spinal stenosis

  Consistent

  Reflect common usage where appropriate

  Surgically relevant

  ‘Able to visualize over the phone’

  2 morphological characteristics:   Nature of disc pathology   Location

  Able to add further descriptors   Neural structures   Clinical context

www.asnr.org/spine_nomenclature/reporting

Disc Degeneration   Annular Tear/Fissure

  Disc Bulge

  Disc Herniation – Protrusion

  -- Extrusion

  Disc Sequestration

Annular tear/ fissure

  ‘Tear’ and ‘fissure’ interchangeable

  ‘Tear’ more common usage   Does not imply trauma

Disc bulge

Generalised extension of disc tissue beyond intervertebral disc space

  ‘Generalised’ = >50% circumference (>1800)

  Relatively short distance, <3mm

Disc Protrusion

  Involves less than 180% of the disc

  The base of the herniation is wider than the height.

  <180 but >90% - broad based

  <90% - focal

DISC PROTRUSION: CT & MRI

Extruded disc   Greatest distance in any plane between

edges > base

T1

Sequestered disc

  Extruded disc material that has no continuity with the disc of origin

  = free fragment

  Migrated disc:   Disc material displaced away from site of extrusion

T2 T2

T1

Image interpretation   A few cases

  68M

  Sudden onset bilateral leg pain and weakness

  Urinary retention

  Dx: Cauda equina syndrome

  Cause: massive sequestration

  Other causes:   Tumour

  Primary of lower cord: ependymoma   Primary of nerve: BPNST   Primary of dura: meningioma   Primary of vertebral body: chordoma, giant cell tumour   Secondary

  Trauma

Clinical details: 54M. Left leg pain, paresthesia and weakness.

MR LUMBAR SPINE Clinical details: 54M. Left leg pain, paresthesia and weakness. Sequences: T1, T2 transverse and sagittal Findings:

Conclusion: Multilevel disc degeneration. Spondylolisthesis at L5/S1 with associated degenerative changes. The most significant lesion is a broad based left central disc extrusion at L4/5 compressing the left side of thecal sac displacing the left L5 and S1 nerve roots.

CT LUMBAR SPINE Clinical Details: 57 M. Episodes of feeling both lower limbs being weak and giving way.

CT LUMBAR SPINE Clinical Details: 57 M. Episodes of feeling both lower limbs being weak and giving way. Findings:

Conclusion: Severe facet joint degeneration and disc degeneration at the L4/5 level resulting in moderately severe central canal stenosis and bilateral subarticular stenosis, more marked on the left.

CT LUMBAR SPINE Clinical Details: 57M. Moderately severe back pain for one year.

CT LUMBAR SPINE Clinical Details: 57M. Moderately severe back pain for one year. Findings:

Conclusion: Bilateral L5 pars defects and L5/S1 spondylolisthesis with secondary degenerative changes as described.