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Degenerative disease of the spine, in the form of intervertebral disc degeneration and bony growth, causing osteophytes and impinging upon the spinal canal and neural foramina, is the most frequent disorder affecting the spine. In this chapter we first discuss briefly the indications for computed tomography or magnetic resonance imaging in suspected degenerative spine disease. We then describe changes of disc height, signal intensity, and disc contour with aging and repeated microtrauma, as well as the imaging techniques most appropriate to image them. A grading system for lumbar disc changes is provided. Stenosis of the canal and neural foramina is reviewed next, concluding with a description of degenerative changes affecting the vertebral endplates and bone marrow.

La lombalgie est lun des motifs les plus fréquents de consultation en première ligne. Bien quil faille éviter lacharnement diagnostique, nous devons être attentifs aux plaintes atypiques ou à la combinaison avec dautres symptômes. La radiographie standard de la colonne vertébrale lombaire est pratiquement toujours normale. Même si la tomodensitométrie est meilleure que la radiographie standard en termes de contraste et de résolution spatiale, sa valeur nest que limitée pour le diagnostic précoce de la spondylodiscite. LIRM est la technique de prédilection pour lexamen de la colonne vertébrale et du canal rachidien.

Lage rugpijn is een van de meest frequente aanleidingen voor een medisch consult in de eerste lijn. Hoewel diagnostische overkill misplaatst is, moeten we op onze hoede zijn bij atypische klachten of de combinatie met andere symptomen. Conventionele radiografie van de lumbale wervelkolom is vrijwel steeds obsoleet. Hoewel CT een beter ruimtelijk- en contrastoplossend vermogen biedt in vergelijking met standaardradiografie, is de waarde van een CT-scan voor de vroegtijdige diagnose van spondylodiscitis eveneens beperkt. MRI is de gouden standaard bij het onderzoek van de wervelkolom en het spinale kanaal.

A woman with systemic lupus erythematosus (SLE) presented with a tester eruption, Transverse myelitis developed at the site of the dermatomal distribution of the rash, SLE and varicella tester virus (VZV) can both cause myelitis, and are difficult to differentiate, The topographic association between the cutaneous and the neurological involvement suggesting VZV myelitis was confirmed by polymerase chain reaction (PCR) for VZV in the cerebrospinal fluid. This case illustrates the potential role of the selective amplification of VZV DNA in cerebrospinal fluid to diagnose central neurological complications associated with VZV. The value of magnetic resonance imaging of the spinal cord in the evaluation of patients with myelitis is emphasized.

A prospective study was undertaken to establish the normal spectrum of early gadolinium-enhanced magnetic resonance (MR) imaging findings in patients who had resolution of symptoms after lumbar discectomy. Thirty-four patients underwent MR examinations 6 weeks and 6 months after lumbar discectomy on a 1.5 T superconducting unit, including sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous administration of gadolinium-DTPA as well as sagittal turbo (or fast-) SE T2-weighted images. All patients showed soft tissue enhancement along the surgical track in the subcutaneous soft tissue lateral to the spinous process and in the epidural space. There was only minimal (45%) or no (55%) mass effect on the dural sac associated with epidural scar formation 6 months after surgery, but often the nerve root at the operative level was surrounded by this enhancing tissue. Facet joint enhancement was seen in most patients 6 weeks (63%) and 6 months (53%) after surgery. Intrathecal nerve root enhancement was observed in six patients, 6 weeks after surgery. Nine patients (20%) had residual mass effect on the neural elements with an enhancement pattern suggestive of a disc fragment. Enhancement of the intervertebral space was seen in 67% of patients 6 weeks after surgery and in 86% of patients after 6 months. It may be concluded that, despite the use of gadolinium-DTPA, MR studies obtained in the initial postoperative period are difficult to interpret, because of the normal sequence of changes. Consequently, the clinical picture still remains thr major indicator for recurrent surgery.

Diseases of the intervertebral disk may result from several multifactorial pathophysiologic processes. In this chapter, we discuss the normal anatomy of the intervertebral disk along with their anatomic variants and pathologic processes responsible for disk disease and their imaging correlates on conventional radiography, computed tomography, and magnetic resonance imaging.