A comparison of radiographic signs of degeneration to corresponding MRI signal intensities in the lumbar spine.

OBJECTIVES: To evaluate plain film radiographic findings of lumbar intervertebral disk degeneration. DESIGN: A cross-sectional observational design was employed. Contingency tables were constructed to evaluate the relationships between radiographic findings of degeneration and the corresponding MRI signal intensities of the inner intervertebral disk. SETTING: Twenty-four consecutive cases were retrospectively selected from an MRI imaging center. PATIENTS: No exclusion was made on the basis of age or sex. MAIN OUTCOME MEASURES: Radiographic findings of IVD degeneration include: Narrowed disk space, osteophyte formation, end-plate sclerosis, vacuum phenomenon, end-plate irregularity and Schmorl's node formation. The inner IVD signal intensity of the sagittal T2-weighted MRI image was visually categorized by three radiologists. The signal intensities were divided into low, medium and high categories. MAIN RESULTS: Visually reduced disk height, osteophytes and eburnation all demonstrate significant relationships with MRI signal intensity. Due to their infrequency, no significant relationships could be found with vacuum phenomena, end-plate irregularity, and Schmorl's nodes when compared to MRI signal intensity. CONCLUSIONS: In conclusion, visually reduced disk height is frequently associated with decreased signal intensity and, therefore, significantly indicates internal disk derangement. Osteophytes are more commonly present when the signal intensity is low. However, high signal intensity is associated with osteophytic change as well. Therefore, osteophytic change is less sensitive and accurate to early inner disk degenerative change. When osteophytes and reduced disk height are present together, a stronger prediction of degeneration is possible then when either finding is present alone. Due to their infrequency, eburnation, vacuum phenomena, end-plate irregularity and Schmorl's nodes are less helpful indicators of degeneration.

Hyperostosis of lumbar spinous process: a radiological feature in a young acromegalic.

Hyperostosis of the spinous process may be associated with diffuse idiopathic skeletal hyperostosis, Baastrup's disease or acromegaly. Radiological differential diagnosis between them are discussed. No case of hyperostosis of the spinous process has been described clinically or radiologically in young acromegalics. This case represents another manifestation of spinal involvement of acromegaly. Coincidentally, the enthesopathy could also be seen clearly in the middle and proximal phalanges in this young patient. Physicians treating spinal diseases should be aware of chronic backache due to the microtrauma of "kissing" hyperostosis of spinous processes, especially in posterior weight-bearing patients. Hyperostosis of the spinous process, platyspondyly or scalloping of posterior vertebral body, when present alone, is not a diagnostic criteria for acromegaly. But their coexistence in a vertebra is pathognonomic and may serve as an additional diagnostic criteria for acromegaly, especially in young adults.

Cervical spondylotic myelopathy: a case report.

A case of cervical spondylotic myelopathy is presented, and the literature reviewing its etiology is discussed. Computed tomography is believed to be the most accurate method to use in order to confirm a diagnosis of cervical spondylotic myelopathy. Manipulation of the cervical spine is contraindicated for this condition.

Atypical presentation of ankylosing spondylitis: a case study.

Ankylosing spondylitis (Marie Strumpell's disease) is a chronic inflammatory disease which principally affects the axial skeleton. The earliest radiographic sign in 90% of the patients with ankylosing spondylitis is a bilateral sacroiliitis. Up to 3% of the patients with ankylosing spondylitis will not present with the initial sacroiliitis. A case is reported of a patient with an atypical presentation. The patient's radiographic presentation consisted of syndesmophytosis without sacroiliac involvement. However, due to the patient's symptoms, radiographic appearance, and laboratory studies, the diagnosis of an atypical ankylosing spondylitis was chosen.

A review of radiographic differential diagnosis of common degenerative spinal disorders.

Radiographic criteria for the diagnosis of degenerative spinal conditions is discussed and reviewed. Pathophysiological aspects are correlated with plain film radiography and Multiplanar Reconstructive Computerized Tomography to provide the practitioner with information relative to better diagnostic capabilities when dealing with common spinal disorders.