Navigating the Adult Spine. Bridging Clinical Practice and Neuroradiology

201 Pages·2006·7.17 MB·English

by  Avital Fast

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BRIDGING CLINICAL PRACTICE AND NEURORADIOLOGY
Avital Fast, MD
Professor and Chairman
Department of Rehabilitation Medicine
Albert Einstein College of Medicine
Montefi ore Medical Center
Bronx, NY
Dorith Goldsher, MD
Director, MRI Institute and Neuroradiology
Department of Medical Imaging
Rambam Health Care Campus
and
Senior Lecturer in Medical Imaging
The Ruth and Bruce Rappaport Faculty of Medicine
Technion—Israel Institute of Technology
Haifa, Israel
Illustrations by Oliver Funk
Medicine is an ever-changing science undergoing continual development. Research and clinical experience
are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy.
The authors, editors, and publisher have made every e(cid:625)ort to ensure that all information in this book is
in accordance with the state of knowledge at the time of production of the book. Nevertheless, this does
not imply or express any guarantee or responsibility on the part of the authors, editors, or publisher with
respect to any dosage instructions and forms of application stated in the book. Every reader should care-
fully examine the package inserts accompanying each drug and check with a physician or specialist the
contraindications stated by the manufacturer. They may di(cid:625)er from the statements made in this book. Such
examination is particularly important with drugs that are either rarely used or have been newly released on
the market. Every dosage schedule or every form of application used is entirely at the reader’s own risk and
responsibility. The editors and publisher welcome any reader to report to the publisher any discrepancies or
inaccuracies noticed.
5
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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA
Fast, Avital, 1947–
Navigating the adult spine : bridging clinical practice and neuroradiology /
Avital Fast, Dorith Goldsher ; illustrations by Oliver Funk.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-888799-98-9 (hardcover)
ISBN-10: 1-888799-98-6 (hardcover)
1. Spine—Diseases—Treatment. 2. Clinical medicine. 3. Spine—
Abnormalities. I. Goldsher, Dorith. II. Title.
[DNLM: 1. Spinal Diseases—diagnosis. 2. Spinal Cord Diseases
—diagnosis. 3. Spinal Cord Diseases—therapy. 4. Spinal Diseases
—therapy. WE 725 F251n 2007]
RD768.F37 2007
616.7’3—dc22
2006020444
Designed by Steven Pisano
MANUFACTURED IN THE UNITED STATES OF AMERICA
06 07 08 09 10 5 4 3 2 1
This book is dedicated to our
families in gratitude for their
unwavering support.
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CCOONNTTEENNTTSS
Preface ix
Contributors xi
1 Anatomy of the Spine 1
2 Spinal Imaging 9
3 Disc Disorders 29
4 Acquired Spinal Stenosis 41
5 Spondylolysis and Spondylolisthesis 55
6 Spinal Infections 63
7 Spinal Cysts 73
8 Spondyloarthropathy 79
9 Rheumatoid Arthritis 85
10 Metabolic Bone Disease 93
11 Neoplastic Diseases 103
12 Paget’s Disease (Osteitis Deformans) 119
13 Vascular Disorders 125
14 Syringomyelia 135
15 Chronic Adhesive Arachnoiditis 139
16 Coccygodynia 143
17 Imaging of the Postoperative Degenerative Spine 147
Yizhar Floman
18 Spinal Injections and Minimally Invasive Procedures 165
Julian Sosner
Index 181
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PPRREEFFAACCEE
Physicians from wide-ranging disciplines such as physiatry,
gerontology, neurology, internal medicine, orthopedics, and
neurosurgery frequently encounter patients complaining of spinal
pain. Although most patients with neck or back pain do not require
a major workup, and their symptoms remit or resolve within a few
weeks, some su(cid:625)er from serious ailments that may compromise their
quality of life or result in permanent disability or death. For patients
with spinal disorders such as malignancy or infection, timely diagnosis
is critical and may improve the patient’s chances of recovery.
Diagnostic tools such as computed tomography (CT) and mag-
netic resonance imaging (MRI) provide important information that
enhance the physician’s ability to understand the origin of the patient’s
complaints and make the most appropriate therapeutic choices, be
they conservative or surgical. Frequently, however, X-rays, CT scans,
and MRI examinations are ordered and the reports provided from the
radiologist are read without the referring physician personally viewing
the actual images. On many occasions, only the radiologist’s conclu-
sions are read, while the full radiological report is ignored. Though this
approach may be expeditious, it does not assure the best possible care.
Ignoring the actual films may deprive the physician of key informa-
tion and lead to wrong therapeutic decisions. Furthermore, in many
instances the radiologist who interprets the films is provided with
scant clinical information or receives none at all. All he or she can do is
report what is seen without being able to correlate the neuroradiologi-
cal material with the patient’s clinical history and physical examina-
tion. As a result, the referring physician is frequently provided with
a “menu” of neuroradiological abnormalities a(cid:625)ecting various spinal
levels, many of which, or sometimes most of which, bear no clinical
relevance.
Careful clinical correlation between the patient’s history, physi-
cal examination, and imaging studies may help both the radiologist and
the referring physician identify the structures and processes respon-
sible for the patient’s symptoms.