What do the images reveal?

Jeffrey P. Johnson, M.D.

Portland Neurosurgery

April 26, 2018

Disclosures

• None

What do the images reveal?

• How I read a spine MRI

• What I look for

• Examples

• What do the images not reveal?

HOW DO I READ A SPINE MRI

How do I Not read a spine MRI

Written reports

Single images

Multiple small panels

Two Images, Two planes, side-by side,

with scout line

Active display of lumbar spine MRI

Highway analogy

Canal Subarticular Recess Foramen

Cauda Equina (or cord) Traversing nerve root (L5 at L4-5) Exiting nerve root (L4 at L4-5)

Least common/most serious Most Common Ganglion - ?Most painful

Highway Right lane, before exit Off Ramp

EXAMPLES

Subarticular recess stenosis

Foraminal stenosis

Foraminal stenosis

Disc Herniation – subarticular recess

Foraminal disc herniation

Spondylolisthesis

Degenerative disc changes

Cervical spine – cord compression

What do the images NOT reveal

• MRI and CT are not “Pain Detectors”

• Results are usually interpreted as “Abnormal”

The spine is not a “Static Structure”

Photo/Imaging might reveal

cosmetic/incidental issues

Cosmetic Issues may be unrelated to

machine dysfunction

Sagittal Balance

What does the spine machine do?

Summary

• Use active display, side-by-side, scout line

• Demonstrate 3D anatomy of spine

• Look for neural impingement

• Highway analogy – 3 locations

• Limitations – static images of dynamic structure