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Beyond Spondylosis: Imaging Of Uncommon Causes For Back Pain And Weakness 2014

Category General Spine Peachy Mae T. Piana, MD Roger Liu, MD Nancy Ibrahim, MD Brooke Devenney-Cakir, MD Joyce Y. Li, MD Purpose Back pain and weakness are common complaints in the primary care office and emergency department. While the patient's history and physical exam remain critically important in the initial assessment, non-classic signs and symptoms as well as unreliable physical exams often make diagnosis difficult. Imaging serves an important role in the prompt recognition of spinal pathologies, minimizes permanent loss of function, and guides treatment. Although spondylosis is a major contributor to morbidity of nontraumatic back pain, there are less common etiologies that can clinically mimic spondylosis. We discuss several nontraumatic disease processes for back pain and weakness in this educational exhibit. Materials & Methods A review of spinal imaging in our PACs system for nontraumatic pain and radioculopathy yielded numerous cases of nonspondylotic disease processes. In this exhibit, we review a spectrum of etiologies that can clinically mimic spondylosis. They can be divided into infectious, inflammatory, vascular, neoplastic, and metabolic etiologies. Results The etiology of non-traumatic non-spondylotic back pain and weakness include infectious, inflammatory, vascular, neoplastic, and metabolic disease processes. We present nontraumatic spondylosis mimics encountered in our medical center and highlight pertinent imaging findings in this pictorial review. These include infectious (discitis-osteomyelitis, epidural abscess and phlegmon), inflammatory (sarcoidosis, Guillain-Barre, and neuromyelitis optica), vascular (hematomas, dural AVF pre- and post-treatment, epidural AVF, and spinal cord infarct), neoplastic (meningioma, schwannoma, myxopapillary ependymoma, and plasmacytoma), and metabolic (Vitamin B12 deficiency and amyloidosis). We outline various teaching points to the cases such as looking at the edge of the image and beyond the obvious spondylotic findings of the spine, and highlight classic imaging findings of these disease processes. Beyond Spondylosis- Imaging of uncommon causes of back pain and weakness.pptx Conclusion With prompt recognition of imaging findings of nontraumatic spinal pathology, we can alert our clinical colleagues to institute early treatment and potentially reverse devastating, long-term neurological deficits. Recognition of nonspondylotic etiologies of back pain and neurological deficit can also potentially avert unnecessary spinal surgery and improve patient outcome. References Byun WM et. al. Guillain-Barré syndrome: MR imaging findings of the spine in eight patients. Radiology. 1998 Jul;208(1):137-41. Clarot F, et. al. Giant Cervical Epidural Veins after Lumbar Puncture in a Case of Intracranial Hypotension. AJNR. 2000 Apr;2(4)1:787-9. Koeller KK, et al. Neoplasms of the Spinal Cord and Filum Terminale: Radiologic-Pathologic Correlation. Radiographs. 2000 Nov-Dec;20(6):1721-49. Smith JK, et. al. Imaging Manifestations of Neurosarcoidosis. AJR. 2004 Feb;182:(2) 289-95.