Devoted to diagnostic and interventional spine imaging and therapeutics


Imaging Spectrum of Metabolic Pathology in the Spine 2012

General Spine

Narayan, Viswanadhan, MD
Sherif, Saad, MD, Non ASSR Member
Christopher, Jones, MD, Non ASSR Member
Joyce, Li, MD, Non ASSR Member
Ryan, Lee, MD, Non ASSR Member



Metabolic pathology involving the spine is not an uncommon disease process that this encountered in routine clinical practice. Etiologies are vast, ranging from toxic, drug induced, endocrinopathies, nutrient deficiencies (i.e. B12/cobalamin), as well as a myriad of other disease processes. As the sequela of these metabolic conditions can be life threatening, it is critical that these entities be suspected early and the underlying etiology of the condition be promptly treated. Often, it is the radiologist that first provides insight as to this underlying disease process. Therefore, we will present a range of conditions that cause metabolic pathology in the spine and discuss their key features of their radiologic examinations.

Methods & Materials

Mutliple plain film, CT as well as 1.5 and 3T MRI images were reviewed over the past five years from multiple institutions.


We will highlight the myriad of metabolic pathology to the spine by showing (but not limited to)the following cases. 1) Subacute Combined Degneration (in a patient with B12 defiency). 2) Calcific Tendinitis of the Longus Coli (in a patient with hydroxyapatite deposition disease, with correlative imaging). 3) Brown Tumor (in a patient with renal failure and associated hyperparathyroidism). 4) Transverse myelitis (medication induced in a paitent with HIV). 5) Extrapontine Myelinolysis involving the cervical cord (related to metabolic correction of hypernatremia). 6) Agressive osteoporosis (in a patient with Cushing's syndrome). 7) Paget's disease of the spine (ivory vertebra) 8) Renal spondyloarthropathy 9) Amyloidosis


There are a wide spectrum of metabolic conditions that can lead to pathology in the spine, both wihin the spinal cord, but also involving vertebral column. It is essential for both the radiologist and the clinician to have a thorough understanding of this disease process and its imaging characteristics. We hope that by showing the various entities that can cause this condition, a greater insight and understanding of this disease process will be obtained.