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MR Imaging of Spinal Emergencies at a Level I Trauma Center 2007

General Spine

Corinne Liu, MD
Steven Lev, MD, Non ASSR Member

Scientific Poster

Exhibit Panels: 3

Purpose

The purpose of our exhibit is to demonstrate some of the highlights of our experience with acute spinal emergencies and to emphasize the importance of prompt radiological diagnosis to prevent further catastrophic injury.

Methods & Materials

We retrospectively reviewed MR/MRA imaging studies of patients with suspected spinal injury presenting through our emergency department during the past ten years. The findings on ancillary imaging modalities, including CT, CTA and myelography, when applicable, and also the pertinent clinical histories were examined. We discuss the key differentiating features of a vast assortment of lesions, and we incorporate a space-based approach to facilitate learning.

Results

In the intramedullary space, lesions most often were the sequelae of acute spinal cord compression, such as contusions and infarctions, as well as transverse myelitis. Emergencies in the intrathecal compartment included arachnoiditis, primary or secondary neoplasms causing compression, and hemorrhage produced by spinal vascular malformations. Differential diagnosis of entities in the epidural space may be enhanced by further subdividing this compartment. Anteriorly, we observed abscesses and phlegmons secondary to osteomyelitis-diskitis, assorted disc herniations and sequestrations, and the consequences of failed back surgery syndrome. Laterally, we noted post-traumatic pseudomeningoceles at the neural foraminae, as well as nerve root compressions by lateral disc extrusions, extension of synovial cysts, and conjoint roots. Posteriorly, cord compression was frequently produced by epidural lipomatous and traumatic or spontaneous hematomas. Although CT can better delineate the bony details of trauma to the vertebral column itself, MR offers the distinct advantage of pinpointing many of the associated soft tissue intraspinal injuries. In addition, MRA can help to diagnose secondary vascular injuries, such as vertebral artery dissection.

Conclusion

Spinal trauma can be devastating, especially if not promptly diagnosed and treated. Familiarity with and recognition of the many conditions and lesions that can be seen in the acute emergency setting can help minimize many of the long-term adverse consequences. Learning points include using a space-based analysis in the interpretation of spinal MR and to appreciate key differentiating radiological as well as clinical clues.