Reading a Mri of the Lumbar Spine
Acquire How to Read Your Lumbar MRI
If you don't similar reading, I have a YouTube video on "How to Read Your Lumbar MRI."
T2 Images | Slicing 101 | Sagittal Images | Axial Images | The Algorithm | The Quiz | Where Am I? | My YouTube Video on How to Read your MRI |
On this page, I will teach you the basics of how to read your MRI images for the well-nigh typical causes of chronic back and/or leg pain.
First, I will go over the pertinent lumbar anatomical structures as visualized on both sagittal (view from the side) and axial (view from underneath) MRI imaging, and then we will go over the typical presentations of some of the common pain-causing spine conditions.
However, before you read any farther, I strongly suggest that you visit the Disc Anatomy folio in lodge to learn or review the basic lumbar spine and disc anatomy. Why? Considering MRI and CT images are non nearly equally easy to read, when compared to the pictures/cartoons on the Anatomy folio. information technology volition definitely be tough going if you don't have that basic understanding before tackling this page!
One of the about challenging function of learning how to read your MRI, also just figuring out what the heck you're looking at, is figuring out what level you are at. I mean, are you lot looking at the L5 disc, the L4 disc, the L3 vertebral body? Professionals typically have expensive imaging software (similar PACS) which automatically tells yous via a cutting line; however, I volition assume that you don't accept such software and volition teach you how to effigy where you lot're at the quondam-fashioned style.
If y'all want to follow along, now might be a good fourth dimension to put your MRI disk into the computer and double-click on the T2 images in order to open them upwardly for viewing. There are many different types of viewing software out there, so yous're going to accept to play around with the one that came with your disk in order to go these images up and running—I'll leave that work to you. Or, if your tech savvy, you can download a program called Onis 2.5 (which is the same one I used during my coaching sessions) which is quite powerful and includes cut lines.
Alert: Never try to diagnose yourself using data gleaned from these pages. This information is for educational purposes just. Also remember it is very difficult for even primary health care providers to read a MRI, let alone the general public. If you're dislocated about your MRI findings or don't agree with the radiology report, why don't yous and I look over your images together during a GoToMeeting coaching session? Y'all can learn all well-nigh this coaching on my coaching service page.
You may also read what my by clients have said about my coaching service here: the testimonial page.
Encounter the T2 Weighted MRI Images:
At present I don't want to go as well complicated hither, merely for our purposes there are basically two types of MRI images that come on that MRI deejay of yours: T2 weighted images and T1 weighted images. And of these two image types, the T2 weighted images are the near valuable, so that's what nosotros'll start with.
Why commencement with T2 weighted imaging? Because T2 weighting accentuates inflammation and as we know from the other pages, that inflammation is frequently the "culprit" behind many pain-generating lumbar spine conditions. For example, a full thickness annular tear may sometimes cause a pocket of swelling and inflammation within the back function ( posterior and/or posterolateral part) of the disc which in turn shows upwardly on T2 weighted images every bit a region of "hyperintensity" (i.e., a region of brilliant white). This miracle is called a HIZ (high intensity zone) which, according to the medical literature database, frequently indicates the presence of a full-thickness annular tear that is painful upon pressurization during provocative discography. You can larn more well-nigh annular tear and the HIZ finding on my annular tear page.
With T2 weighting, yous tin can also see the nerve roots inside of the thecal sac and, in some cases, even the dural sleeves (aka, root sleeve) of the traversing nervus roots (left image). Such visualization may permit for the identification of some of the more than rare causes of chronic back and leg pain, such equally arachnoiditis, cancer or nerve tissue tumors.
The figure left is a T2-weighted axial image which is cut through the L5 disc. Note the very large and round thecal sac which is filled with cerebrospinal fluid (big purple star and extremely bright white). At 2 o'clock and 10 o'clock, you can see the traversing S1 nervus roots (larger red arrow is pointing at the reading-left one) which is likewise filled with cerebrospinal fluid (tiny purple star). This MRI is of such high quality you can actually see the sensory and motor nerve root with in the traversing nerve roots. finally, y'all tin also see the exiting L5 nerve roots (yellowish arrow).
Together, these three circular structures (the thecal sac, and the 2 traversing nerve roots) brand upward a "Mickey Mouse" appearance which is typically but seen at the L5 and sometimes L4 level.
Piddling shaky was what I simply said? Bank check out this labeled axial image which may assistance you understand the roots.
Slice & Die: What the heck does an MRI automobile do?
The MRI machine has the capability to re-create your lumbar spine, slice by slice, in iii planes: a view from the side (sagittal), front (coronal), and lesser-up (axial). Typically, the coronal series is non performed.
Unlike an x-ray machine which creates a compressed one-slice picture of the entire lumbar spine (it is like the spine was run over by a steamroller and smashed into one view), MRI (and CT) creates a sequential (in club) multi-slice series of images, which are typically taken from left to right, at intervals (aka: cuts or slices) of 3-5mm. Past employing this strategy, every nook and cranny of the lumbar spine is captured on at to the lowest degree one piece, which allows for the viewing of fifty-fifty the smallest of pathologies.
The effigy in a higher place is a T1-weighted MRI film of 12 sequential slices through the lumbar spine. This series of images could have hands been put into deejay format.
In order to aid you empathise this slicing concept of MRI technology, consider this analogy.
Upon your request, a deli worker will grab a log of salami (analogous to your torso), turned on the slicing auto (coordinating to an MRI motorcar), and, from ane of the ends, begin slicing off thin pieces of salami, which you can so employ for your sandwich.
Such slices of salami are coordinating to the axial MRI images.
I suppose you could put the salami log in the deli slicer lengthwise (not shown), which would give you sagittal slices of salami for a very long sandwich! These long slices of salami would be analogous to the MRI sagittal images.
Sagittal Images
The sagittal MRI images are hands downward the easiest to wait at and empathize. Every bit mentioned above, MRI re-creates the lumbar spine by producing a sequential series of images so that every part of the lumbar spine is captured in an orderly fashion.
There are three important sagittal regions that we need to discuss: the mid-sagittal region, the para-sagittal region and the foraminal-sagittal region.
Mid-Sagittal Region
As the name implies, the mid-sagittal region is composed of those few slices that were taken from the middle of the lumbar spine. For those of you who don't sympathize that judgement, let'due south use the samurai warrior analogy.
Pretend that a samurai warrior (figure 1) with a razor sharp sword is facing y'all. He raises his sword high overhead and so comes down with the sword, kickoff slicing through the crown of your head. Then the blade continues downward through the midline of the body passing between your eyes, through the bridge of your nose, through the breastbone, through the bellybutton, and finally through the symphysis pubis, which results in y'all existence cut exactly into two pieces.
If we looked at either side of the bisected lumbar spine, the view would be that of the mid-sagittal cut—a cut right down the middle.
Got the idea now? (Sorry for the gruesome analogy, but that seems to piece of work.)
Although only one cut will correspond the true mid-sagittal view (a cutting correct down the very center of the body), the mid-sagittal region technically extends laterally (to the side) until it totally encompasses the space that is occupied by the thecal sac. (effigy 6) [2] *I personally don't similar this rule, for thecal sacs come up in many dissimilar sizes (figure 7) and prefer to say the mid-sagittal region extends 7mm on either side of the true mid-sagittal cut.
How do you lot tell which sagittal prototype represents the truthful mid-sagittal cut? Merely scroll through the images until you find the i that has the largest looking spinal canal (black line on figure 2).
Figure 2 is a truthful mid-sagittal cutting through the lumbar spine, where the patient'due south belly button is to the left of the epitome and the back to the right.
There are ii main osseous (made of bone) structures that are clearly visible on the mid-sagittal view of a vertebra: the foursquare-shaped vertebral body of the vertebra (yellow outline) and the spinous process (blueish outline) of the posterior arch. The junction of the spinous process with the laminae make upward the anterior border of the posterior arch which besides forms the back of the central canal.This is covered with ligamentum flavum (Green L).
The extremely hyperintense space (almost pure white) between the vertebral bodies and posterior arch is the thecal sac (red T), which of course is filled with CSF. This structure may or may non completely fill the vertebral culvert, which is the space between the posterior vertebral trunk (Lead), pedicles, and lamina as represented by the black line I take drawn. Remember, this should measure twenty mm.
In the mid-sagittal view, the nervus roots of the cauda equina are typically not terribly visible (white-blue arrowheads) except as they go closer to their neuroforamina (non shown).
Situated between each of the v lumbar vertebral bodies, are the five lumbar discs (ruby-red outline & D) that carry about 80% of the axial-load of the torso and act every bit a pivot-point for trunk motion.
Clinically speaking, this view is ideal for picking upward a sometimes pain-producing condition called central stenosis, which occurs when the thecal sac gets squeezed and inflamed by a narrowed cardinal canal. (Learn more about central stenosis)
Para-Sagittal Region
As the name implies, the para-sagittal regions are composed of slices that are lateral to (to the outside of) the mid-sagittal region just medial to the offset of the neuroforamen.
How tin can you tell if a cut is out of the midsagittal region?
As noted on figure #3, you start to see the traversing nerve roots show upwardly (scarlet arrows). Retrieve that the transversing nervus roots are still within the contents of the thecal sac (the exception is at L5 where information technology has already budded out of the thecal sac).
When it becomes fourth dimension for the traversing nerve roots to do their task, they can be seen moving anteriorly in their oblique posterior to anterior, superior to inferior management. They cannot be seen, however, really emerging from the thecal sac on these views.
Another style that you can tell yous are away from the mid sagittal region is that the horizontal dimensions of the vertebral canal get progressively smaller. In fact, one time you hit the beginning of the intervertebral foramen (a.k.a. neuroforamen) zone (as we will see below) you tin can no longer see any vertebral canal.
The parasagittal region is very important for looking for potential pain generators. For example, lumbar disc herniations typically occur in the paracentral zone and are visualized on para sagittal cuts.
Symptomatic facet joint cysts are too typically found in the paracentral zone, simply they are plant more than posteriorly positioned as compared to a disc herniation.
In patients who accept degenerative spondylolisthesis, the inferior articular process frequently "guillotines" into this para sagittal region (– specifically, in the paracentral zone and/or proximal foraminal zone.
Within the lateral recess, the traversing nervus roots (the ones going down to the next vertebral level) are likewise vulnerable to posterior pinch past osteoarthritic change of the superior articular processes, a condition chosen lateral spinal stenosis. [2] (Learn more)
Figure three.ane is a cut through the para-sagittal zone / lateral recess that demonstrates a moderate-sized disc herniation (blood-red arrows).
Note the presence of a moderate -sized disc herniation at L4/5 (red arrows). If y'all look closely, y'all tin can likewise see the herniation touching 1 of the traversing nerve roots and even pushing information technology a little fleck off course (green pointer). This is sometimes chosen "tenting."
As we have learned on the disc herniation page, the "one-2 punch" of compression and inflammation can lead to an extremely disabling condition chosen sciatica (radicular pain is a ameliorate word to use if you're a medical professional. Y'all tin can learn more nigh sciatica on my sciatica page.
As you will learn (or may have already learned) on the Disc Herniation Page, disc herniations that are big enough to actually deviate a lumbar nerve root are non normally seen in asymptomatic patients [one] and are often problematic. the research indicates that approximately 30% of all adult humans without low back pain will accept a disc "protrusion." Remember, I disc protrusion is a small disc herniation (<4-5 mm). Simply bigger herniations, which are called "extrusions" and "sequestrations" are rarely present in asymptomatic people.
Foraminal-Sagittal Region
Every bit the proper name implies, the foraminal-sagittal region (a term not commonly used) is a region lateral to the para-sagittal region which encompasses the earth-shaking neural foramina (aka, intervertebral foramina, IVF, neuroforamina).
As you may recall from the Disc Anatomy Page, the neural foramina are bony openings located on either side of the spine that let the spinal nervus roots to exit the spine and behave their important data to every nook and cranny of the body.
The foraminal-sagittal region, which is typically represented by merely one slice, demonstrates some new beefcake that includes the exiting nervus roots (and sometimes even their accompanying claret vessels).
Figure 4 is a foraminal-sagittal cut that demonstrates the boundaries of the correct neural foramen (pinkish circle) quite nicely: The roof and flooring are created past the pedicles (P) (the strongest role of the vertebra) of the vertebra above and below, respectively. The posterior boundary is created by the superior articular process of the vertebra beneath, and the inductive purlieus is created by the disc and vertebral torso (VB).
Note that the neural foramina are hyperintense structures, secondary to their high fatty content (fat has a high water content and therefore glows white on T2 MRI). This color scheme provides a practiced background for the hypointense exiting nerve roots (reddish arrows).
Although disc herniations typically occur within the paracentral region of the spinal canal, they may likewise occur inside the neural foramina. These foraminal disc herniations (aka: far lateral disc herniations) tin can be especially troublesome, for not merely are they tough to achieve surgically, they may too compress the ultra sensitive dorsal root ganglia (DRG) of the dorsal lumbar nerve roots which typically live within these foramina. Such compression, which is still considered a class of lateral stenosis, may event in severe and debilitating radicular pain on the side affected.
Just as the lateral recess may become stenotic from a thickening of the superior articular process (function of the facet articulation), the neural foramen may also become stenotic from osteoarthritic thickening of whatsoever of the structures that create the bony hole.
Centric Images
Although the centric images are much tougher to become a handle on, they are very informative. For example, on these images you can see the exact location of facet cysts, disc herniations, stenosis, and fractures. Therefore, information technology is imperative that you understand them.
In add-on to the cafeteria slicer analogy previously employed, we can as well utilise the Lumberjack analogy to describe how the views are created by the MRI machine.
Let's pretend that your torso is a log lying face up in the wood. Ii lumberjacks detect you, pull out their crosscut saw, and go on to cut you upwardly, slice by piece. (figure 4) The resultant pieces of woods are analogous to the cuts that are seen when we scroll through the axial images on your MRI deejay, except these cuts are 3-5 mm thick, and not the 12-18 inches cuts that the lumberjacks would make.
Axial Anatomy: find the football and the wishbone!
As my coaching clients know, I like to begin teaching folks how to read axial images by having them look for the slingshot-similar posterior curvation and the football game-similar intervertebral disc. So, in gild to confirm that they are at the disc level, I have them look for the bright white thecal sac which should be betwixt the two structures. This educational activity method is what we volition now work on.
Figure 5 is a existent disc-level T2-weighted axial MRI prototype in which I take outlined the disc, (white) the thecal sac, (green) and the posterior arch (yellow). I take also colored the left neural foramen red and marked the right side of the image.
*Information technology is of import to note that all MRI and CT axial images, whether they exist on disk or film, are reversed with regard to sidedness—anything on the right of the image is in reality on the left. This is because nosotros are really looking up from beneath the slice and non downward from higher up.
In order to help train your eyes, I take placed two identical images on each side of the effigy. Beginning look at the image that is marked and written report the structures. So look at the unmarked image on the right and do visualizing those structures without the assistance of the lines that I have drawn. Keep going dorsum and along between the two images until yous experience very comfy that you don't demand the lines. At present mouse click through the axial images on your DVD and exercise finding the football and wishbone.
Okay, now information technology's fourth dimension to look at the structures more than in particular:
Figure half dozen is a cartoon of a typical lumbar T2-weighted axial image through the L4 disc. Got it down? see if you can pass the quiz that I give to my students (Take the Quiz)..
Annotation that the disc is composed of ii parts: the tough annulus and the Jell-O-similar nucleus, the latter of which is typically more hyperintense on T2-weighted MRI.
Because you are having back pain, the chances are adept that your discs are quite degenerated. Therefore, you probably will not exist able to meet the nucleus considering your entire disc volition exist blackness—an indication of DDD).
Annotation the parts of the posterior arch and the superior articular processes of the vertebra below (not visualized), which join the inferior articular processes at this level and form the facet joints.
Too annotation that the traversing L5 nerve roots (the ones destined for the neural foramina below this level) have not yet budded off the thecal sac. The exiting L4 nerve roots, even so, have clearly butted off the thecal sac and are coursing out the same-level neural foramen.
In reality, many of you volition not exist able to see all of these structures this clearly because the quality of MRI images varies greatly between MRI centers.
Disclaimer: remember folks, never second-guess the radiologist or your physician with any information you may glean from this tutorial! Over again, This material is for educational purposes just. Every bit I stated above, I practice offer a consultation service and I would be happy to go over your images and talk with yous about your own unique
The Inspection Algorithm
In gild to search your images for possible pain generators, I volition teach you lot a elementary algorithm that is to be used at every disc-level epitome.
Audit the Disc
Once y'all take found the desired disc level (learn how to find information technology desired level down below), brainstorm the algorithm by looking at the disc. Specifically, (we volition use effigy vii) carefully examined the posterior and posterolateral margins of the disc (yellow line), noting any focal outpouchings (prominent bumps) that may be present. If you come across one, then you're most likely looking at a disc protrusion. Practise y'all meet such an outpouching in figure seven? The respond is no.
Another pathology to await for is a full general jutting (i.e., a disc burl) of the back of the disc which can narrow the neural foramen and compress the anterior spinal culvert. Such narrowing can contribute to lateral and fundamental stenosis, respectively. What almost figure 7, do you lot see any disc bulging? The reply is no.
The concluding slice of disc pathology to look for (for our purposes) are indications of an annular tears. Delight recall from the annular tear page that an inflammatory process may occur in the posterior one-third of the disc following an annular tear into that region. This inflammatory process may prove upwardly as a region of dense hyperintensity (brilliant white) in the outer annulus. Can yous see an annular tear on this image? The respond is no.
Inspect the Neural Foramina and Thecal Sac
Next, permit'south look at both of the neural foramina in order to brand sure they are open and that no stenosis has occurred (i.due east., a constriction between purple lines of effigy seven).
Recall that the neural foramen may be narrowed anteriorly past osteoarthritic thickening of the posterolateral vertebral body, by a posterolateral disc herniation, or past a jutting disc. The foramen may besides be narrowed posteriorly by osteoarthritic thickening of the superior articular process. What nigh it, practice you see any narrowing of the foramina in figure vii? The answer is no.
Side by side, let's plough our attention to the thecal sac. Unremarkably the thecal sac should be symmetrically shaped into a shield-like configuration (figure vii) with the lumbar nerve roots visible and lined-up forth its periphery (this is certainly non e'er the instance).
The delicate thecal sac, withal, is vulnerable to compressive forces and may exist compressed by cardinal and paracentral disc herniations, osteoarthritic-thickening of the posterior vertebral body or laminae, or hypertrophy of ligamentum flavum. Any of the aforementioned compression mechanisms would result in primal stenosis.
Do you run across significant compression-related deformity of the thecal sac in figure vii? The answer is no.
Inspect the Posterior Arch
Although CT is the gilded standard for detecting fractures of the posterior arch, sometimes they are still visible on MRI.
Therefore, carefully inspect the posterior arch for signs of cortical disruption (breaks in the outlines of the wishbone), particularly at the region of the pars interarticularis, is imperative.
Also re-assess the "V" of the wishbone in guild to make sure that ligamentum flavum thickening or facet thickening is not compressing the thecal sac.
Finally, observe the human relationship between the superior and inferior articular processes in guild to ensure that at that place is sufficient coronal orientation of the facet joint.
Sometimes the facet joints may be orientated too sagittally, which tin allow frontwards slip to occur—a condition called degenerative spondylolisthesis. Learn more about this on the spondylolisthesis page. (read more)
What practise you think? How does the posterior curvation look in effigy seven? The answer is that it looks fine. At that place is some fat/tissue densities covering part of the correct posterior lateral facet region, merely that is completely normal. The facet joints are angled obliquely (which means they are coronal enough) and no cortical disruption is elucidated.
Disc Pathology: time for a quiz.
Think you got it downwardly? If so, it'southward time for one of my infamous quizzes:
#1) Do y'all take whatever thought what is going on here (figure 8)? Go through the algorithm I've shown you; what did you come up with?
Afterwards inspecting the posterior margin of the disc, y'all should have immediately noticed a focal outpouching (bump) of the posterior disc which is representative of a moderate-large disc protrusion (a.k.a. herniation) within the cardinal-right lateral recess. (click here to run across, red heart)
If yous missed information technology following the disc inspection, then you should have definitely caught information technology while you were inspecting the thecal sac, which is smashed in the right forepart region past the herniation.
Some other quiz question: is this a T2-weighted prototype?
The answer is no. Look at the thecal sac. Is it hyperintense (white)? No, it is hypointense (dark), which means information technology is non a T2 and most likely the T1-weighted prototype.
Finally let'south look at the neural foramina. How do they look? Notwithstanding the skillful-sized disc herniation, both lateral foramina are within normal limits and not compressed.
#2) Do you have any idea what is going on here (figure 9)?
How does the posterior disc margin expect? Well, in that location are no focal outpouchings (bumps); however, the unabridged disc is "bulging" backwards so that it has narrowed the neural foramina likewise as the central culvert. This condition is chosen, as you may have guessed, a jutting disc (disc bulge) without focal disc herniation.
What well-nigh the thecal sac? Kickoff of all, I threw you a curveball: this is not a T2 weighted image... right? The thecal sac is not bright white, just the but hypointense (dark). Therefore, for our purposes, it is a T1-weighted image. You should take also noted that the posterior arch is aberrant. Specifically, ligamentum flavum (LF) (which is usually barely seen) has greatly hypertrophied (second) and has compressed the posterolateral corners of the thecal sac. so what is this status called? Central stenosis.
#3) What's going on here? Go through your algorithm, and tell me what y'all come across?
The posterior and posterolateral contour of the disc are normal, for there is neither disc bulging nor disc protrusion. We cannot see the nucleus pulposus on this T2-weighted image, therefore the patient has degenerative disc disease (DDD).
As well, particularly noteworthy is the presence of a adequately hyperintense (white) flattened teepee-similar defect in the disc (remember, this should be black), which is indicative of a massive bilateral annular tear inside the annulus (click here to see, yellow arrows)
What about the thecal sac?
It looks pretty skilful equally information technology is symmetrical in shape and is non existence compressed or indented by anything. In fact, you tin clearly see the traversing nerve roots floating in the CSF without signs of compression. (click here to see, green arrows)
What about the neural foramina? Skillful job! They await fine and are wide open up. Can y'all come across the dorsal root ganglia? (Click hither to see, pink arrows)
And finally, what about the posterior arch? Information technology looks admittedly fine with no pregnant ligamentum flavum thickening, obvious fracture, or facet slip.
#iv) What's going on hither? Let'due south meet, the posterior and posterolateral contour of the discs seem to be okay.... are yous certain?
Most of you probably missed this one. If you look very closely you might see... something. I'll tell yous later.
What almost the thecal sac? This is clearly a T2 weighted paradigm (hyperintense thecal sac with scattered nervus roots {they don't ever lineup}) that shows a symmetrical and open up thecal sac;withal, the thecal sac is definitely contacted past the disc and at that place is some thickening of ligamentum flavum bilaterally. I would call this mild fundamental stenosis, merely that'due south the least of our worries.
What nearly the neural foramina? The right i looks fine (recollect, that is the left side of the image) but the left one as a big problem? Do you run into it now?
This is an example of a very large and left foraminal (a.k.a., far lateral) disc herniation that is inside the neural foramen. (Click here to see it) Wow! How could you miss that! You can even meet the faint outline of the annular tear which let loose this monster!
If this was missed on MRI, which happens more than oftentimes than you would like to believe, and a traditional microdiscectomy was performed, the surgeon would not have been able to visualize this region of the spine and would take missed seeing the massive herniation; the discectomy would take failed miserably.
Do you lot run into annihilation else on figure 11? Did you forget to bank check the posterior arch?
There is one more defect in the left posterior arch. Can you see it at present? (click here to meet it)
There appears to exist a fracture of the left lamina which is typically secondary to a previous discectomy/laminectomy.
Although you really need a case history here to find out what's going on. I don't run across whatever scar tissue in the epidural space, which would bespeak previous discectomy, and this defect is not through the pars interarticularis (the weakest office of the posterior arch). And then, at this point, the credo of this cortical disruption is unclear. (*I happen to know it was a fracture from a work-related injury, only you lot could never tell that by just looking at this picture alone.)
I hope you enjoyed the quiz and did well on it. Please come back here from time to time, for I plan on adding more questions in the not so afar future.
What Level Am I At? Final Axial lesson
At the first of this page, I promised that I would show you how to figure out what level of the spine you are at on the axial images without purchasing fancy software. So hither goes.
With your T2 weighted axial images open, scroll all the way down through the images until you come to the sacral base of operations, which looks like figure 12. If your MRI Center was as well lazy to become downwardly this depression, at least look for a pic that looks like this (click here).
Notwithstanding don't see it? So your MRI middle was either really lazy, or you lot're not looking difficult plenty. The simply other thing I tin can say is try scrolling all the way up through the images and look for T12, which typically has ribs attached to the vertebral body. If you know which management is up, and then you can scroll all the way downwards to the wider L5 lumbar vertebra (assuming the sacred base is not there).
Sacral Base Anatomy
The astute reader might have noticed that there is some dissimilar anatomy at this level. Of detail importance are the sacroiliac joints (SI joints) which are outlined with pink arrows. Arguably 5-10% of chronic difficult-to-diagnose low dorsum pain may be coming from inflammation of these joints, so they should not be overlooked during the assessment. Too note the sacral base, which is really the vertebral torso of the S1 segment. This is what the L5 disc sits on top of. The red arrows are pointing to the S1 traversing nervus roots, which will soon exit through the sacral foramen.
Moving On Up:
In Order to figure out what disc level you lot are at, always coil down to the sacral base and then merely piece of work your mode up through the images, from disc to disc, counting as you go. That's the fox: count each disc every bit you go and this way you will always know where you're at. I'll walk y'all through it:
Nosotros are at the sacral base on this DVD. (effigy 13)
Now first scrolling upwardly image by image:
The first mouse click brings us to 1up, where the anatomy hasn't changed too much. The second mouse click brings u.s. to the "2 up" image, where things accept definitely changed (you can see the right facet joint now {white arrows}). The 3rd mouse click brings us to "3 up" where the anatomy continues to change (the S1 traversing roots are only starting to bud off the thecal sac on this image). With the 4th click of the mouse, nosotros take reached "iv up" which is the L5 disc. (In reality, this MRI is of such high quality, that you can really see the L5 disc on ii up, iii upwards and 4 up).
Hopefully, you now have the idea of how to work your way up the spine and by counting the discs equally you go up, y'all will always know where y'all are.
Even so having problem? I will go upwardly one more level for you, and the rest of the fashion you're on your own.
One more mouse click brings y'all above the L5 disc onto the L5 vertebral body (1 up).
Another mouse click brings you to "2 up".
Two more mouse clicks brings you to "iv up."
Another ii mouse clicks brings you up to "6 up." Some other mouse click brings y'all up to "seven up."
And finally, one more mouse click brings you upwards to the "8 upwards" image of the L4 disc. Annotation, that it is blacker than the vertebral body. If information technology were a healthy disc, yous would see a hyperintense (white) nucleus pulposus.
I hope you lot've enjoyed this tutorial and again want to remind the reader that I practise offer a Coaching Service where I become over your MRI disk personally, create a PDF central image worksheet and email it to you, and finally speak with y'all on the phone (or Skype) for an hour regarding your MRI images and your electric current pain dilemma.
References
1) Boos N, et al. 1995 Volvo Accolade in clinical science: The diagnostic accuracy of MRI, piece of work perception, and psychosocial factors in identifying symptomatic disc herniations." Spine 1995; 20:2613-2625.
2) Botwin KP, et al. Lumbar spinal stenosis: beefcake in pathogenesis. Phys Med Rehabil Clin N Am 2003;fourteen:1-15.
Source: https://www.chirogeek.com/MRI%20READING/mriReading.html
0 Response to "Reading a Mri of the Lumbar Spine"
Post a Comment