More articles from SPINE
- Time to Reconsider Routine Percutaneous Biopsy in Spondylodiscitis?
Percutaneous image-guided biopsy, while valuable, is an invasive procedure, and evidence has shown rather disappointing positive microbiologic culture yields of around 33%. Recent evidence also has shown that percutaneous image-guided biopsy rarely adds any new information when blood cultures have positive findings and that an effective empiric treatment can be started in most of cases even when the microbiologic culprit remains unknown. Finally, there is currently no evidence that percutaneous image-guided biopsy improves patient outcome.
- The Restless Spinal Cord in Degenerative Cervical Myelopathy
Patients with degenerative cervical myelopathy show altered spinal cord motion with increased and ongoing oscillations at and also beyond the focal level of stenosis. Phase-contrast MR imaging has promise as a biomarker to reveal mechanical stress to the cord.
- Variability of T2-Relaxation Times of Healthy Lumbar Intervertebral Discs is More Homogeneous within an Individual Than across Healthy Individuals
Using prospectively acquired T2-relaxometry data from 606 intervertebral discs in 101 volunteers without back pain in a narrow age range (25–35 years), the authors calculated intra- and intersubject variation in T2 times of IVDs graded by 2 neuroradiologists on the Pfirrmann scale. Intrasubject variation of IVDs was assessed relative to other healthy IVDs (Pfirrmann grade, #2) in the same individual. Multiple intersubject variability measures were calculated using healthy extraneous references ranging from a single randomly selected IVD to all healthy extraneous IVDs, without and with segmental stratification. They conclude that the study demonstrates a significantly higher variation in the T2 times of IVDs across subjects, and suggests that normative measures based on the T2 times of healthy lumbar IVDs from the same individual are likely to provide the most discriminating means of identifying degenerated IVDs on the basis of T2 relaxometry.
- Cauda Equina and Filum Terminale Arteriovenous Fistulas: Anatomic and Radiographic Features
Intradural AVF below the conus medullaris may develop either on the filum terminale or the cauda equina (lumbosacral and coccygeal radicular nerves). Only 3 detailed cauda equina AVFs have been reported in the literature. The authors present the angiographic and MR imaging findings of cauda equina and filum terminale AVF cases, supplemented with literature research to characterize the radiologic features of the 2 entities. On angiography, filum terminale AVFs were invariably supplied by the extension of the anterior spinal artery accompanied by a closely paralleling filum terminale vein. Cauda equina AVFs were fed by either a radicular or a spinal artery or both arteries, often with a characteristic wavy radicular-perimedullary draining vein.