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MRI of Disc Herniation and Lumbar Stenosis

- Discussion:
    - MRI findings in normal subjects (from Boden-SD)
          - note that there is a 29% prevalence of disc herniation in asymtomatic individuals;
          - patients less than 60 years of age:
                 - 20 per % will have a herniated nucleus pulposus
                 - degeneration or bulging of a disc at at least one lumbar level in 35 % of patients less than thirty-nine years of age;
          - patients more than 60 years of age:
                 - 36 % of patients will have a herniated nucleus pulposus;
                 - 21 % will have spinal stenosis;
    - disc herniation:
          - MRI is emerging as the most accurate study for disc herniation;
          - disk herniation is characterized by extension of the disk beyond margins of adjacent vertebral bodies;
    - degernative changes: may be overestimated on T2 signal images;
    - diff dx:
          - disk space infection is characterized by abnormally high signal intensity w/in intervertebral disk & paraspinal tissues on T2 images;

- Type I Changes:
    - includes decreased signal intensity on T1 images & incr signal intensity on T(2) images;
    - associated w/ end-plate disruption and fissuring w/ ingrowth of vascularized fibrous tissue;
    - seen in about 5 % of pts who undergo MRI scanning for disk disease;

- Type II Changes:
    - characterized by incr signal intensity on T(1) images & slightly increased signal intensity on T2-weighted images;
    - seen in about 16 % of the patients;
    - these changes are assoc w/ fatty marrow replacement in vertebral body.

- Type III Changes:
    - sclerosis is caused by the presence of woven bone.
    - end-plate defect sometimes w/ Schmorl's nodules;
    - intravertebral disk herniation that can be associated with sclerosis w/ in the vertebral body adjacent to intravertebral herniated disk

MRI and discography of annular tears and intervertebral disc degeneration. A prospective clinical comparison.

Visualisation of symptomatic nerve roots. Prospective study of contrast-enhanced MRI in patients with lumbar disc herniation.

High-resolution MRI in the investigation of recurrent pain after lumbar discectomy.

Magnetic resonance imaging after pedicular screw fixation of the spine.

Current assessment of spinal degenerative disease with magnetic resonance imaging.

Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.

Magnetic resonance imaging of the lumbar spine in people without back pain.

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