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Degenerative and Inflammatory Disorders of the Vertebral Column: Imaging – Pathologic Correlation, Dr. Donald Resnick, 03/03/22

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Hello and welcome to Noon Conferences hosted by MRI Online. Noon Conference

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was born out of the pandemic to keep the radiology community connected with

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free live conferences and make learning accessible from anywhere. You can

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access the recording of today's conference and previous Noon Conferences

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by creating a free MRI Online account. The link will be provided in

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the chat box. You can also sign up for a free trial of

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MRI Online premium membership to get access to hundreds of cases across

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all key radiology subspecialties. Learn more at mrionline.com. Today, we're

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honored to welcome Dr. Donald Resnick for a lecture on degenerative and

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inflammatory disorders of the vertebral column, imaging pathologic correlation.

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Dr. Resnick has partnered with MRI Online and several international colleagues

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to develop a four day virtual live conference on March 24th to March

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27th on the topic of synovial joints. As a participant in today's Noon Conference

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lecture, you are eligible for a 10% discount on registration. See the chat

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box for more information. We are grateful for Dr. Resnick's contributions

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to MRI Online and the global radiology community.

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At the end of the lecture, join Dr. Resnick in a Q&A session

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where he will address the questions, as you may have, on today's topics.

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Please use the Q&A chat feature to submit your questions,

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and we will get to as many as we can before our time

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is up. With that being said, we welcome you. Dr. Resnick,

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please take it from here. Thank you very, very much.

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It is a privilege for me to be here and talking to

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people, I gather from various parts of the world. So, good morning,

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good afternoon, good evening. I picked the topic for a number of reasons.

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Number one, it's a very common problem that we deal with,

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and that is to image patients who have pain in their back,

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dealing with degenerative or less commonly inflammatory disorders of the

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vertebral column. But let me also indicate why I like this particular topic.

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I went into musculoskeletal imaging, well, decades ago, as many of you know,

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and it was prior to the appearance of MRI on the scene,

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and so I chose musculoskeletal imaging because of conventional

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radiography. As I travel around the world and I lecture, I'm often asked

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to give talks on MRI imaging of the musculoskeletal system. But it's nice

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to have the opportunity to talk a little bit about conventional radiography.

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I will show you some MRI images as well.

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And in addition, this particular talk allows me to use a technique that

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really we developed years ago, and that is to correlate the imaging features

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with what we see pathologically, particularly growth specimens.

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And I think that's important because if you understand

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pathology, you understand the way it appears on the imaging study.

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So with that said, let's start with my three general objectives. The first

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of these is to review some of the important rheumatologic disorders that

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involve the spine and the sacroiliac joint, emphasizing that technique of

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imaging pathologic correlation. The second of my three objectives is to

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stress the distribution of sacroiliac joint involvement in a number of disorders,

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and we'll use ankylosing spondylitis as our prototype or point of reference.

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And then finally, in the last few minutes of this particular lecture,

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what we will deal with will document a number of disorders that involve

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the spine, especially the upper spine, the cervical region. And here,

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we'll use rheumatoid arthritis as our point of

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reference. So, let's start with some anatomy. And what I'm showing you is

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a drawing I made of a discovertebral junction. And you can see here

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on a lateral perspective that we have two vertebral bodies separated by

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an intervertebral disc. Each vertebral body has an elevated rim and a central

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depression. The central depression is covered by a cartilaginous endplate.

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As you all know, each intervertebral disc has a rather central portion,

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the nucleus pulposus surrounded by concentric fibers that we designate the

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annulus fibrosus, abbreviated AF in this particular drawing. Now, there's

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one aspect of the annulus fibrosus that's gonna become important during

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my lecture, and that is the existence of very strong outer fibers.

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They have a name, we call those Sharpey's fibers,

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and those fibers will, in fact, anchor the intervertebral discs to the anterior

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and lateral surfaces of the vertebral bodies. In the top right,

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you can see with the arrows, those Sharpey's fibers. So let's make an

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important point about their anatomy. Those fibers attach not to the tip

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of the vertebral body, but several millimeters away from the tip.

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That's gonna become important when we talk about bone outgrowths that involve

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the discovertebral junction. There are two degenerative diseases that involve

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the intervertebral disc. The names are complicated, the names are not important,

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but the concepts behind these diseases are important. Intervertebral osteochondrosis,

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a fancy name for a degenerative disease that tends to begin within the

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nucleus pulposus of the intervertebral disc. I'll talk about that

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in a moment. The second, again, with a fancy name, is spondylosis deformans.

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And although there's a bit of a debate about the precise pathogenesis of

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the morphological alterations that occur in this disease, most people believe

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it begins in the outer fibers of the annulus fibrosus. And indeed,

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we'll talk about that disease as well. So let's begin by talking about

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the first of those two degenerative diseases; intervertebral chondrosis

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or osteochondrosis. The bad news is, it's gonna go on in most of

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you who are listening to my particular lecture today as you get older.

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The basic pathology is, as we age, there is dehydration

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and desiccation within the nucleus pulposus. Those changes create abnormal

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spaces within the nucleus, and gas, principally nitrogen

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from surrounding tissue collects within those spaces. The gas produces a

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radiolucency. We all recognize it. We know it as a vacuum phenomena, shown

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here. It begins in the nucleus, but soon as the clefs extend out

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into the annulus, the vacuum also extends to the periphery of...

Report

Description

Faculty

Donald Resnick, MD

Professor Emeritus, Department of Radiology

University of California, San Diego

Tags

Musculoskeletal (MSK)

MSK

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