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...
Donald Resnick, MD
Professor Emeritus, Department of Radiology
University of California, San Diego
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