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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 3 min.
36 topics, 3 hr. 17 min.
Introduction to Degenerative Spine Disease
6 m.MRI Pulse Sequences for Degenerative Spine Disease
7 m.Anatomy of an Intervertebral Disc
4 m.Pulse Sequences For Lumbar Spine Imaging
10 m.Nomenclature of Intervertebral Disc Disease
12 m.Disc Protrusions vs. Extrusions
8 m.Disc Sequestration
8 m.Reporting of Lumbar Spine Degenerative Changes
14 m.Case of Lumbar Spine Degenerative Disc Disease
11 m.Case of Disc Protrusion
5 m.Appropriate Reporting of Spine Degenerative Changes
7 m.Describing Disc Protrusion Location and Important Features
4 m.Analyzing a Disc Extrusion
3 m.Foraminal/Far-Lateral Disc Herniation
5 m.Cervical Spine Disc Extrusion
8 m.Annular Fissure
3 m.Contained vs. Uncontained Disc Herniation
7 m.Terminology for Herniation Location
4 m.Modic Classification of Degenerative Marrow Changes
9 m.Modic Type 1 Endplate Changes
3 m.Identifying an Annular Fissure
3 m.Modic Type II Endplate Changes
4 m.Differentiate Postoperative Scar vs. Recurrent Herniation
8 m.Identify Common Causes of Spinal Canal Stenosis
7 m.Grading and Common Causes of Spondylolisthesis
7 m.Spondylolisthesis Secondary to Spondylolysis
3 m.Synovial Cyst
4 m.Clinical Importance of Posteriorly Projecting Synovial Cyst
3 m.Common Causes of Acquired Stenosis
6 m.Ossification of the Posterior Longitudinal Ligament (OPLL)
6 m.Diffuse Idiopathic Skeletal Hyperostosis (DISH)
3 m.Role of CT for the Identification of OPLL
5 m.Association of OPLL and OLF
3 m.Evaluation of Uncovertebral Joints
2 m.Uncovertebral Degenerative Disease and Foraminal Narrowing
4 m.Other Causes of Low Back Pain and Spinal Canal Stenosis
8 m.0:00
This is a patient who had nonspecific back
0:04
pain that was bilateral and a little bit worse
0:08
on the left side than the right side.
0:11
As you scroll through the
0:13
sagittal STIR images,
0:16
what strikes me is a little bit of narrowing
0:19
of the spinal canal at the L4-L5 level,
0:22
with some element of decreased
0:26
signal intensity within the disc.
0:27
There may be a slight anterolisthesis
0:30
of L4 with respect to L5.
0:34
However, as you go further laterally,
0:36
you come to the facet joint.
0:39
And what one identifies here is high signal
0:42
intensity in the synovium of the facet joint
0:44
with something which is projecting posteriorly
0:47
from that facet joint.
0:49
If we look on the contralateral side,
0:51
we see the same phenomenon.
0:53
High signal intensity between the superior facet of
0:59
L5 and the inferior facet of L4,
1:01
which appears to communicate with
1:04
a cystic area more posteriorly.
1:07
These two are synovial cysts.
1:12
They are posteriorly projecting synovial cysts.
1:15
So just as you can have a synovial cyst that
1:18
will go anteriorly and potentially indent the
1:21
thecal sac and/or the exiting nerve roots,
1:24
you can have synovial cysts that project posteriorly.
1:27
On the axial scan, if I do the localizer again
1:31
and we come to that level,
1:33
you'll notice the bright signal intensity
1:35
synovium of the facet joint,
1:38
the overlying thickened ligamentum flavum.
1:41
Again, which sort of begs the question,
1:42
how can that synovial cyst get through that
1:44
thick ligamentum flavum?
1:46
In this case, however,
1:48
what we are seeing are bright signal intensity
1:52
cysts that are projecting posterior to the
1:55
facet joint, again, associated with,
1:59
as you saw, with a connection here, with that
2:04
synovium and extending posteriorly.
2:07
This is through the left side.
2:10
So this is a source of back pain.
2:13
It is something that should and could
2:15
be treated. They could be drained.
2:18
You can do facet blocks and reduce the
2:22
irritation or inflammation, or pain associated
2:25
with the inflamed facet joints.
2:29
But it is something that's worth reporting
2:31
because this, as I said,
2:33
could be that source of back pain as opposed
2:37
to focusing too much on the disc bulges or
2:42
disc herniations in this individual.
Interactive Transcript
0:00
This is a patient who had nonspecific back
0:04
pain that was bilateral and a little bit worse
0:08
on the left side than the right side.
0:11
As you scroll through the
0:13
sagittal STIR images,
0:16
what strikes me is a little bit of narrowing
0:19
of the spinal canal at the L4-L5 level,
0:22
with some element of decreased
0:26
signal intensity within the disc.
0:27
There may be a slight anterolisthesis
0:30
of L4 with respect to L5.
0:34
However, as you go further laterally,
0:36
you come to the facet joint.
0:39
And what one identifies here is high signal
0:42
intensity in the synovium of the facet joint
0:44
with something which is projecting posteriorly
0:47
from that facet joint.
0:49
If we look on the contralateral side,
0:51
we see the same phenomenon.
0:53
High signal intensity between the superior facet of
0:59
L5 and the inferior facet of L4,
1:01
which appears to communicate with
1:04
a cystic area more posteriorly.
1:07
These two are synovial cysts.
1:12
They are posteriorly projecting synovial cysts.
1:15
So just as you can have a synovial cyst that
1:18
will go anteriorly and potentially indent the
1:21
thecal sac and/or the exiting nerve roots,
1:24
you can have synovial cysts that project posteriorly.
1:27
On the axial scan, if I do the localizer again
1:31
and we come to that level,
1:33
you'll notice the bright signal intensity
1:35
synovium of the facet joint,
1:38
the overlying thickened ligamentum flavum.
1:41
Again, which sort of begs the question,
1:42
how can that synovial cyst get through that
1:44
thick ligamentum flavum?
1:46
In this case, however,
1:48
what we are seeing are bright signal intensity
1:52
cysts that are projecting posterior to the
1:55
facet joint, again, associated with,
1:59
as you saw, with a connection here, with that
2:04
synovium and extending posteriorly.
2:07
This is through the left side.
2:10
So this is a source of back pain.
2:13
It is something that should and could
2:15
be treated. They could be drained.
2:18
You can do facet blocks and reduce the
2:22
irritation or inflammation, or pain associated
2:25
with the inflamed facet joints.
2:29
But it is something that's worth reporting
2:31
because this, as I said,
2:33
could be that source of back pain as opposed
2:37
to focusing too much on the disc bulges or
2:42
disc herniations in this individual.
Report
Description
Faculty
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
Tags
Spine
Non-infectious Inflammatory
Neuroradiology
Musculoskeletal (MSK)
MRI
Acquired/Developmental
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