MRI
Infection
- T1
- Body – dec
- Disc – dec
- Destruction of margin between body and disc space
- T1 fat suppressed with Gad
- Abscess is dark with rim enhancement (due to hypervascularity)
- Gadolinium – ring enhancement
- Contrast, fat suppression and evaluating appearance of disk, endplates, epidrual space and paraspinal tissues will differentiate infection from degenerative and tumour
- T2
- Body – dec
- Disc – inc (brught signal because free water due to pus)
- Pattern – infection; DISC-centric lesion
Tumour
- T1 – dec
- T2 – inc
- Increased both in: Hemangioma + Chordoma
Degenerative
- Modic Type 1
- Vascular, inflammation, edema
- No trabecular damage or marrow change
- T2 – disc hypointense
- Modic Type 2
- Trabecular damage
- Fatty replacement of marrow (marrow replaced by visceral fat)
- Modict Type 3
- Trabecular fractures with trabceular shortening and widening
- T1 – hypointense
- T2 – hypointense disc
Disc Destruction
- Infection
- Inflammatory
- Degenerative
Decompression in setting of infection
- Discectomy is more dangerous – annulus is degenerated
- Pituitary can punch through the front
- Not an en-bloc resection
- Not aggressive in the front
- Laminectomy with a bit of the posterior part of the body off
- It will autofuse the
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