Uncommon manifestations of intervertebral disk pathologic conditions

Felix E. Diehn, Timothy Maus, Jonathan M. Morris, Carrie Carr, Amy L. Kotsenas, Patrick H Luetmer, Vance T Lehman, Kent R. Thielen, Ahmad Nassr, John T. Wald

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Beyond the familiar disk herniations with typical clinical features, intervertebral disk pathologic conditions can have a wide spectrum of imaging and clinical manifestations. The goal of this review is to illustrate and discuss unusual manifestations of intervertebral disk pathologic conditions that radiologists may encounter, including disk herniations in unusual locations, those with atypical imaging features, and those with uncommon pathophysiologic findings. Examples of atypical disk herniations presented include dorsal epidural, intradural, symptomatic thoracic (including giant calcified), extreme lateral (retroperitoneal), fluorine 18 fluorodeoxyglucose– avid, acute intravertebral (Schmorl node), and massive lumbar disk herniations. Examples of atypical pathophysiologic conditions covered are discal cysts, fibrocartilaginous emboli to the spinal cord, tiny calcified disks or disk-level spiculated osteophytes causing spinal cerebrospinal fluid (CSF) leak and intracranial hypotension, and pediatric acute calcific discitis. This broad gamut of disease includes a variety of sizes of disk pathologic conditions, from the tiny (eg, the minuscule calcified disks causing high-flow CSF leaks) to the extremely large (eg, giant calcified thoracic intradural disk herniations causing myelopathy). A spectrum of clinical acuity is represented, from hyperacute fibrocartilaginous emboli causing spinal cord infarct, to acute Schmorl nodes, to chronic intradural herniations. The entities included are characterized by a range of clinical courses, from the typically devastating cord infarct caused by fibrocartilaginous emboli, to the usually spontaneously resolving pediatric acute calcific discitis. Several conditions have important differential diagnostic considerations, and others have relatively diagnostic imaging findings. The pathophysiologic findings are well understood for some of these entities and poorly defined for others. Radiologists’ knowledge of this broad scope of unusual disk disease is critical for accurate radiologic diagnoses.

Original languageEnglish (US)
Pages (from-to)801-823
Number of pages23
JournalRadiographics
Volume36
Issue number3
DOIs
StatePublished - May 1 2016

Fingerprint

Intervertebral Disc
Embolism
Discitis
Spinal Cord
Thorax
Intracranial Hypotension
Pediatrics
Osteophyte
Spinal Cord Diseases
Fluorodeoxyglucose F18
Diagnostic Imaging
Cysts
Radiologists
Cerebrospinal Fluid Leak

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Uncommon manifestations of intervertebral disk pathologic conditions. / Diehn, Felix E.; Maus, Timothy; Morris, Jonathan M.; Carr, Carrie; Kotsenas, Amy L.; Luetmer, Patrick H; Lehman, Vance T; Thielen, Kent R.; Nassr, Ahmad; Wald, John T.

In: Radiographics, Vol. 36, No. 3, 01.05.2016, p. 801-823.

Research output: Contribution to journalArticle

Diehn, FE, Maus, T, Morris, JM, Carr, C, Kotsenas, AL, Luetmer, PH, Lehman, VT, Thielen, KR, Nassr, A & Wald, JT 2016, 'Uncommon manifestations of intervertebral disk pathologic conditions', Radiographics, vol. 36, no. 3, pp. 801-823. https://doi.org/10.1148/rg.2016150223
Diehn, Felix E. ; Maus, Timothy ; Morris, Jonathan M. ; Carr, Carrie ; Kotsenas, Amy L. ; Luetmer, Patrick H ; Lehman, Vance T ; Thielen, Kent R. ; Nassr, Ahmad ; Wald, John T. / Uncommon manifestations of intervertebral disk pathologic conditions. In: Radiographics. 2016 ; Vol. 36, No. 3. pp. 801-823.
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