Lumbar Stenosis

Lumbar spine stenosis is most common in middle age and the elderly.Symptoms include pain in the lower back and lower extremities, limited movement, numbness and tingling , weakness. Most cases of lumbar stenosis is caused by degenerative and arthritic changes in the intervertebral discs, ligaments and the facet joints surrounding the lumbar canal. Men are affected more so than women. CT scans with or without intrathecal contrast is one diagnostic way to find stenosis. However,MRI is better at viewing soft tissue, the cauda equina, spinal cord, ligaments , epidural fat, subarachnoid space and intervertebral discs. Decompressive lumbar laminectomy is the surgical treatment for lumbar stenosis.This is a serious surgery with risks. Although around ninety five percent of patients find some level of relief and consider this to outweigh the risk. Lumbar bracing, bed rest, physical therapy and pain management are the non surgical treatments.
Figures 4A and 4B . (Left) Unenhanced T₁-weighted axial magnetic resonance scan at a lumbar level showing severe stenosis. The combination of ligament and facet joint hypertrophy concentrically reduces the diameter of the lumbar canal. The significant reduction in the relative amount of epidural fat and subarachnoid cerebral spinal fluid signal is further evidence of the degree of canal stenosis. (Right) Unenhanced T₁-weighted sagittal magnetic resonance scan of the lumbosacral spine showing severe canal stenosis at the L4-5 level, produced by a combination of disc herniation, spondyloarthritis and posterior element hypertrophy. Compare this stenosis with the moderate degree of stenosis observed at levels above. Mild spondylolisthesis is also evident at L5-S1. Magnetic Resonance Imaging

Chance Fracture

This is an image of a reformatted sagittal CT image of the lower thoracic spine. There is a horizontal fracture through the spinous process and pedicles. There is also a compression fracture of the vertebral body. These types of injures are seen in impact injures where hyperflexion has occured with lap seatbelt injuries. It is also seen in certain types of falls. The most common symptom is back pain. Half of the patients with this type of injury also have serious blunt injury to their internal organs. These are usually lower level of t-spine so spinal cord injury is rare. However, spinal nerve damage is common resulting in bowel and bladder problems. Treatment of these fractures are done with immobilization and surgical fixation.

Cervical Spine Dislocation.

This is a Sagittal MRI of a facet dislocation of C-7 on T1. Cervical fractures and/or dislocations occur when injuries applied to the cervical spine are greater than the strength of the vertebral bodies or the the supporting ligaments. Subluxation or dislocation occur when there is a disruption in the posterior soft tissue supporting ligaments. These can occur with or without neurologic injury, depending on the extent . Sometimes the initial diagnosis is made by plain radiographs of the lateral c-spine in flexion and extension. This should only be done in the presence of a spine surgeon and in a patient who is awake.

Bow Hunter Syndrome

This pathology interested me because of the name Bow Hunter's Syndrome. My husband is a bow hunter, so it caught my attention. It is when the vertebrobasilar artery is occluded or there is stenosis of one VA. It can occur at any level of the cervical spine. Certain spinal abnormalities, like osteophytes, put pressure on the vertebral arteries at the back of the upper neck where the arteries enter the brain. This results in the blood flow being compromised to the brain which can result in a stroke. It is usually caused by a certain head rotation which causes the VA to be susceptible to compression by muscles,fibrous ligaments or other bone structures during a particular rotation of the head. Apparently, in 1978 Dr. Sorensen had a patient who showed vertibrobasilar insufficiency when practicing archery, thus the name Bow Hunter's Syndrome.
Symptoms include headaches, nausea, vomiting, blurred vision, deafness, dizziness, syncope, vertigo and "drop attacks" which are episodes of falling to the ground without losing consciousness.

3-D CTA, Computed Tomography Angiography and/or MRA, Magnetic Resonance Angiography are two methods in diagnosing Bow Hunter's Syndrome. Studies have found that 3-D CTA has several benefits in diagnosing and treatment options. It allows great visualization of the anatomical relationship between vascular lesions and surrounding bone structures. It provides multiple projections of the anatomic complexity of the vascular structures. It also provides useful information regarding surgical options and approaches.

Neck immobilization is sometimes used for treatment. The downfall to this is the restrictions of lifestyle for the patient. Direct surgical decompression is usually the treatment of choice to try and alleviate the symptoms as well as the problem.

Lyphandenopathy

Lymphadenopathy is a disease of the lymphnodes whether by inflammatory cells or neoplastic cells. Our lymphnodes have a full time job filtering lymphatic fluids of harmful particles before entering our venous blood supply. There are many things that humans can be exposed to are thought to cause different forms of lymphadenopathy. Certain insect and animal bites, infectious contacts, environmental exposures such as tobacco, alcohol, ultraviolet radiation and chronic use of medications are just a few things thought to attribute to lymphandenopathy.
This subject interests me because my own father was diagnosed with Lymphoma in 2003-04. I have learned that people with autoimmune deficiency diseases are more susceptible to lymphandenopathy. My father was diagnosed with rheumatoid arthritis (autoimmmune disease) at the age of 43, which would explain the later diagnosis of lymphoma. However, I also believe the potent and sometime chemo related drugs he took for years to function, aided in his diagnosis of lymphoma. Significant fever, night sweats, muscle weakness, unusual rashes were just a few of his symptoms that would strike at unrelated times.
Lymphadenopathy is described as a node larger than one centimeter , although some nodes larger that 5mm are considered abnormal depending on location. Nodes of a lymphoma patient are firm, fixed and rubbery, while inflammed nodes from a non specific infection are painful, tender nodes that are usually bilateral and mobile.

Arteriovenous Malformations

AVM's are masses of abnormal blood vessels that can grow in any area of the brain or other parts of the body. AVM's are very rare and occur in only one percent of the population. Even though the cause is not known, it is suspected they are present at birth due to abnormal development of blood vessels in utero. They are not cancerous and do not spread to other parts of the body. They are usually discovered between the ages of twenty to forty. These masses eventually hemorrhage. When this happens, it can damage the surrounding tissues in the brain , resulting in a stroke. Permanent brain damage, disabilities and even death are effects of a bleed. Symptoms of an AVM are headaches, seizures or stroke like symptoms. However, an AVM can be present in the body and show no signs or symptoms.

Treatment options include surgery depending on location of the AVM. Radiation treatments have an eighty percent success rate in shrinking the AVM for a period of two to three years. Complications are low with this type of treatment. Embolization is another type of treatment that consists of a small catheter placed into the brain vessels to the AVM. A liquid type glue is injected into the vessels blocking the AVM off. This type of treatment is usually combined with radiation or surgery.

Here is a few radiography pictures of an AVM.

Juvenile Angiofibroma

Coronal CT scan of lesion filling left nasal cavity and ethmoid sinuses blocking maxillary sinuses and deviating septum to the right side.
Media type: CT

Media file 2: Axial CT scan of lesion involving the right nasal cavity and paranasal sinuses. Courtesy of J Otolaryngol 1999;28:145.
Media type: CT

Media file 3: Coronal MRI scan showing extension of the lesion to the cavernous sinus.

Angiofibromas are most common in adolescent boys. The average age being fifteen. There is a theory that it originates from hormonal activity. It is a non cancerous growth of the back of the nose or upper throat. The problem with an angiofibroma is that it continues to grow and can damage facial bones and sinuses. Symptoms of angiofibromas are frequent nosebleeds, stuffy nose or difficulty breathing, chronic nasal discharge and sometimes hearing loss. The best way to detect an angiofibroma is by CT. If the benign tumor is causing bone damage, surgery may be necessary to remove it. If chronic nosebleeds are the problem, embolization can be performed to prevent the tumor from bleeding. In some cases, the tumor can expand into the cranium or ocular orbit. Radiation therapy would be the treatment of choice to temporarily halt the growth of the tumor. Some angiofibromas disappear on their own. However, many continue to grow and can even return after surgery is performed.