Post Surgical Spinal Evaluation

One of the most challenging areas of diagnosis is to be found in acquiring and interpreting medical images in the patient who has undergone lumbosacral surgery for spinal degenerative disease. The section illustrates the features of expected and abnormal postsurgical spinal imaging. These discussions provide the background, practical information, and graphic examples necessary to enable the medical imaging physician to better approach the clinicoradiologic evaluation of the postsurgical patient.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145202/1/cpmia0808.pd

Resurrection

Growing up on a farm that has been in my family since 1849, I gained an admiration and reverence for the land that so many of my family members have worked. Like ghosts or spirits that walk the place, monument-like markers exist, signifying the actions and lives of those who came before me. A tractor may remain parked as it has been for years since the last time it was driven. A broken crock full of metal now slowly sinks into the earth under years of maple leaves fallen from the massive trees that my grandfather planted when he was six years old. A winter-killed field of grass frosted with a light snow cracks like eggshells under my chore boots. And a dead cow lies in a pasture to be consumed by scavengers of all species. I find stories on my family’s farm, and I record, document, and preserve them almost obsessively in my detailed graphite drawings and mixed-media acrylic paintings. My paintings begin with detailed underdrawings that often remain visible in the final painting. The underdrawings provide a visible structure or armature like bones on the body or the vaulting in a Gothic church. I create these mixed-media acrylic paintings using watered-down acrylic, acrylic ink, and handmade acrylic paints using natural pigments applied in multiple thin washes and using detailed, woven mark making. However, it is not so much the people or even the places as it is the opportunity within each painting or drawing to capture something timeless—something that would have been true yesterday or ten thousand years ago. I consider my method of using underdrawings to have precedent in the techniques of Northern European artists from the 15th and early 16th century such as Robert Chaplin, Hans Memling, and Albrecht Dürer. Underdrawings are drawings done on panel, canvas, paper, or other substrate that assist in resolving compositional issues before the artist starts painting. Later painters took inspiration from these historical models in terms of both subject matter and working method and would apply concepts gleaned from these artists. One painter who did this Iowa native Grant Wood. The combination and juxtaposition of Regionalism, with its emphasis upon a particular rural venue, and the paradoxical mystery of Surrealism form the aesthetic precedent that is the basis of my artwork. I enjoy painting every blade of grass while allowing a disconcerting ambiguity to lurk below the surface to encourage viewers into a deeper dialogue with the paintings. I strive to find the sublime in the mundane that permeates each life to preserve and portray that for the future. An entire world is portrayed within the individual line

Promissory Note, 19 October 1844

https://egrove.olemiss.edu/aldrichcorr_b/1086/thumbnail.jp

Spondylosis Deformans

This unit presents a basic protocol of conventional and fast spin echo acquisition for detecting spondolysis deformans. The margins of the osteophytosis associated with spondylosis deformans are generally well defined utilizing fast spin echo acquisitions. An alternate protocol is presented for gradient recalled echo acquisitions that may be used in the sagittal and/or transverse planes to clearly distinguish between discs and soft tissue, and to clarify the spinal neural foramen in the cervical region.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145207/1/cpmia0803.pd

Spinal Canal Stenosis

This unit presents a basic protocol for fast spin echo sequences for imaging to diagnose stenosis of the spinal canal. Spinal stenosis is defined generally as a narrowing of one or more of the following: the central canal, foramina, and lateral recesses of the lumbar spine. Specifically, this stenosis can be classified into three types as defined by location: (a) stenosis of the central spinal canal, (b) stenosis of the intervertebral spinal neural foramen or foramina, and (c) stenosis of the lateral recess(es) of the central spinal canal.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145322/1/cpmia0802.pd

Extradural Spinal Cord/Cauda Equina Compression

Clinical signs and symptoms suggesting acute or subacute compression of the spinal cord or cauda equina constitute a medical emergency requiring urgent diagnosis in order to effect appropriate therapy for alleviating the pathologic process responsible for the compressive phenomenon. The purpose of MR imaging in such cases is to determine the level(s), degree, and, if possible, the type of disease process in order to assist in therapeutic planning gauged toward relieving the neurologic compression. This unit presents a basic protocol for conventional and fast spin echo imaging of spine for such cases. Two alternate protocols are presented for cases where it is necessary to distinguish between the spinal cord and the extradural tissue comprising this structure.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145200/1/cpmia0807.pd

Spinal Primary Neoplasia/Metastasis

This unit presents a basic protocol for conventional and fast spin echo imaging of spine for visualization of the spinal compartment to assess the extent and degree of spinal cord or cauda equina compression frequently associated with primary and metastatic neoplasia. An alternate protocol is presented for the cases e.g., neurofibromatosis with multiple bilateral neoplasms extending through the neural foramina, where a coronal acquisition may be helpful to analyze the perispinal tissues for tumor extension either inward to, or outward from, the central spinal canal.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145240/1/cpmia0805.pd

Spinal Trauma

This unit presents a basic protocol for conventional and fast spin echo imaging of spine for detecting spinal trauma. MR demonstrates traumatic change quite well within the spinal cord and epidural tissues. An alternate protocol is presented based on contrast enhanced acquisitions where MRI scan that has findings that do not match the clinical findings.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145402/1/cpmia0806.pd

Extradural Spine

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145336/1/cpmia0800.pd