Basics of Spine Interpretation in 5 minutes

In this lecture, Dr. Katie Bailey walks us through a rapid lecture about how to approach the basics of the spine. In about 5 minutes, you can learn most of what you need to know about spine interpretation when you first sit down to look at spine imaging.

This approach is based on the ABCDEs of spine. Each letter tells you something about what you should be looking for on the imaging.

Alignment. The way the vertebral bodies are oriented with respect to one another is alignment. This means lateral curvature (scoliosis), AP curvature (lordosis or kyphosis), and translation. Listhesis is conventionally described based on the level above with respect to the level below.

Bones. When thinking about the bones, you should look at the characteristics of the bones themselves. On CT, that could mean loss of normal bone density (lytic) or increased bone density (sclerotic). On MRI, you describe the appearance of a lesion with respect to the adjacent marrow. It is either hyperintense (more intense) or hypointense (less intense) compared to the normal marrow.

Cord/cauda equina. The cord itself is a key part of the image and you should look for any lesions within the cord or cauda equina. The cauda equina should be around the L1 level.

Disc. The discs have a wide range of degenerative pathology, which is discussed elsewhere. You should describe degenerative disease as well as any other abnormal conditions of the disc, such as infection.

Everything else. Finally, you should look at soft tissues and surrounding structures outside the spine. This is slightly different at each level of the spine where the structures vary slightly.

Summary. With this quick approach, you can rapidly move from a spine novice to a spine apprentice and you’re ready to learn more about different pathology within the spine. Check out some of the other spine videos to learn more about topics such as spine tumors, demyelinating disease, and degenerative disease.

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