Plain X-rays:
Flexion-extension views are useful for identifying spondylolisthesis and spinal instability. Â
Supportive findings (on AP and lateral views):
- Disk space narrowing.
- Vertebra body osteophytes.
- Endplate and facet sclerosis.
Disk protrusion: protrusion of the vertebral disk nucleus pulposus through the annulus fibrosus
Disk herniation (disk extrusion or disk prolapse): complete extrusion of the nucleus pulposus through a tear in the annulus fibrosus
Disk sequestration: extrusion of the nucleus pulposus and separation of a fragment of the disk.
MRI spine without IV contrastÂ
Preferred initial imaging modality for suspected radiculopathy or myelopathy.
Supportive findings
Disk degeneration: Dehydrated disk that appears hypointense on T2-weighted images.
Disk prolapse/herniation: herniation of disk tissue with surrounding edema.
Evidence of impingement/compression of a spinal nerve or the spinal cord: may be visible, e.g.:
- Focal narrowing of the spinal canal
- Compression of the thecal sac.
- Edema of the spinal cord: Appears hyperintense on T2-weighted images)
Degenerative disk disease with disk extrusion
MRI lumbar spine (T2-weighted; sagittal plane)
Hypointense degenerated disks at L4–5 and L5–S1 are accompanied by disk space narrowing. A disk extrusion at L4–5 has migrated superiorly behind the L4 vertebral body and narrows the thecal sac.
Cervical disk herniation
MRI cervical spine (T2-weighted; sagittal plane) of a patient with symptoms of cervical myelopathy A herniated disk at C5–6 effaces the dural sac and compresses the spinal cord. Hyperintense compression-induced edema is seen within the cord.
