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| Lumbar
Abnormalities |
All photos by Wolfgang Rauschning, MD |
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Mid-sagittal
section view of the normal lower lumbar spine of a young
female. The black arrows indicate normal disc height and anatomy.
The following structures are labeled and easily identifiable: the
nucleus pulposus (NP) of the L4-L5 disc, the large Batson's plexus
of veins (BP), the cauda equina (CE), and the ligamentum flavum
(LF). |
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Lateral
sagittal section through the pedicles of the same specimen.
The distinct texture of the lamella of the lateral portion of the
annulus fibrosus (AF) can be seen. The L4 nerve root (NR) can bee
seen as it exits beneath the L4 pedicle (P). The pristine cartilage
of the facet joints (F) can be easily seen. The black arrow indicates
normal lipping of the posterior inferior vertebral endplate. |
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Axial
cross section at the mid-pedicle level of a normal lumbar
vertebra. The coarse trabecular pattern of cancellous bone in the
vertebral body (VB) can be readily identified. Note how the trabecular
bone becomes more dense as it nears and enters the pedicles (P).
Individual nerve roots can be seen suspended within the cauda equina
(CE). The facet joints (F) are clearly visible and contain pristine
cartilaginous surfaces. The vessels of Batson's plexus can be identified
between the posterior vertebral body and the cauda equina. |
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Coronal
section through a normal spine at the pedicles (P) of
L2, L3, and L4. The L2-L4 nerve roots (NR) can be seen exiting the
cauda equina (CE). Note how the dorsal root ganglia (G) are positioned
beneath the pedicles at each level. Also note that the superior
nerve roots run close to the lateral margins of the pedicles beneath.
The black areas lateral to the cauda equina on both sides between
L2 and L3 identify Batson's plexus. |
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Sagittal
view cross-section of a degenerated L4-S1 vertebral segment.
The L4-L5 disc (DD) bulges anteriorly beneath the ALL and posteriorly
into the lateral recess, abutting the thickened ligamentum flavum (LF).
The epidural veins are completely blocked. The L5-S1 disc is completely
resorbed with total loss of disc height. |
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This
sagittal section shows severe degenerative changes of the
L4-5 motion segment. Note the almost complete resorption of the disc
(D) with marked sclerosis (S) of the endplates and osteophyte (O) encroachment
into the spinal canal. There is significant overriding of the articular
surfaces with osteophyte (O) development on both the superior
and inferior margins. There is infolding and redundancy of the ligamentum
flavum (LF) further compromising space in the intervertebral foramen.
The black area in the foramen is Batson's plexus of veins. |
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Sagittal
cross section through the pedicles of a severely degenerated
lower lumbar segment. The L5-S1 disc is almost completely degenerated,
and there is marked sclerosis of both the inferior endplate of L5 and
the superior endplate of S1. As a result of the loss of disc height,
the L5 nerve root is being "guillotined" by the L5 pedicle above.
There is marked overriding of the L5-S1 articular processes with a
complete loss of surface cartilage. Compare this with the cartilage
surfaces of the L4-L5 facet joint. |
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Axial
view cross-section at the L4 vertebra reveals significant
central and lateral recess stenosis. The white arrows indicate sclerosis
and osteophyte development at the vertebral body. Osteophyte development
(O) can also be seen on the superior articular processes. Note how
the osteophytes bridge across and compromise the lateral recess space.
The ligamentum flavum (LF) is redundant on both sides and severely
limits the central canal. |
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Axial
view cross-section at the L4-L5 disc level revealing severe
degenerative spinal stenosis. The disc is compressing on the thecal
sac anteriorly. The nerve roots of the cauda equina (CE) are severely
compressed by the ligamentum flava (LF) posteriorly. Deterioration
can also be seen at the facet joints (F). |
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Axial
cross-section at the L5-S1 level. A foraminal herniation
(H) of the L5-S1 disc has tracked upward behind the L5 body. The herniation
displaces the L5 dorsal root ganglion (G) laterally and slightly superiorly
and flattens the medial border of the ganglion.
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Sagittal
cross-section of a thoracolumbar compression fracture. The
anterior compression of the vertebral body portion and retropulsion
of a large triangular bone fragment (outlined) suggest a flexion-compression
mechanism. The facet joints are bruised but not fractured. |
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Sagittal
view of a Chance-like fracture/dislocation of the thoracolumbar
spine. In this situation the injury has occurred through the T12-L1
disc space. There is associated complete disruption of the posterior
ligaments. The T12 body is translated anteriorly over L1. Arrows indicate
a hematoma in the conus medullaris. |
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Sagittal
cross-section of a thoracolumbar spine showing osteoblastic
tumor invading L1. This typically is associated with metastatic disease
from the prostate gland. There are endplate irregularities with circumferential
expansion of the vertebral body. |
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V I R G I N I A S P I N E I N S T I T U T E 2 0 0 5 © |
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