ARRS 2022 Abstracts

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E2024. Don’t Break Your Back Over Spine MRIs: A Primer on Spinal Emergencies
Authors
  1. Michelle LaRosa; Westchester Medical Center
  2. William Gao; Westchester Medical Center
  3. Quan Nguyen; Westchester Medical Center
  4. Javin Schefflein; Westchester Medical Center
Background
Back and neck pains are prevalent presenting symptoms that lead to emergency department visits. An estimated 3.15% of all emergency visits in the United States from 2004 to 2008 are contributed by low back pain. And among those, up to 7% require immediate or urgent treatment for various etiology, including vertebral fractures, cancer, infections, spinal cord/cauda equina compression, and vascular pathologies. Although spinal CT is the imaging modality for first line screening of spinal abnormality, MRI is the gold standard for spinal pathologies. MRIs demonstrate high sensitivity and specificity in spinal and paraspinal pathologies, which can, for example, help determine the chronicity of fractures, differentiate benign versus malignant etiologies, and recognize the signs of infection, cord infarction, or compression at their earliest presentation. A basic knowledge of the normal appearance of spine on MRI, of native spine and postoperative appearance, as well as familiarity with characteristic imaging features of spinal emergencies on MRI is crucial in identifying the red flags of spinal emergencies and guide referrers in appropriate treatment and management.

Educational Goals / Teaching Points
The goals of this exhibit are to review normal basic anatomy of the spine and normal postoperative appearance on spinal MRI; discuss the common spinal emergencies and their characteristic imaging features, focusing on MRI presentation; and highlight pertinent details to include in the report that may guide patient management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes: review of normal spinal anatomy and its appearance on MRI, as well as normal postoperative appearance on spinal MRI; discussion of common emergency spinal scenarios that are evaluated with MRI of the spine, including fractures, cord compression/cauda equina syndrome, and spinal infections; and review of characteristic imaging features of these spinal emergencies with focus on MRI. Finally, we highlight pertinent details to include in the report that are important to patient management, including differentiating benign and malignant compression fracture.

Conclusion
After reviewing this educational exhibit, readers would be able to recognize key anatomy of the spine on MRI, recognize key imaging features and patterns of urgent and emergent spinal findings on MRI, and provide a report that is tailored to the referrer and aid in patient management.