E2335. My Back! A Case-Based Review of Spine Ligamentous Anatomy and Pathology
  1. Collin Edwards; New York Presbyterian - Columbia University
  2. Connie Liou; New York Presbyterian - Columbia University
  3. Zohaib Ahmad; New York Presbyterian - Columbia University
Back pain is an extremely common symptom with a variety of acute and chronic etiologies. Spinal ligaments play an important role in spinal stability and mechanics, and may be subject to a variety of pathologic conditions. These structures include the craniocervical ligaments (tectorial membrane, transverse ligament, alar ligaments) and cervical/thoracic/lumbar ligaments (anterior longitudinal, posterior longitudinal, interspinous, supraspinous ligaments and ligamentum flavum.) Each of these structures may be susceptible to acute injury from a range of mechanisms or chronic pathology from conditions such as inflammatory spondyloarthropathies. MRI plays an important role in the workup of both acute spinal injury and chronic changes. However, ligamentous pathology may be overlooked without specific attention and familiarity with the normal appearance of these structures.

Educational Goals / Teaching Points
The purpose of this exhibit is to review spinal ligamentous anatomy including normal MRI appearance, demonstrate case examples of traumatic ligamentous injuries, and describe and depict non-traumatic pathology of spinal ligaments using MRI examples. By reviewing these topics, viewers will gain familiarity with normal and abnormal MRI appearances of spinal ligaments.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The presentation will begin with a spinal ligamentous anatomical review. This will be followed by a predominately case-based presentation of traumatic injuries of craniocervical ligaments (including the tectorial membrane, transverse ligament and alar ligaments) and cervical/thoracic/lumbar ligaments (including the anterior and posterior longitudinal ligaments, ligamentum flavum, interspinous ligaments and supraspinous ligaments). Finally, a discussion of non-traumatic spinal ligamentous pathology will include inflammatory spondyloarthropathies, ligament hypertrophy and ligament cysts.

This exhibit aims to review spinal ligamentous anatomy and pathology through a predominately case-based presentation. The target audience includes radiology trainees and practitioners who are seeking a review of acute and non-acute spinal ligamentous pathology. While these injuries are relatively rare causes of back pain, they represent an easily overlooked entity if interpreted by a non-experienced radiologist.