Subjective assessment of alpha angles is suboptimal unless one is quite confident of a bone abnormality.

For now, magnetic resonance (MR) is the best noninvasive imaging modality to evaluate vertebral bone marrow thanks to its inherent soft-tissue contrast and non-ionizing nature. A daily challenging scenario for every radiologist interpreting MR of the vertebral column is discerning the diseased from normal marrow. This requires the radiologist to be acquainted with the used MR techniques to judge the spinal marrow as well as its normal MR variants. Conventional sequences used basically to image marrow include T1W, fat-suppressed T2W and short tau inversion recovery (STIR) imaging provides gross morphological data. Interestingly, using non-routine MR sequences; such as opposed phase, diffusion weighted, MR spectroscopy and contrasted-enhanced imaging; may elucidate the nature of bone marrow heterogeneities; by inferring cellular and chemical composition; and adding new functional prospects. Recalling the normal composition of bone marrow elements and the physiologic processes of spinal marrow conversion and reconversion eases basic understanding of spinal marrow imaging. Additionally, orientation with some common variants seen during spinal marrow MR imaging as hemangiomas and bone islands is a must. Moreover, awareness of the age-associated bone marrow changes as well as changes accompanying different variations of the subject's health state is essential for radiologists to avoid overrating normal MR marrow patterns as pathologic states and metigate unnecessary further work-up.

The interpretation of spinal images fixed with metallic hardware forms an increasing bulk of daily practice in a bus�� imaging department. Radio�ogists are required to be familiar with the instrumentation and operative options used in spinal fixation and fusion procedures, especia���� in his or her institute. This is critica� in eva�uat-ing the position of imp�ants and potentia� comp�ications associated with the operative approaches and spinal fixation devices used. Thus, the radiologist can play an important role in patient care and outcome. This review out�ines the advantages and disadvantages of common��� used imaging methods and reports on the best yield for each modality and how to overcome the problematic issues associated with the presence of metallic hardware during imaging. Baseline radiographs are essentia� as the�� are the base�ine point for eva�uation of future studies shou�d patients deve�op s��mptoms suggesting possib�e comp�ications. The�� ma�� justif�� further imaging workup with computed tomography, magnetic resonance and/or nuc�ear medicine studies as the eva�u-ation of a patient with a spinal implant involves a multimodality approach. This review describes imaging features of potential complications associated with spinal fusion surgery as well as the instrumentation used. This basic knowledge aims to help radiologists approach ever��da�� practice in c�inica� imaging.

HRUS confirms clinically diagnosed CTS in about half of the patients with normal NCS.

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