Spinal vacuum phenomena: anatomical study and review.

Resnick, D; Niwayama, Gen; Guerra, J.L. Lopez; Vint, V; Usselman, JA

doi:10.1148/radiology.139.2.7220878

Cited by 236 publications

(128 citation statements)

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“…Furthermore, chronic instability in untreated, mobile vertebral fractures may lead to osseous necrosis or an intravertebral cavity (cleft) (23). Gas or water within an intravertebral cleft depends on time and position under different circumstances (24,25). However, fractures without edema on MR images are considered healed (23).…”

Section: Musculoskeletal Imaging: Bone Marrow Edema In Vertebral Compmentioning

confidence: 99%

Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

Wang

Tsai

Chuang³

et al. 2013

Radiology

153

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Purpose:To assess the use of the dual-energy computed tomographic (CT) virtual noncalcium technique in the evaluation of bone marrow edema in vertebral compression fractures. Materials and Methods:This prospective study was approved by the institutional review board; informed consent was obtained from all patients. Sixty-three consecutive patients with 112 thoracic and/or lumbar vertebral compression fractures were studied between January 2011 and April 2012. All patients underwent both dual-energy CT (100 kV and Sn140 kV, where Sn indicates the use of a 0.4-mm tin filter) and magnetic resonance (MR) imaging. Dual-energy CT data were postprocessed by using a three-material decomposition algorithm for generating noncalcium images of the collapsed bodies. Two radiologists evaluated for the presence of abnormal attenuation alterations in the bone marrow by using color-coded maps and measured CT numbers on noncalcium grayscale images. Bone sclerosis and intravertebral air were evaluated with CT scans. MR images served as the reference standard. CT numbers were subjected to receiver operating characteristic curve analysis. Results:MR imaging depicted 46 edematous and 66 nonedematous vertebral compression fractures. Eighty-two bodies were classified as having less than 50% sclerosis and/or air. Significant differences in noncalcium CT numbers between edematous and nonedematous vertebral compression fractures were found for both readers (P , .0001).CT numbers for the diagnosis of bone marrow edema on the basis of MR imaging revealed areas under the receiver operating characteristic curve of 0.799 and 0.841 for readers 1 and 2, respectively (P = .56). Use of a cutoff value of 280 to differentiate edematous vertebral bodies resulted in a sensitivity of 96.3%, specificity of 98.2%, and accuracy of 97.6% in the group of vertebral bodies with less than 50% sclerosis and/or air. Conclusion:Dual-energy CT virtual noncalcium images were able to depict bone marrow in the collapsed vertebral bodies, especially in those with less than 50% sclerosis and/or air.q RSNA, 2013

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Section: Musculoskeletal Imaging: Bone Marrow Edema In Vertebral Compmentioning

confidence: 99%

Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

Wang

Tsai

Chuang³

et al. 2013

Radiology

153

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“…10) Progressive dehydration of the central disc in patients with degenerative disc disease produces enlarging clefts that are subsequently filled with gas released from the surrounding tissues. 14,15) The gas can occur in the spinal canal, foraminal, or extraforaminal regions. Most gas is asymptomatic but is now well recognized as one of the causes for lumbar radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Gas in the spinal canal can be caused by tumors, infection, trauma, discography, and disc degeneration. 10,14) Accumulation of gas can be epidural, intradural, or intradiscal. Gas can be found in the spinal canal, foramen, or extraforaminal region.…”

Section: Introductionmentioning

confidence: 99%

Gas-Containing Disc Herniations: Dual Nerve Root Compression at a Single Disc Level

Ryu

Rathi

Shin

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 72-year-old man presented with gas-containing disc herniations resulting in dual nerve root (exiting and traversing root) compression at the single level manifesting as lower back pain with the right anterolateral thigh and medial calf pain and no response to 4 weeks of conservative treatment. Physical examination revealed positive Lasegue's sign at 409 , but the patient had no evidence of neurological deficit. Magnetic resonance imaging showed two separate disc herniations, a posterocentral herniated disc that had migrated inferiorly at the L3-4 level and compressed the L4 traversing root, and another that had compressed the L3 exiting root in the extraforaminal area at the same level. Coronal computed tomography demonstrated the presence of gas in the spinal canal and extraforaminal area at the L3-4 level, and the vacuum phenomenon was also noted at the L3-4 intervertebral disc. Microscopic discectomy was performed using midline and paramedian approaches, and the presence of gas was confirmed by bubbles after pouring saline into the area intraoperatively. Histological examination revealed fibrous tissue. The patient was discharged with complete relief of pain. This is a rare case of symptomatic gas-containing disc herniations causing dual compression of exiting and traversing roots at a single disc level.

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“…19,20) The gas consists predominantly of nitrogen and is enclosed in a membrane of cartilage fragments that communicate with the disk. 4) The cause of gas development within the spine is still unknown.…”

Section: Discussionmentioning

confidence: 99%

“…13,19) Disk degeneration is intimately related to the vacuum phenomenon, which is relatively common in old age. The gas associated with the vacuum phenomenon has been found in the spinal canal, intervertebral foramen, epidural space, and subarachnoid space, 8,17) but disk herniation with gas has rarely been reported.…”

Section: Introductionmentioning

confidence: 99%

Surgical Experience of Gas-Containing Disk Herniation

Choi

Kim

Lee

2010

Neurol. Med. Chir.(Tokyo)

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Disk herniation with gas or gas-containing disk herniation (GCDH) is rare, although epidural gas is associated with the vacuum phenomenon. The clinical, radiologic, and surgical findings were retrospectively analyzed of 18 patients with GCDH. The demographic, clinical, and radiologic findings including computed tomography and magnetic resonance imaging, as well as operative methods were examined. The mean age was 64.4 years (range 51-84 years). All patients presented with acute radiculopathy or exacerbation of chronic pain associated with GCDH of the lumbar spine. All lumbar GCDHs were related to the vacuum phenomenon. Ruptured disks predominantly compressed the nerve root with gas in 17 cases, except in one with only compressed nerve root by gas without disk herniation. All patients had confirmed GCDH at surgery. All patients underwent removal of GCDH and five with another level of spinal stenosis or disk herniation underwent selective decompression. The six patients with instability underwent fusion. Visual analogue scale score of radicular pain was improved from 7.4 ± 0.9 before surgery to 3.2 ± 0.7 at the 3-month follow-up examination. No recurrence occurred after surgery. GCDH can occur as a space-occupying lesion in epidural space as well as a cause of radiculopathy. GCDH may indicate the source of clinical symptoms in the degenerative spine, especially combined with spinal stenosis or multiple spinal disk herniations.

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Spinal vacuum phenomena: anatomical study and review.

Cited by 236 publications

References 0 publications

Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

Gas-Containing Disc Herniations: Dual Nerve Root Compression at a Single Disc Level

Surgical Experience of Gas-Containing Disk Herniation

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