Imaging Osseo-ligamentous Spine Anatomy

Imaging of osseo-ligamentous spine is performed utilizing a combination of plain radiography, computed tomography (CT), CT myelography, and magnetic resonance imaging (MRI). High-resolution depiction of osseous anatomy is best appreciated on conventional CT, which makes this modality an excellent examination for suspected traumatic osseous injury and assessment of benign and malignant lesions and systemic osseous disorders with spine involvement or for preoperative planning. MRI is better for evaluation of ligaments, discs, facet joints, and the paravertebral tissues. In those individuals where MRI is contraindicated, CT myelography, although slightly more invasive, is an excellent alternative. CT myelography is also helpful in patients with intracranial hypotension or suspected spinal CSF leak or in evaluating the intradural space. MRI, with its high contrast resolution, is often the preferable modality, giving clearer differentiation of adjacent structures and a greater degree of information from the different pulse sequences. This chapter illustrates and describes the normal osseo-ligamentous spine anatomy as depicted on MRI, CT, and CT myelography. Commonly used spinal MRI protocols and common artifacts are also briefly discussed.