Lumbar Disc Nomenclature 2.0

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A number of highly relevant changes in reporting¬†nomenclature. ¬†Some things have not changed, such as the term herniation which is a general category of disc disruption and really should only be used in the vaguest possible sense, such as in the impression “Multiple disc herniations detailed at each level above”.

More importantly, the clarification of locations of protrusions, extrusions, and sequestrations (image on the right). Adoption of standard nomenclature puts the radiologist and surgeon on the same page and eliminates the ambiguity inherent in non-standard reporting.

Adoption of standard nomenclature puts the radiologist and surgeon on the same page and eliminates the ambiguity inherent in non-standard reporting.

Other minor changes such as the replacement of the term “annular tear” with “annular fissure” attempt to remove etiology from the report and focus on accurate description.

On a related note, I am eager to see the results of the LIRE trial which has the potential to help clinicians understand the frequency of abnormal MRI findings.

Google Drive Link to Full Article

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MDCT of Pelvic Ring Disruptions

 

Good review of signs of rotational instability in pelvic fractures and Tile Classification

Tile Classification:

 

Tile classification 

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  • A: stable
    • A1: fracture not involving the ring (avulsion or iliac wing fracture)
    • A2: stable or minimally displaced fracture of the ring
    • A3: transverse sacral fracture (Denis zone III sacral fracture)
  • B – rotationally unstable, vertically stable
    • B1: open book injury (external rotation)
    • B2: lateral compression injury (internal rotation)
      • B2-1: with anterior ring rotation/displacement through ipsilateral rami
      • B2-2-with anterior ring rotation/displacement through contralateral rami (bucket-handle injury)
    • B3: bilateral
  • C – rotationally and vertically unstable
    • C1: unilateral
      • C1-1: iliac fracture
      • C1-2: sacroiliac fracture-dislocation
      • C1-3: sacral fracture
    • C2: bilateral with one side type B and one side type C
    • C3: bilateral with both sides type C