Spinal Manifestations of Systemic Disease

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Key points

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    Identifying the predominant pattern of disease (musculoskeletal system vs nervous system) helps generate an appropriate differential diagnosis.

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    Radiologists must thoroughly review the electronic medical record and prior imaging (including nonspine imaging) to add specificity to the differential diagnosis.

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    CT and MR imaging are often complementary in assessment of spinal manifestations of system disease.

Normal anatomy and imaging techniques

Spinal involvement in systemic disease is markedly varied but often disease-specific, which may include bones, synovial joints, intervertebral disks, paraspinal soft tissue, epidural space, meninges, or spinal cord. Thus, interpreting radiologists must be familiar with spinal anatomy. Identifying the space of origin of a spinal lesion (intradural extramedullary, prevertebral, osseous, and so forth.) may help generate a succinct, appropriate differential diagnosis. Additionally, it is critical

Imaging protocols

A 1-size-fits-all approach to imaging protocols may not be optimal when approaching potential cases of spinal manifestations of systemic disease, although using a routine spine protocol may simplify workflow (Table 1). Given the necessity for total neuraxis imaging in many of these patients, acquisition of volumetric pulse sequences (thus allowing high-fidelity multiplanar reconstructions) versus acquiring equal field-of-view cervicothoracic and thoracolumbar sagittal sequences may reduce

Background

Spinal neuroarthropathy uncommonly occurs in patients with loss of sensation, proprioception, and abnormal range of motion, resulting in destruction of the joint capsule and ligaments.1, 2 Repeated stress produces microfractures, callus formation, joint dislocation, and bone destruction.

Presentation

Patients present late in the disease process with spinal instability. A high index of suspicion is required to make a diagnosis early in the disease process, because pain is typically much less severe than

Summary

Numerous systemic diseases may manifest with spinal involvement, which makes approaching these cases a challenge for the interpreting radiologist. By compartmentalizing the imaging findings into musculoskeletal versus nervous system processes, digging into the electronic medical record, and carefully examining extraspinal imaging findings (including those found in nonspine imaging examinations), a succinct, appropriate differential diagnosis usually can be synthesized, if a single correct

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    • The authors report no conflicts of interest, financial or otherwise, with regard to this article.

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