The meniscus is considered "extruded" when it extends beyond the tibial margin. We hypothesize that severe degeneration, large radial tears, complex tears, and tears involving the meniscal root would alter meniscal stability and cause more substantial extrusion.The knee MRI database at Thomas Jefferson University Hospital was searched for reports describing meniscal extrusion; MR images were reviewed retrospectively. On mid coronal images, extrusion of the medial meniscus was quantified in millimeters. A separate, independent review of the meniscus evaluated degeneration severity and tear (type and extent). Radial tears were divided into those involving more (large) or less (small) than 50% of the meniscal width. Tears that involved the "root" at the tibial spine were recorded. Chi-square analysis compared these findings with extrusion extent, divided into minor ( 3 mm) extrusion.One hundred five knees were reviewed (12 men and 93 women; age range, 34-83 years; mean age, 56 years). Distribution of medial meniscus extrusion was 2 mm (n = 17), 3 mm (n = 17), 4 mm (n = 27), 5 mm (n = 14), 6 mm (n = 16), and 7-10 mm (n = 14). Mild, moderate, or marked degeneration was seen in 47%, 26%, and 27% with minor extrusion, respectively, and in 17%, 41%, and 42% with major extrusion, respectively (p = 0.003). Tears were seen in 59% (20/34) with minor extrusion versus 89% (63/71) with major extrusion (p = 0.001). Tears involved one third, two thirds, or all of the meniscus in 75%, 25%, or 0%, respectively, with minor extrusion and 46%, 40%, or 14% with major extrusion, respectively (p = 0.014). Longitudinal (nonradial) and horizontal tears were not associated with extent of extrusion (p = 1.0). Oblique tears were significantly associated with minor extrusion (minor, 26% [9/34]; major, 4% [3/71]; p = 0.003). Radial tears were seen in 9% (3/34) with minor extrusion versus 21% (15/71) with major extrusion (p = 0.20). All three radial tears with minor extrusion were small; conversely, 87% (13/15) of radial tears with major extrusion were large (p = 0.019). Complex tears were seen in 18% (6/34) with minor extrusion versus 59% (42/71) with major extrusion (p < 0.001). Tears involving the meniscal root were seen in 3% (1/34) with minor extrusion and 42% (30/71) with major extrusion (p < 0.001).Substantial medial meniscus extrusion (> 3 mm) is associated with severe meniscal degeneration, extensive tear, complex tear, large radial tear, and tear involving the meniscal root.
Cross-sectional retrospective review of 539 patients with lumbar spine magnetic resonance imaging (MRI).The purpose of this study was to determine the prevalence of lumbar posterior element interspinous bursitis (Baastrup disease) and to measure the association with degenerative disc disease findings, deformities, age, and gender in symptomatic people.Case reports and small case series describing Baastrup disease exist. The prevalence of Baastrup disease on MRI and association with other degenerative-related findings has not been reported.The study group consisted of 539 patients (51% males, 49% females; age range, 7-89 years old) undergoing routine lumbar spine MRI using sagittal T1-weighted, sagittal T2-weighted, and axial T2-weighted pulse sequences. Retrospective consensus review by 2 observers evaluated for the presence of: fluid intervening between consecutive spinous processes (criterion for Baastrup disease), disc degeneration (spondylosis) and contour abnormalities (bulges, herniations), marrow endplate signal alteration (Modic changes), central canal stenosis, lordosis, scoliosis, and displacement (anterolisthesis, retrolisthesis). Statistical analyses were descriptive statistics and determining associations between these MRI findings and Baastrup disease (using chi and Wilcoxon rank sums).Lumbar interspinous bursitis (Baastrup disease) was present in 8.2% (44 of 539) of the study population. There were associations between the presence of Baastrup disease and age (P = 0.001), central canal stenosis (P = 0.0013), disc bulging (P = 0.0341), and anterolisthesis (P = 0.0429). There were not associations between Baastrup disease and disc degeneration, disc herniation, endplate findings, retrolisthesis, scoliosis, lordosis, or gender.Lumbar interspinous bursitis (Baastrup disease) is uncommon but not infrequent in symptomatic patients undergoing lumbar spine MRI. Patients with MRI evident Baastrup disease tend to be older, have central canal stenosis, bulging discs, and anterolisthesis. Further investigations determining the clinical significance of this finding are necessary.
Welcome to this issue of Topics in Magnetic Resonance Imaging on “MRI in Interventional Musculoskeletal Disease.” This is a timely topic of interest because radiologists are performing an increasing variety and volume of interventional procedures in the appendicular and axial musculoskeletal system with a keen interest in exploiting nonionizing modalities. These procedures may be diagnostic, therapeutic, or both. In this issue, we will highlight the recent advances in the application of magnetic resonance imaging (MRI) for interventions by a group of experts who have helped to develop this field from its infancy and those who continue to promulgate this work today. Although numerous articles have been written on musculoskeletal interventions, it is the intention of this monograph to provide a new perspective by describing cutting-edge innovative procedures, novel applications, and modalities with a view toward the future. For radiologists looking to expand into these areas, several emerging techniques and technologies will be described. There are numerous reasons why MRI is well suited for image guidance. Its multiparametric and flexible image contrast provides not only characterization of diseased tissue but the definition of the related anatomy and some functionally relevant tissue parameters (flow, perfusion, diffusion, tissue temperature). This makes MRI one of the best imaging methods to provide intraprocedural guidance. Additional features, such as the lack of ionizing radiation, interactive multiplanar imaging, volumetric imaging, and the ability to do real-time or near-real-time imaging updates, make MRI a superb modality for integration with therapy. The result is a remarkable tool for a wide variety of procedures that encompass nearly the entire application gamut of minimally invasive surgical and percutaneous radiology efforts. There are some limitations for interventional MRI, which will also be highlighted in this publication. The original concept of MRI-guided procedures has evolved into complex, integrated image-guided and computer-assisted applications in surgery and interventional radiology. The successful development of interventional MRI has required innovative approaches, novel applications, efficient use of computer technologies, advanced therapy devices, and a more sophisticated and diverse technological infrastructure. The authors contributing articles on these topics take advantage of the unique environment drawn from the intersection of interventional experts and magnetic resonance imagers. We thank the authors for their considerable contributions to this issue. They certainly have made this an outstanding sampling of the current status and future directions of interventional MRI. Finally, we thank Dr Scott Atlas, who entrusted us with assembling this issue. We hope you find the information in these articles intriguing and provocative as well as an adjunct to your knowledge on the repertoire of available magnetic resonance–guided procedures for patients with a variety of musculoskeletal disorders.
Femoroacetabular impingement is a relatively recently described cause of hip pain that involves degenerative change in the hips of younger patients (less than thirty-five years old) as a result of predisposing pathoanatomy. The two types of impingement, cam and pincer, often occur together and overlap to varying degrees. The diagnostic workup begins with radiography, but magnetic resonance imaging and magnetic resonance arthrography provide more accurate imaging that characterizes not only the pathoanatomy but also other associated findings, including labral tears and cartilage damage.
Study Design. Randomized, double-blinded, placebo-controlled trial Objective. Examine the effect of intravenous ketorolac (IV-K) on hospital opioid use compared to IV placebo (IV-P) and IV acetaminophen (IV-A). Summary of Background Data. Controlling postoperative pain while minimizing opioid use following lumbar spinal fusion is an important area of study. Methods. Patients aged 18-75 years undergoing 1-2 level lumbar fusion between April 2016 – December 2019 were included. Patients with chronic opioid use, smokers, and those on systemic glucocorticoids or contraindications to study medications were excluded. A block randomization scheme was used and study personnel, hospital staff, and subjects were blinded to assignment. Patients were randomized postoperatively. The IV-K group received 15mg (age > 65) or 30 mg (age <65) q6h for 48h, IV-A received 1000 mg q6h, and IV-P received normal saline q6h for 48h. Demographic and surgical details, opioid use in morphine milliequivalents (MME), opioid related adverse events (ORAE) and length of stay (LOS) were recorded. The primary outcome was in-hospital opioid use up to 72h. Results. 171 patients were included (58 IV-K, 55 IV-A, 58 IV-P) in the intent-to-treat (ITT) analysis, with mean age 57.1 years. The IV-K group had lower opioid use at 72h (173±157 mg) versus IV-A (255±179 mg) and IV-P (299±179 mg) ( P =0.000). In terms of opiate use, IV-K was superior to IV-A ( P =0.025) and IV-P ( P =0.000) on ITT analysis, although on per-protocol (PP) analysis the difference with IV-A did not reach significance ( P =0.063). When compared to IV-P, IV-K patients reported significantly lower worst ( P =0.004), best ( P =0.001), average ( P =0.001), and current pain ( P =0.002) on POD1, and significantly shorter LOS ( P =0.009) on ITT analysis. There were no differences in ORAEs, drain output, clinical outcomes, transfusion rates, or fusion rates. Conclusions. By reducing opioid use, improving pain control on POD1, and decreasing LOS without increases in complications or pseudarthrosis, IV-K may be an important component of ERAS protocols.
