Spine Imaging and Intervention

Spine imaging and intervention has become a large field in itself, and this issue can only touch on a handful of selected topics. We have put together a series of select articles that we hope will be of interest to readers practicing spinal imaging.

In the last few years, percutaneous verbal augmentation has been in the news since two articles in the New England Journal of Medicine cast doubt on the efficacy of the technique. Hargunani et al review both the basic principles of vertebroplasty and some of the current controversies. We consider vertebroplasty a particularly important topic because the use of this technique potentially affects the lives of many of our patients. The article by Munk et al discusses the use of ablative therapies in the treatment of metastatic disease of the spine. These methods are now often combined with cement injection, known as vertebroplasty. Most experience at present is with radiofrequency ablation, but increasingly cryotherapy is proving to be a particularly important and effective technique. These ablative therapies are being used more frequently and promise to be an invaluable tool in the palliation of metastatic bone disease. In selected patients, however, surgical excision may be a valuable option. In this setting, preoperative embolization of spinal metastatic disease not only facilitates the surgery but in many cases converts an unresectable case into an operable one. This important topic is reviewed by Dr. Heran.

Yeo et al review scoliosis in adults. Surgeons have developed numerous techniques so patients with scoliosis, who previously were considered untreatable, are now candidates for therapy. It is important for radiologists to become familiar with the imaging of scoliosis, both in the pre- and postoperative settings. In view of this, we have also included an article by Venu et al on plain radiographic assessment of spinal hardware. Many of us see a variety of devices on radiographs and are often uncertain what to look for. This article should be helpful.

In the last few years, a variety of new and exciting techniques have been developed. Murphy et al present an article on the treatment of Tarlov cysts, once dismissed as an incidental finding of little, if any, clinical significance and now recognized as a source of pain. This is only one example of the many new frontiers being explored in the treatment of spinal disease, which are outlined by Murphy in an article indicating some of the potential directions for innovation now being developed. Although we have come a long way in terms of what we are able to do for patients, many important problems still need to be solved.

The final article by Gangi et al reviews percutaneous techniques in the treatment of neck pain of discal origin, an informative review that discusses a less familiar subject than the injection of joints around the spine.

We hope these articles will help facilitate your practice of radiology and also provoke a renewed appreciation for the continuing innovation demonstrated by our colleagues who have an interest in spine imaging and intervention.