Extradural, Normal Marrow Signal

Kevin R. Moore, MD

DIFFERENTIAL DIAGNOSIS

Common

Disc Herniation
- Intervertebral Disc Herniation, Cervical
- Intervertebral Disc Herniation, Thoracic
- Intervertebral Disc Herniation, Lumbar
- Intervertebral Disc Extrusion, Foraminal
Osseous Degenerative Disease
- Intervertebral Disc Bulge
- Facet Arthropathy, Cervical
- Facet Arthropathy, Lumbar
- Facet Joint Synovial Cyst
Infection
- Abscess, Epidural
- Abscess, Paraspinal
Trauma
- Hematoma, Epidural-Subdural
- Hematoma, Spontaneous Epidural
- Hematoma, Paraspinal
Neoplasm
- Neuroblastic Tumor
- Lymphoma
- Schwannoma
- Neurofibroma
Ligamentous Ossification
- OPLL
- DISH
- Ossification Ligamentum Flavum
Ligamentous Hypertrophy
Peridural Fibrosis
Perineural Root Sleeve Cyst

Less Common

Epidural Lipomatosis
Teratoma, Sacrococcygeal

Rare but Important

Neurenteric Cyst

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Clinical context helps narrow differential list

Helpful Clues for Common Diagnoses

Disc Herniation
- Intervertebral Disc Herniation, Cervical
  - Localized displacement of disc material beyond vertebral ring apophyses
- Intervertebral Disc Herniation, Thoracic
  - T6 → T11 most common, rare in upper thoracic spine
- Intervertebral Disc Herniation, Lumbar
  - Most common at L4-5, L5-S1
- Intervertebral Disc Herniation, Foraminal
  - Soft tissue mass contiguous with parent disc → extruded disc material in neural foramen
Osseous Degenerative Disease
- Intervertebral Disc Bulge
  - Generalized circumferential disc extension beyond vertebral ring apophyses
- Facet Arthropathy, Cervical
  - Osteoarthritis of synovially lined apophyseal joints → facet overgrowth + joint space narrowing
- Facet Arthropathy, Lumbar
  - Similar findings to cervical spine
- Facet Joint Synovial Cyst
  - Extradural cystic mass communicating with facet joint + degenerative changes disc, facet joint
  - Lumbar (90%) > > cervical, thoracic
Infection
- Abscess, Epidural
  - Extradural spinal infection with abscess formation ± spondylodiscitis
- Abscess, Paraspinal
  - Suppuration of paraspinal soft tissue from direct extension or hematogenous pathogen dissemination
  - Calcified psoas abscesses ⇒ tuberculosis
Trauma
- Hematoma, Epidural-Subdural
  - Hypo-, iso-, or hyperintense depending on blood product age
- Hematoma, Spontaneous Epidural
  - Accumulation of hemorrhage between dura & spine without significant trauma or iatrogenic procedure
- Hematoma, Paraspinal
  - Frequently associated with vertebral body fracture
  - Signal intensity reflects blood product composition, age
Neoplasm
- Neuroblastic Tumor
  - Ganglioneuroma, ganglioneuroblastoma, and neuroblastoma
  - Intraspinal spread has important treatment and prognostic implications
- Lymphoma
  - Variable imaging manifestations are often nonspecific
- Schwannoma
  - Schwann cell neoplasm of peripheral nervous system
  - Consider neurofibromatosis type 2 if many tumors identified
- Neurofibroma
  - Nerve sheath tumor of spinal root, neural plexus, peripheral nerve, or end organs
  - Plexiform neurofibroma pathognomonic of NF1
Ligamentous Ossification

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