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Chapter 22

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1. Normal filum terminale

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Figure 22-1

Normal filum terminale.

The filum terminale internum is a fibrous band that extends from the apex of the conus medullaris to the inferior aspect of the thecal sac. On sonography, the filum appears as a thin echogenic band (arrows on this image of a 22-day-old infant). Real-time observation usually shows a wafting motion of the filum during respiration. The filum terminale externum continues inferiorly and attaches to the first segment of the coccyx; this portion is not discernible on ultrasound.

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2. Annular epiphyses

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Figure 22-2

Annular epiphyses.

Beginning ossification of the annular epiphyses in an 8-year-old boy results in linear calcifications (arrows) at the vertebral endplates.

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3. Normal cervical spine; age 11 years

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Figure 22-3

Normal cervical spine; age 11 years.

The vertebral bodies are rectangular. The annular epiphyses appear as thin ossifications (arrows) at the endplates. There is bony fusion of the dens to the body of C2.

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4. Normal cervical spine; age 6 months

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Figure 22-4

Normal cervical spine; age 6 months.

The developing vertebral bodies have oval configurations. The annular epiphyses are not yet ossified. The subdental synchondrosis (arrow) is clearly visible. There is artifactual widening of the prevertebral soft tissues due to swallowing.

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5. Pseudosubluxation

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Figure 22-5

Pseudosubluxation.

There is anterior slippage of the C2 vertebral body relative to C3 on this lateral flexion image of a 3-year-old child. There is appropriate orientation of the spinous processes with the posterior cervical line. Also, note physiological prominence of the atlantodens interval and widening of the distance between the spinous processes of C1 and C2.

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6. Block vertebra

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Figure 22-6

Block vertebra.

The C6-C7 intervertebral disc (arrow) is narrow and lacks normal central hyperintensity on this sagittal T2-weighted image of an asymptomatic 10-year old. Undergrowth of the portions of the vertebral bodies adjacent to the hypoplastic disc results in focal expansion of the CSF-filled spinal canal.

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7. Block vertebra

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Figure 22-7

Block vertebra.

A coronal CT image demonstrates near complete fusion of the C6 and C7 vertebral bodies. Bone trabeculae extend between the lateral aspects of the fused segments.

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