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Bone Path I > 2 - Congenital Anomalies > Flashcards

2 - Congenital Anomalies Flashcards

1
Q

What is nonsegmentation of C0 from C1

A

Occipitalization

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2
Q

Four examples of occipital vertebrae

A

Third condyle
Epitransverse process
Paracondylar process
Paramastoid process

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3
Q

What is a third condyle?

A

Occipitalization vertebrae from the front of forament magnum to anterior tubercle

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4
Q

What is epitransverse process?

A

Occipitalization vertebrae off TP of C1 that articulates with C0.

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5
Q

What is paracondylar process?

A

Occipital vertebrae off C0 next to condyle to TP of C1

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6
Q

What is paramastoid process?

A

Occipital vertebrae adjacent to mastoid to TP of C1

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7
Q

Basilar impression

A

When dens is pushed up into foremen magnum

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8
Q

What 2 measurements are used to see if there is basilar impression?

A

McGregor’s line: palate to inferior occiput

Chamberlain’s line: palate to posterior foramen magnum

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9
Q

What is abnormal measurement for McGregors Line

A

If dens is >8-10 mm above line it means there is occipitalization

If dens is >4.5 mm above line it means there is basilar invagination

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10
Q

What is abnormal measurement for Chamberlain Line

A

If dens is >3 mm above the line, basilar invagination

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11
Q

What are primary and secondary reasons for basilar impression?

A

1˚ : occipitalization, C1 posterior arch agenesis - spina bifida occulta

2˚ : bone softening d/t Pagets, osteomalacia, fibrous dysplasia

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12
Q

What is Arnold-Chiari malformation

A

Downward displacement and elongation of brain stem and cerebellar tonsils

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13
Q

Sx of Arnold-Chiari malformation

A

Mild HA, neck pain, stridor, apnea, nystagmus, CN palsies

Many are asymptomatic

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14
Q

stridor

A

High-pitched breath sound resulting from turbulent air flow in larynx or lower in bronchial tree

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15
Q

Other findings associated with Arnold-Chiari malformation

A

Syringomyelia and hydrocephalus

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16
Q

Arnold-Chiari malformations greater than ____ are concerning

A

3mm

<3mm is not concerning

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17
Q

In an MRI how can you tell the difference between T1 and T2 weighted

A

T1 CSF is dark

T2 CSF is bright

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18
Q

What is syringomyelia

A

Spinal cord cavity (syrinx)

19
Q

Etiology of syringomyelia

A

Pressure, tumor, congenital, Arnold-Chiari malformation (2˚ to pathologically CSF dynamics)

20
Q

What is spina bifida occulta, is it significant?

A

Failure of fusion of 2 posterior arch ossification centers that produce midline defect

Usually NOT significant. Though some authors disagree and say increased posterior disc herniation and isthmic spondy

21
Q

How does spina bifida appear on xray?

A

No spinolaminar junction

22
Q

What are the things you need for stability between C1-C2? (4)

A

Intact dens,
Anterior arch,
Lateral masses,
Transverse ligaments

23
Q

What are signs seen on xray of posterior arch agenesis?

A

Hypertrophy and sclerosis of anterior arch, megaspinous of C2

24
Q

Etiology of posterior arch agenesis

A

Congenital
SOL
Infection (e.g. osteomyelitis) though unlikely because there is no vertebral body (vertebral bodies contain blood vessels, desirable to infection to spread more easily)

25
Q

What is posterior ponticle of C1?

A

Partial or complete ossification of oblique portion of atlanto-occipital membrane

So it looks like a bony arch from posterior arch to lateral masses

26
Q

What is characteristic of Trisomy 21 (Down Syndrome) ?

A

Atlanta-axial instability due to lax transverse ligament and therefore that can cause increased ADI (atlanto-dental interspace)

Prone to cervical spondylitis and myelopathy

27
Q

What is ossiculum terminale and what does it look like?

A

Non-fusion of 2˚ growth center of the dens

Looks like a little bone at the tip of the dens.

Also called Persistens of Bergman

28
Q

How do you DDX ossiculum terminale/persistens of Bergman from acute fracture?

A

Congenital ossiculum terminale would be sclerotic and not have a clean line

29
Q

What is os odontoideum?

A

2 halves of odontoid unite and do not fuse to C2

30
Q

Is os odontoideum considered stable or unstable?

A

Unstable. The transverse ligament is intact but unstable because dens is unattached to C2 body

31
Q

What is a hypoplastic/agenesis odontoid

A

Odontoid halves do not develop fully or at all

32
Q

Should you manipulate hypoplastic/agenesis odontoid?

A

Not if its unstable. Obviously.

Do flexion/extension films.

33
Q

What is block vertebra/synostosis?

A

Non segmentation of 2 adjacent segments.

34
Q

What are the radiographic findings for block vertebra/synostosis? (triad)

A

Wasp waist appearance
Rudimentary disc
Fused posterior elements

35
Q

Surgical vs congenital block vertebra/synostosis

A

SPs separated

36
Q

Most common vertebral levels for congenital block vertebra?

A

C2/3
C5/6
L4/5

37
Q

What is klippel-feil syndrome?

A 
Multiple block vertebra,
Spina bifida occulta,
Scoliosis,
Sprengel’s deformity (1 scap undescended), and
Platybasia

Rule #3 applies here: look for soft tissue anomalies. May have GU anomalies especially kidneys (e.g. horseshoe kidney, 2 ureters from 1 kidney, etc)

38
Q

What is the classic triad for klippel-feil syndrome?

A

Short, webbed neck (pterygium colli)
Lowered hairline
Reduced cervical ROM

39
Q

What is sprengel’s deformity?

A

Congenitally undescended scapula

40
Q

What chunk of bone may be present in Sprengel’s deformity?

A

Omovertebral bone: a chuck of bone that fixes scapula to spine

41
Q

What is cervical spondylolisthesis?

A

Congenital form caused by bilateral agenesis of pedicles and dysplasia of articulation processes

42
Q

What cervical level is most commonly involve in spondylolisthesis? What sex is more common?

A

C6
M>F

Spina Bifida Occulta (SBO) is commonly at this level too

43
Q

What level is a cervical rib most common at?

A

C7, 6, 5.

If rib is at C5 pt will have ribs at C6, C7 too.

Bone Path I (5 decks)

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