3 - Spinal Anomalies Flashcards
What are C1 lateral mass notches
Apparent defects in the medial aspects of lateral masses — lucencies of atlas represent attachment sites of transverse ligament
What are central maxillary incisors
May look like vertical fracture through dens but actually is space between teeth
What is Mach effect?
Overlapping structure of posterior arch C1. Could also be lips, tongue, occiput.
Don’t mistake this for a fracture or os odontoideum — may need to retake xray
What are paraodontoid notches?
Notches next to dens that represent part of the growth centers/synchondrosis that didn’t fill with bone.
What is eagles syndrome
When you have stylohyoid ossification AND dysphagia (trouble swallowing)
What is DISH?
Diffuse
Idiopathic
Skeletal
Hyperostosis
What is facet notching?
Can mimic erosion or fracture, no trauma. Yet trauma can cause it
Rotation of the spine may cause articulate pillars to overlap which may mimic
Vertebral pillar fracture
Why might a pseudofracture show up in the cervical spine in Lateral view?
Because of arthrosis. Arthrosis will cause hypertrophied and sclerotic uncinate processes and that presents as a pseudofracture in lateral view.
(Recall what the joints of leuska look like in AP cervical — and then recall what they look like when the joint gets curved)
What is the pyriform sinus?
Bilateral leucency medial to VB on AP film. May look like lesion but its just airspace
What are Hahn’s venous clefts?
Vascular channels seen as horizontal lucencies through mid-vertebral body. Most common in lower thoracic spine
Normal finding
What are block vertebra and is it more common in lumbar or cervical?
Non segmentation of 2 adjacent segments.
MORE common in cervical.
Most common lumbar is L4/5
When you see multiple block vertebra, what syndrome do you think about?
Klippel-Feil syndrome
Congenital block vertebra triad of findings
Remnant disc
Wasp waist
Posterior element fusion (50% of cases)
What are butterfly vertebra? How do you know if its congenital?
Central hourglass shaped lucency in body on AP radiograph. Continuous disc material from adjacent discs. The body is often wider and may look like a burst fracture
Congenital because the end plates of L4 and S1 conform to the butterfly shape
What causes hemivertebra?
Failure of ossification center
What does a hemivertebra look like?
Wedge shaped vertebra.
How do you know hemivertebra is congenital?
Absence of osteophytes.
DDX disc degeneration = osteophytes
What is the concern with hemivertebra?
May cause scoliosis
What are schmorl’s nodes?
Herniation of NP through vertebral endplate due to weak endplate, trauma or pathological process
Does disc size change with schmorl’s nodes?
Yes, may be smaller because they get imbedded into vertebral body
DDX schmorl’s node from nuclear impression
Schmorl’s nodes are larger, sclerotic, jagged
Nuclear impression (persistent notochord) is smooth, larger and often posterior
Sometimes large schmorl’s nodes can change the vertebral body size — how?
Longer AP but shorter
What is anterior limbus vertebra/bone?
Similar to schmorl’s node in that NP herniated through endplate. Specifically through ring apophysis: 2˚ growth area of vertebral body.
In other words, a piece of disc squeeze into the bone and prevent the 2˚ growth area from joining the body.
What does anterior limbus vertebra look like on lateral film?
Almost like a fracture or cut off piece of the anterior-superior vertebral body
DDX tear drop fracture from anterior limbus vertebra
Teardrop Fx is anterior-inferior w/o corticated edges
Anterior limbus vertebra is anterior-superior WITH corticated edges
What is Cupid’s bow deformity?
Developmental phenomenon that is unrelated to osteopenia or mechanical stress on spine
What is spina bifida occulta?
Failure of posterior elements (lamina) to fuse, usually leaving lucent cleft
NO protrusion
In spina bifida Vera, what radiographic evidence might you see
Larger defect in posterior elements that allow meninges and/or spinal cord protrusion
What is diastematomyelia
2 spinal cords
An intraspinal canal cartilage, osseous or fibrous sagittal bar dividing the spinal cord into 2 hemicords.
What might be visualized on radiograph with diastematomyelia?
Increased interpediculate distance
Osseous intracranial density
What sx might suggest diastematomyelia?
Tethered cord syndrome, CES
What radiographic findings suggest pedicle agenesis
Absent pedicle on one side with hypertrophy and sclerosis of contralateral pedicle due to altered stresses
What is the most common cause of pedicle agenesis?
Osteolytic metastasis
But there wouldn’t be hypertrophy of opposite pedicle because that’s a process that happens over time and breast/colon cancer doesn’t have time to do that
What is characteristic of transitional L/S vertebra?
Undifferentiated L5 or S1
What does transitional L/S vertebra look like?
when SP is spatulated/tall (>19 mm) unilaterally or bilaterally and this may form accessory joints with sacral ala or be fused to sacrum
Spatulated transverse process is associated with what?
Transitional L/S vertebra (lumbarization/sacralization)
Spatulated TP may be associated with a small remnant disc and form an extra assymetrical joint with the sacrum
What is facet tropism asymmetry?
Asymmetry of articulation facets at any level
Facet tropism is most common at what level
L5-S1
Facet tropism is when facets are _______ and not purely sagittal or coronal
Curved
What is clasp-knife syndrome?
Spina bifida PLUS L5 SP enlargement (long, slender)
Is articulate process agenesis common?
Nope.
Where are lumbar ribs often seen? What do the TPs look like?
First lumbar vertebra
Sometimes with lumbosacral transitional segment
TPs are usually hypoplastic
Sometimes secondary growth centers (apophysis) don’t fuse-how do you DDX from fracture?
Scerosis
What is an unfused inferior articulate process in skeletal mature individual called?
Oppenheimer’s ossicle
And where does Oppenheimer’s Ossicle tend to happen?
IAP (Inferior Articular Process) of L3
What is illiolumbar ligament ossification?
👀 Ossification of illiolumbar ligament
A trapezoidal shaped L5 body if seen with L5 spondylitic spondylolisthesis may indicated
Higher probability of slippage. Otherwise its a normal variant.
What is sacral dysplasia/agenesis?
Congenital absence of distal portion of spinal column. “Caudal regression syndrome”
**Strong association with maternal diabetes
What condition has a strong association with maternal diabetes?
Sacral dysplasia/agenesis
Iliac apophysis is also called
Risser’s sign
What is triradiate cartilage?
Area of synchondrosis between ilium, ischium, pubis
What does triradiate cartilage look like in peds?
Radiolucency at the acetabulum
NORMAL FINDING
What is ischial apophysis?
Secondary growth center at ischium
Common site of avulsion fracture in peds by hamstring muscles
What is ischiopubic synchondrosis?
Area of synchondrosis between ischium and pubic in peds. Radiolucent area may look like callous formation of healing fracture… but its not.
Totally normal.
What is paraglenoid soul I?
Notched out area at inferior aspect ilium adjacent to SI joints.
More common in females.
Iliac nutrient grooves
Normal iliac vasculature seen as Y or V shaped lucent grooves with sclerotic margins
In thoracic its called: “Hans venous channel”
What is phleboliths?
Radiopacities superior to superior pubic rami. Located within pelvic veins.
NO clinical significance.
What is os acetabuli
Accessory ossicle located adjacent to superior-lateral aspect of acetabulum
What is sacrococcygeal synostosis
Anomaly in which sacrum and coccus do not go through segmentation.
No clinical significance.
What is ring epiphyses?
Anteroinferior margin - the growth center does not fuse.
Normal in peds.
Precuts excavatum?
Midline depression of sternum
What is rhomboid fossa?
Represents attachment of rhomboid lig to first rib. May or may not be bilateral, symmetrical.
