7c. Spine Pathologies Flashcards
what are the 3 things that bones should be examined for
examined for fractures collapse/height/avulsion
parallel facet joints
abnormal calcification
what should be examined for disc spaces
examine for symmetry/normality of the intervertebral discs between each vertebra
what are the spaces that should be checked for dens view of C spine
height of disk symmetrical on both sides
distance between medial sides of lat masses and peg are equal on both sides
check if lateral aspect of C1 and 2 aligned
what are the lines to be checked for alignment of vertebral bodies and processes
anterior and posterior vertebral lines
what may widening prevertebral soft tissue indicate
pus or blood build up in the neck leading to swelling of tissue
what is the max prevert soft tissue space distance in C3
max 5mm
what is the max prevert soft tissue space distance in C2
<7mm anterior to C2
what is the max prevert soft tissue space distance in C7
<2cm anterior to C7
what is retropharyngeal infection and what does it look like
collection of pus and space gets larger and pushes out anteriorly and can obstruct airway by retropharyngeal mass/infection
anterior to C2/3 there is an increase in prevertebral soft tissue space
what is scoliosis
side to side curvature of the spine
what is kyphosis
AP curvature of spine
what are the 3 causes of scoliosis
idiopathic, associated with cerebral palsy and muscular dystrophy
what are the 3 causes of kyphosis
idiopathic, fractures, osteoporosis
how can kyphosis impact the spinal cord
spinal cord stretches around the deformity/kyphotic angle and can result in impingement
what is spina bifida occulta
small defect of posterior elements of a vertebra
what is spina bifida - myelomeningocele
spinal canal remains open along several vertebrae in the lower/middle back
both the membranes and the spinal cord or nerves exposed in sac
what is spina bifida - meningocele
no cord protruding just fluid in sac
Fluid filled sac at back with no neural tissue often occur below level of where you have spinal cord like in sacrum
what is a cause of spina bifida
Deficiency of folic acid
what is multiple sclerosis
autoimmune disease response that destroys myelin sheath that insulates nerve fibres
what does multiple sclerosis affect
brain and spinal cord
where can lesions of multiple sclerosis develop
brain, optic nerves and spinal cord
metastases has what appearance on xrays
increased bone signal
what do sclerotic metastases do to the bone strength and what does this mean for #
retain strength in bone so unlikely fracture, increases bone density
what do lytic metastases do to the bone strength
decrease density and destroy bone
what can metastases do to the spinal cord
can encroach on spinal cord and cause spinal cord compression
if the metastases are high signal and bright but the spinal canal is dark what MRI type is it
T1 as its contrast enhanced and metastases have higher water content
will there be a difference between pre and post contrast for metastases in MRI T2
no
what is multiple myeloma
white blood cell malignancy and deposits widely in bone
what appearance does multiple myeloma have for bone on images
moth eaten appearance
what does multiple myeloma do to the bone in the spine
Spine taken over by tumor and destroys bone and replaced bone so bone becomes weaker and collapse on itself, vert reduced in height and tumor replacement between bony fragments
what other condition resembles multiple myeloma
osteoporosis
what is ewing sarcoma
aggressive primary bone tumor, locally invasive and has soft tissue mass
what do patients present with for ewings sarcoma
swelling and pain at site of tumor
what is characteristic of ewing sarcoma on images
soft tissue mass expands into the spinal canal
what are bone hemangiomas
benign malformed vascular lesions
where do bone hemangiomas occur most frequently
occur most frequently in vertebral column, commonly in L spine
what are bone hemangiomas seen as on images
bright round spot
what are 3 characteristic features of OA in the vertebral column
bony spur/osteophyte
vertebral/intervertebral height loss
nerve root entrapment/compression
what is typical of TB in the spine
collection of fluid ant to vert itself and collection post compressing spinal cord (ant collect is typical of TB)
what is gibbous TB
Gibbous is acute angulation/kyphosis of sp cord due to TB
what is osteoporosis in the spine
compression fracture risk and greatly reduced bone density
why does osteoporosis in the spine increase fracture risk and what results
Once structure of vertebrae itself becomes frail it can collapse on itself, lose height ant but post mostly fine -> kyphosis results (wedge fractures)
what does a osteoporotic vertebra create in the lateral veiw
wedge shape
what is a slipped disk
intervertebral disk has defect and soft centre of disk protrudes into spinal canal and can compress nerve roots emerging from spinal cord or compress spine
what is disc herniation
height of disc reduced so less space for spinal nerve
content of disc squished posteriorly and impinges on nerve as it exits foramina
what are the most common areas for disk herniation
L3-5 commonly
C spine second most common area of spine
what is spinal stenosis
reduce space for spinal cord
what is the 3 most common cause of spinal stenosis
disc herniation
thickening of ligamentum flavum
OA
what scan is needed if suspect a Cspine injury
CT scan
what is a tear drop # caused by
hyperflexion injury
head acutely flexed forwards causing compression of vert so ant part breaks off (hyperflex injury)
what is a burst fracture
Fragments of bone going ant and post that can protrude into the spinal canal and can impinge on sp cord
why is a C2 dens fracture so unstable
once dens #s, only ligament holds C1 and 2 together so very unstable
what can be seen in a sagittal view for a C2 dens #
small collection of blood could be ant to dens
why is C2 body # deadly
because it can cut straight through the spinal cord that could kill the patient
what is a jefferson fracture
compression fracture of C1 bony ring
what 3 things to be checked in a jefferson fracture
check height which is equal both sides, distance betw dens and med border of lat masses, Lateral masses movement
what is spondylolithesis
both or one of pars in the vert
Vert body slipped ant to lower levels and can cause compression of nerve roots
