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SKEL D > (Carter Lecture) > Flashcards

(Carter Lecture) Flashcards

1
Q

RA involves the cervical spine in ____ to ____ % of patients

A

50-80%

  • This varies by your source, however Carter believes this is still a high number. Note, that radiograpically, RA in the
    C-Spine is about 30 %
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2
Q

Involves SI joints in _______ % of patients

A

25-35%

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3
Q

RA Involves thoracic and lumbar spine in less than _____ of patients

A

5%

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4
Q

Spinal involvement almost always occurs after the _________________________________

A

extremities have been involved

  • The extremities are affected first always
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5
Q

RA in the Atlanto-Occipital area

Loss of ______ space with ________
Vertical translation of odontoid causing “________ -basilar
_________

A

Loss of joint space with erosion

Pseudo-basilar invagination

  • Carter, called this a vertical subluxation of the odontoid*

This is a good place to draw McGregor’s or Chamberlain’s line

Chamberlain: 3mm
McGregors Male: 8mm
McGregors Female: 10mm

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6
Q

RA: Atlanto Axial

30-50% of patients
Erosion of the _____(“whittled_______”)

A

dens, whittled odontoid

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7
Q

RA: Atlanto Axial Areas of Involvement

ADI ___________

Bursitis between dens and _________ _________

Alar ligament attachment

Passible rupture of transverse ligament (increased ADI)

A

ADI synovitis

transverse ligament

Note: Identical changes can happen in this area (c1/c2) from PA, AS, Reiter’s, and SLE (PARS)

Flexion/extension films ARE indicated

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8
Q

RA in Cervical Spine: C 3,4, and 5

Multi level ________(esp. C2-C4) creating a “step ladder or
doorstep” appearance

Joint narrowing with erosions on the _______ joints (can lead to ________)

Disc _________with end-plate ________

Generalized osteoporosis

Occasionally can get erosions on SP’s causing tapering

“_________ ________ appearance”

A

Anterolisthesis (especially C2-C4)

apophyseal; ankylosis

Disc Narrowing and end-plate erosions

Sharpened pencil appearance

Note: Flexion films very helpful

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9
Q

RA vs OA Characteristics

AES SEA

A

RA

  • ADI
  • Erosions
  • Stair stepping

OA

  • Sclerosis
  • Enlarged Facets
  • Anterolisthesis (usually one level if present)
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10
Q

RA sequence

1.
2.
3.
4.

A

Synovitis
Marginal Erosions
Granulation Erosions
Subluxation, Dislocation

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11
Q

What area of the spine is RA frequent and detail its characteristics/findings?

Think of the Resnick

A

C3-C7

Facet Articulations
Endplates
Combination of the two lead to subluxations (marginal and articular erosions, subluxations, etc)

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12
Q

RA in SI joints

►Iliac ___________ and mild loss of joint space
►Sclerosis (minimal or absent) more dominant on ___ side
►Usually unilateral but if bilateral it is ___________
►Ankylosis is very rare

A

Erosions

Iliac

Asymmetric

Ankylosis is rare but if present, it would have a Rosary bead presentation, as there is in AS.

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13
Q

AS (Ankylosing Spondylitis) aka

A

Marie-Strumpell’s or Bechterew’s

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14
Q

AS starts in the _____ and ______ ____ the spine

Remember Carter’s 30 Under 30 rule

A

SI joints and Moves UP

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15
Q

Onset for AS is typically ___ to ___ yoa with an average of 26/27 years old

male or female predilection and MC in Caucasians

A

15-35

Male

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16
Q

Low back pain esp. on waking, possible leg pain which can ____________ sides

 Progressive loss of ________
 Decreased _________ expansion

 Loss of secondary curves often with exaggerated head carriage

A

Alternate sides

Progressive loss of ROM

Decreased chest expansion

Loss of 2ndary curve and exaggerated head carriage

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17
Q

AS patients have 20x chance to develop ___issues or ____ disease

A

GI, Chron’s disease

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18
Q

AS: Extraskeletal Associations

Ocular - __________, and often precedes back pain by
Cardiac- ____________
Lungs: Upper lung fibrosis and/or cavitations
GI

OTHER Associations
 Chronic pancreatitis (80%)
 Renal failure from amyloidosis (8%)
 Lab: elevated ESR, HLA-B27 in (90%),

Negative __________ factor

A

Iritis, which often precedes back pain by up to 6 months

Cardiac changes include aneurysms (usually thoracic)

Lungs: Upper lung fibrosis and/or cavitations

Crohn’s and ulcerative colitis in 18% (20 x greater chance to develop GI issues or Chron’s disease

Rheumatoid

19
Q

Early AS (5 signs)

B/L and \_\_\_\_\_\_\_\_\_\_\_
Pseudo-\_\_\_\_\_\_ of joint 
Rosary bead erosions
Sclerosis ( will always be more prominent on iliac side) and begin to \_\_\_\_\_\_ the si joint space intermediately 
Best seen on sacral tilt film
A

b/l and symmetric

pseudo-widening of the joint

obliterate

20
Q

Chronic AS

\_\_\_sign (oblieration of jt. space)
\_\_\_\_\_ sign (bridging ossification of the upper 1/3 of SI joints)

Compete fusion of SI joints

A

Ghost sign

Star sign

21
Q

AS Moving up the Spine

Focal destruction and erosion of body rim at annulus
enthesis known as a “_________ lesion”

Healing of erosion causes transient reactive sclerosis resulting in “_____________________”

First changes occur at thoracolumbar junction
(60% of the time)

A

Romanus lesion

Shiny corner sign

Note as the SPINE gets involved, inflammation of the ALL occurs ALWAYS and followed by the facet joints, and sometimes the PLL.

22
Q

AS: Marginal Syndesmophytes

  • Thin ossification of ALL across disc spaces causing __________ syndesmophytes and leading to ________ spine/poker spine

The calcified ALL will fill the anterior body concavity (________) or slightly thicken it (barrel shaped)

A

marginal syndesmophytes, bamboo/poker spine

squaring or slightly thicken (barrel shape)

23
Q

Anterior Ossification of ALL in AS is always ______ in comparison to DISH, which is thick.

A

Thin

24
Q

AS in the Thoracic spine

Occasionally it may skip the thoracic spine however it can involve _________ articulations

A

Costovertebral

25
Q

AS facet fusion radiographically is described as

A

Trolley track sign

26
Q

Intra and ________ ligament ossification aka ________ sign

A

Supraspinous

Dagger sign

27
Q

AS in the Uper cervical spine is _____ ranging __- __%

A

Rare; 2-15%

28
Q

Carrot Stick Fx

M/C in lower ________ and _________
junction

A

cervicals

thoracolumbar junction

Note, Epidural hematomas are present in 20% of carrot stick fxs

29
Q

Complication of Carrot Stick # is kown as what tpe of lesion

A

Andersson

30
Q

Characteristics of Anderssons Lesion

Development of pseudoarthrosis

Rapid loss of adjacent ___________

Sclerosis
_____________ of VB

A

Endplates
Sclerosis
Fragmentation of VB

31
Q

Thin anterior ossification

Lower SI involved

A

AS

Note, in AS SI joint involvement is ALWAYS bilateral and symmetrical.

32
Q

Thick (disc and mid body) flowing ossification

No lower SI involvement, may have upper SI radiographic activity

A

DISH

33
Q

In patient’s with AS you want to check _______ breathing via Respiratory Excursion. Why?

A

Diaphragmatic

34
Q

Enteropathic Arthritis is a type of condition that groups together GI disease that creates articular abnormalities

Common: _________ colitis and _______ disease

Uncommon: Whipple’s, Salmonella enteritis, Shigella enteritis, Yersinia enteritis, Post-bypass operations, Collagenous colitis

A

Ulcerative Colitis and Chron’s Disease

35
Q

AS patients have a __ % chance of developing GI disease

A

20

36
Q

EA in the spine is indistinguishable from AS

4 x more common to involve ____ only versus the ____ and _____ together.

A

SI

SI and spine

37
Q

Extra Spinally EA affects teh knees, elbows, wrists, and _____.

The only radiographic finding for EA is ________

and possibly ________

Normally patients with EA, the swelling typically subsides within __to___ months

A

ankle

Soft tissue swelling and possible erythema

1-3 months

38
Q

Psoriatic Arthritis (PA)

Spine involvement in up to _____ % with _____ disease
Most common site in the spine _____ to ______
Can cause upper cervical instability (as in RA)
Spinal changes indistinguishable from ______ syndrome
75% HLA-_____

A

60 %; skin disease
T11-L3
Reiter (aka Reactive) remember that PA is an inflammatory artrhopathy and upper C complex can be involved

HLA-B27

39
Q

PA

Classified as a _______ Arthropathy, characterized radiographically by __- marginal ________

Typically there is Skin/Nail Involvement

A

Seronegative

Non-marginal Syndesmophytes (thick midbody to midbody)

40
Q

PA is

Unilateral or bilateral and _________

A

asymmetric

Note, PA can easily be mistaken for DDD

41
Q

thick non-marginal syndesmophytes AKA

A

parasyndesmophytes

42
Q

PA: SI joints

30-50% of patients
Usually bilateral asymmetric but can be unilateral
Erosions with mild sclerosis
Typically does not proceed to fusion

A

.

43
Q 
Simple immobilization (cast/splint) or reduced activity 
(i.e. clay shoveler’s fx)

No neurologic involvement

A

Stable

SKEL D (1 decks)

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