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Diagnostic imaging I test 2 > DDD, herniations part 1 > Flashcards

DDD, herniations part 1 Flashcards

1
Q

radiology of DDD

A 
decreased disc height
osteophyte formation
endplate sclerosis
vacuum phenomenon
subluxation (retrolisthesis)
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2
Q

spondylosis deformans are marked by what?

A

osteophytes

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3
Q

what part of the disc is associated with spondylosis deformans

A

outer disc

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4
Q

intervertebral chondrosis is marked by what?

A

reduced IVD space

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5
Q

what part of the disc is associated with intervertebral chondrosis?

A

inner disc

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6
Q

what is intervertebral disc osteochondrosis?

A

primary degeneration of the nucleus pulposus

loss of disc height with minimal osteophytes

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7
Q

intervertebral disc osteochrondrosis has what radiographic feature?

A

Knutson’s vacuum phenomenon

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8
Q

what is knutson’s vacuum phenomenon?

A

radiolucent collections of nitrogen gas within annular fissures

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9
Q

where is vacuum phenomenon best seen?

A

anterior margin of IVD on extension films

normally seen in synovial extremity joints under slight distraction

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10
Q

what is spondylosis deformans?

A

degeneration of the annulus with prominent osteophytes

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11
Q

what is osteophytosis due to?

A

breakdown at the site of attachment of the outer annular fibers, including Sharpey’s fibers to the vertebral margin

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12
Q

in osteophytosis, how do the osteophytes grow?

A

develop at the stressed areas of the ALL and keep going horizontally

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13
Q

what ligaments does osteophytosis sterss?

A

vertebral attachment of ALL

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14
Q

does osteophytosis fuse?

A

not usually

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15
Q

what are the common signs and symptoms of cervical spondylotic myelopathy?

A 
clumsy or weak hands
leg weakness or stiffness
neck stiffness
pain in shoulders or arms
unsteady gait
atrophy of hand musculature
hyperrefleia
lhermitte's sign
sensory loss
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16
Q

what are intercalary ossicles?

A

annulus degeneration

NOT fractured osteophytes

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17
Q

what does endplate sclerosis indicate?

A

infraction, compression and necrosis of stressed subchondral bone trabeculae

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18
Q

modic type 1 (which MRI? what does it indicate?)

A

dark T1
bright T2
indicates inflammation (bone marrow edema)

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19
Q

modic type 2 (which MRI? what does it indicate?)

A

bright T1
bright T2
indicates fat

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20
Q

modic type 3 (which MRI? what does it indicate?)

A

dark T1
dark T2
indicates sclerosis

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21
Q

what needs to be present to be considered modic changes?

A

DDD

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22
Q

what does it indicate when no modic changes to modic type 1?

A

more likely hypermobile

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23
Q

what does it indicate when modic type 1 goes to modic type 2?

A

more stable

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24
Q

modic type 2 going to modic type 1 or modic type 2 going to no modic indicates what?

A

unstable or infection

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25
Q

type one modic changes are more common in what part of the spine?

A

cervical

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26
Q

type 2 modic changes are more common in what part of the spine?

A

lumbars

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27
Q

Schmorl’s nodes

A

abrupt, focal, radiolucent IVD displacement into the cancellous bone of the adjacent vertebra

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28
Q

who do schmorl’s nodes typically occur in?

A

young children, little significance

if in adults, could represent clinically significant endplate infractions/fractures

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29
Q

criteria to be scheuermann’s disease

A

at least 3 vertebra with disc space narrowing
endplate irregularity
wedging of 5 degrees or more

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30
Q

who normally gets scheuermann’s disease?

A

adolescent onset (13-17)

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31
Q

what disease may result in pain, cosmetic deformity and premature DDD?

A

scheuermann’s disease

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32
Q

what is juvenile discogenic disease?

A

thoracolumbar scheuermann’s disease

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33
Q

what is the etiology of juvenile discogenic disease?

A

appears to be failure of embryologic vascular channels, centrum defects, and notochord clefts to disappear, leaving endplate defects

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34
Q

juvenile discogenic disease produces what pathologies?

A

early degeneration
segmental dysfunction
associated pathology in facet joint

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35
Q

posterior subluxations are primarily associated with what?

A

DDD (principally the annulus)

36
Q

anterior subluxation are primarily associated with what?

A

posterior joint arthrosis (degenerative spondylolisthesis

37
Q

describe degeneration of the cervical spine

A 
most common at C5/6
decreased disc height
posterior and anterior vertebral body osteophyte formation
posterior joint arthrosis
uncovertebral arthrosis
intercalary ossicles
38
Q

describe uncovertebral degeneration

A 
within 3-7th cervical levels
most commonly middle to lower cervical spine
bulbous osteophytes (frontal projection)
pseudofracture (lateral projection)
may encroach IVF
39
Q

describe zygapophyseal degeneration (facet arthrosis)
where?
x ray findings
where is neurological involvement demonstrated?

A

MC lower lumbar, middle cervical and upper throacic spine
xray is characterized by increased radiodensity and irregularity, hypertrophic changes, and osteophytes
neurological involvement is demonstrated on axial imaged of CT and MRI

40
Q

baastrup’s disease

A

when the spinouses can touch (kissing spine disease)

41
Q

how can chiro help in degeneration?

A

assist function

42
Q

how can pharma help in degeneration?

A

decrease inflammation

43
Q

how can surgery help in degeneration?

A

joint replacement

44
Q

how can social support help in degeneration?

A

decrease stress, increase social function

45
Q

how can physiotherapy help in degeneration?

A

increase circulation, decrease pain

46
Q

where is the source of pain in degeneration?

A 
distention of joint capsule
contracture of joint capsule
muscle spasms
periosteal elevation
direct pressure on subchondral bone
47
Q

what are the consequences of degeneration?

A 
loss of muscle strenght
decreased ROM
limited function
crepitus
joint effusion
depression/anxiety
48
Q

what is DISH?

A

exuberant hypertrophic changes involving the anterior vertebral body margins

49
Q

symptoms/signs of DISH

A 
very common
males over 50
incidence among diabetics
may be asymptomatic
neck stiffness
dysphagia in 20%
hoarseness
50
Q

where does DISH occur?

A

ALL of middle and lower thoracic, upper lumbar and lower cervical regions

51
Q

define entheseopathy

A

pathological osseous proliferation at tendon or ligament insertion
it is degenerative and inflammatory

52
Q

what are the radiographic signs you would see with DISH

A

flowing ossification of the anterior vertebral body margins with ankylosis
preservation of disc height (or minimal evidence of disease)
absence of sacroiliits (excludes AS)

53
Q

what is OPLL?

A

ossification of the PLL, seen as a radiolucent line along the posterior aspect of the vertebral bodies

54
Q

what can OPLL be associated with?

A

DISH, but doesn’t have to

55
Q

what can OPLLr result in?

A

loss of sagittal diameter of spinal canal, with resultant myelopathy

56
Q

OPLL is present in __% of DISH patients.

A

40-50%

57
Q

what are signs and symptoms of OPLL?

A

abnormalities are insidious
sensory and motor disturbances in the legs
progressive difficulty walking
paresthesias and diminished tactile senses over gradually increasing areas

58
Q

what is a common treatment of OPLL?

A

laminectomy

59
Q

if you see someone who has OPLL, what do you do?

A

send them for a neurosurgical consult
MR, CT
do NOT adjust

60
Q

what are indications for imaging (MRI)?

A 
true radicular symptoms
evidence of NR irritation
failed conservative treatment
surgical candidate
red flags
61
Q

prevalence of disc herniations are similar in who?

A

low back pain and radiculopathy patients

62
Q

radiculopathy patients are more likely to have what?

A

extrusions and nerve root compression

63
Q

is there a correlation between severity of disease and function and apin?

A

no

64
Q

who usually has a better sense of health?

A

patients who were blinded

65
Q

red flags for potentially serious conditions

A 
features of cauda equina syndrome
significant trauma
weight loss
history of cancer
fever
IV drug use
steroid use
patient age over 50 years
severe, unremitting night-time pain
pain that gets worse when patient is lying down
66
Q

what aer the most common complaints of people with herniations?

A

back pain

worse with sneezing, flexion, sitting and bowel function

67
Q

only __% of back pain patients suffer from a disc herniation

A

5%

68
Q

what is the prevalence of herniations among the asymptomatic patients?

A

20-35%

69
Q

what are some predictive factors of herniations if they don’t have symptoms?

A

lesion size and direction
canal size, ligamentum flavum hypertrophy
temporal/phase of herniation

70
Q

what is the prognosis of a herniation?

A

good

71
Q

what is the most serious complication of a herniation?

A

cauda equina syndrome

72
Q

what is cauda equina syndrome?

A

one of the most serious complications of disc herniations

73
Q

herniated discs do what to nerves that cause cauda equina syndrome?

A

compress multime nerve roots

74
Q

what are the symptoms of cauda equina syndrome? what do you do?

A 
altered bowel and bladder function
impotence
saddle paresthesia
progressive muscle atrophy
immediate neurosurgical consultation
75
Q

what are some examples of aggressive management of disc herniations?

A 
percutaneous discectomy
microdiscectomy
discectomy (MC)
laminectomy
chemonucleolysis
76
Q

surgery foe a disc herniation is considered if…

A

there is cauda equina syndrome
lack of progress with conservative care
muscle atrophy
too much pain

77
Q

what are some forms of conservative care for disc herniations?

A 
chiropractic
limited bed rest
drugs
injections
physical therapy
acupuncture
78
Q

midline disc herniations in the cervical spine cause what?

A

myelopathies

79
Q

lateral disc herniations in the cervical spine cause what?

A

compresses the NR below

80
Q

midline/paracentral herniations in the lumbar spine do what?

A

compress NR below

81
Q

foraminal disc herniation in lumbars involve what?

A

compression of the nerve root at the same level

82
Q

what is the best imaging for disc herniations?

A

MRI

83
Q

what is the function of the IVD?

A

nucleus and annulus work together to dampen forces

84
Q

what does proper function of the disc depend on?

A

integrity of the compoenets of the disc
stability of annulus
hydration of nucleus
separation offered by endplates

85
Q

describe the pathway that leads to injury of the nucleus of a disc?

A

decreased oxygen–>decreased chondrocytes–>decreased proteoglycans–>decreased water–>increased annular stress–>increased annular fissures

86
Q

the natural cohesion of the nucleus is denatured by what?

A

endplate fractures and blood exposure

87
Q

what are the contents of the spinal canal?

A 
thecal sac (cord, cauda equina)
epidural fat
internal vertebral plexus
ligamentum flavum
PLL

Diagnostic imaging I test 2 (8 decks)

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