Diagnostic imaging part 2: lumbar spine Flashcards
What is the single most over-requested diagnostic imaging procedure?
lumbar radiography
What are the problems with so many extra lumbar radiographies?
Economic impact, irrelevant findings that lead to inappropriate diagnosis and treatment, and 50% of people will have an identifiable abnormality of the disc or spinal canal (asymptomatic)
For those who are asymptomatic that get a lumbar MRI, _____% have an identifiable abnormality of the disc or spinal cord, _____% with disc protrusions, _______% with annular tears, but these findings do not predict the development of ___________
50, 27, 38, LBP
Article from the lancet concluded that pts with LBP do not need to be imaged unless _________________________
there is serious pathology or red flags suspected or present, because it doesn’t improve outcomes
what are the 2 most common views of the lumbar spine?
anteroposterior and lateral
What does a 3 view of the lumbar spine consist of?
AP, lateral, and magnified coned lateral view of L5-S1
What does a 5 view of the lumbar spine consist of?
AP, lateral, magnified coned lateral view of L5-S1, and incorporates a left and right oblique view
What does a 7 view of the lumbar spine consist of?
AP, lateral, magnified coned lateral view of L5-S1, left and right oblique view, and flexion and extension view
What to look for when looking at an AP view of the spine?
alignment and present of abnormal bone
What to look for when looking at a lateral view of the spine?
Smooth, gentle curvature along: anterior vertebral bodies, posterior vertebral bodies, anterior base of the spinous processes, and the tips of the spinous processes
With an oblique projection, we need to look at _______________; will show a _____________ view and fracture of the ______________
patency of the facet joint and pars interarticularis; Scottie dog, pars interarticularis
In the oblique view of the spine, what does it mean if the Scottie dog has a collar?
there’s a fracture
MRI is probably not medically necessary in adult patient with low back pain ___________ neurological deficits AND _________ signs of serious disease or “red flags” unless __________________
without; without; unless surgery is being considered
Indications for lumbar MRI: Leg pain with or without associated _________ and documented focal neurologic deficit (such as ______________).
back pain; motor weakness, dermatomal sensory loss, or significant reflex abnormality
Indications for lumbar MRI: Pain/radiculopathy in adults not improving despite ____________, which includes physical therapeutic modalities and appropriate pharmacologic intervention. Acutely in the setting of __________________
4 weeks of non-surgical treatment; major trauma
Indications for lumbar MRI: Recent less severe trauma to the spine with abnormalities on ___________________
neurologic exam or abnormal x-ray or persistent localized pain
Indications for lumbar MRI: Clinical suspicion of an infectious process such as ____________ involving the spine or spinal cord, spinal cord or adjacent structures or spaces.
abscess, osteomyelitis, or discitis
Indications for lumbar MRI: Clinical suspicion of primary ___________ with symptoms and/or findings suggesting involvement of the spine, spinal cord, meninges or positive bone scan
lumbar spine cancer
Indications for lumbar MRI: Clinical suspicion of lumbar __________ or lumbar ____________ compression with extremity weakness, bladder/bowel symptoms, ataxia, spasticity, spinal level sensory loss
myelopathy; nerve root or cauda equina
Indications for lumbar MRI: Suspected spinal cord (conus medularis) ______ or spinal (cauda equina) cord __________
infarct; tumor
Indications for lumbar MRI: Significant ____________. For pediatric patients where imaging of the entire spine is needed an MRI may be more appropriate to minimize ________________
scoliosis; radiation exposure
Indications for lumbar MRI: In children, suspicion of ______________________
congenital or acquired abnormalities of spine and/or cauda equina or tethered cord
Indications for lumbar MRI: Known diagnosis of cancer with suspicion of ___________________
metastases to the lumbar spine, meninges, or spinal cord
Indications for lumbar MRI: Further investigation of spinal abnormality of ___________ cause seen on plain film
unknown or uncertain
Indications for lumbar MRI: Findings consistent with ____________________ (bilateral sciatica, saddle anesthesia, bladder/bowel disturbance, etc.)
cauda equina syndrome
Indications for lumbar MRI: Sign/symptoms suggestive of ____________ (pseudoclaudication; pain/numbness/tingling with activity, relieved by rest, sitting, spinal flexion; suggestive x-ray findings).
spinal stenosis
