Extra stuff- DD of the spine Flashcards
What condition involves degeneration of the annulus with prominent osteophytes that remain at the corners of vertebral bodies?
Spondylosis deformans- associated with intercalary ossicles
What condition involves the degeneration of the nucleus pulposus or inner disc and has a reduced IVD space/ loss of disc height and minimal osteophytes?
Intervertebral chondrosis
What is Knutson’s phenomenon?
Aka Vacuum phenomenon- radiolucent collections of nitrogen gas within annular fissures
Where is Knutson’s phenomenon best seen?
Anterior margin of IVD on extension films
What are 4 radiologic findings of DDD?
Decreased disc height
Osteophytes
End plate sclerosis
Vacuum phenomenon
What is an increased bone density or thickening of the subchondral layer that may appear exaggerated or mimic an infection or blastic tumor
Endplate (subchondral) sclerosis
Hemispheric spondylosclerosis
Which modic change represents marrow edema/ inflammation and where is it most common?
Modic type 1
MC in cervicals
What does a modic type 1 change suggest?
Hypermobility
Which modic change represents marrow replacement/ fat and where is it more common?
Modic type 2
MC in lumbars
Which modic change represents thick woven sclerotic bone?
Modic type 3
CT and x-ray represent what type of change?
Trabeculation changes
MR reflects what type of change?
Marrow changes
If fatty marrow disappears it could mean?
More unstable or possible infection
Which radiologic test is best for evaluating obvious defects in the pars?
Plain radiographs
What test do we use to evaluate for active spondylolysis or stress reaction in non-fracture pars?
SPECT bone scan
What is becoming the gold standard for evaluating spondylolysis and pars defects?
MR
What is an abrupt focal radiolucent IVD displacement into the cancellous bone of an adjacent vertebra?
Schmorl’s node
Who do you typically see Schmorl’s nodes in?
Children- usually insignificant
When you see a schmorl’s node in an adult what does it usually represent?
Significant end plate fracture
Where is Scheurermann’s disease typically seen in the spine?
T7-T12
What is thoracolumbar scheurermann’s disease called?
juevenile discogenic disease
With a posterior subluxation what is the diagnosis?
DDD- MC annulus
What is an anterior subluxation?
Spondylolisthesis- posterior joint arthrosis MC cause
What is the #1 cause of anterior subluxation in kids?
Stress fracture- L5 in females MC
What is the #1 cause of anterior subluxation in adults?
Posterior joint arthrosis- females L4 middle age MC
Where is the MC degeneration of the cervicals?
C5/6
Where does the MC uncovertebral degeneration occurs?
C3-C7
With uncovertebral degeneration, a frontal projection=
Bulbous osteophytes
With uncovertebral degeneration, a lateral projection=
Pseudofracture **sign of uncinate hypertrophy
Why are nerve roots rarely effected with uncovertebral degeneration?
They lie in superior aspect of IVF
If nerve roots are affected with uncovertebral degeneration what is the MC cause?>
Facet hypertrophy
Where is zygapophyseal degeneration most common?
Lower lumbar
Middle cervical
Upper/middle thoracic
What is the MC cause of disc calcification?
Idiopathic
Where is the bifurcation of the aorta?
L4/5
Sacroilitis is unique to what?
Ankylosing spondylitis
What percentage of DISH patients will have OPLL?
40-50%
When the PLL ossifies in the cervical region, their is often a decrease in sagittal canal diameter with resultant ______
Myelopathy
What is the cause of anterior cord syndrome?
Stenosis- OPLL
What is the cause of posterior cord syndrome?
Compression
In the cervical spine, midline herniations create _____
Myelopathies
In the cervical spine, lateral herniations ______
Compress the NR BELOW
In the lumbar spine, midline/ paracentral herniations compress _____
The NR BELOW
In the lumbar spine, foraminal herniations involve the NR _____
At the same level
The gold standard for imaging for herniations is _____
MRI
What are the 3 types of annular tears?
Circumferential, radial, transverse
Natural cohesion of the nucleus is denatured by _____
Endplate fracture and blood exposure
Herniation only happens if?
Annulus pathway is present
If no annulus pathway is present then there is?
An internal disruption
What are the contents of the spinal canal?
Thecal sac Epidural fat Internal vertebral plexus Ligamentum flavum PLL
What allows direct drainage from the pelvis via the spinal canal? It is a common site allowing cancer into the canal?
Batson’s venous plexus
Which types of herniations can be seen on mid-sag MRI cuts?
Central and paracentral
what is a very dense central/nucleus pulposus disc calcification?
onchronosis
which conditions do you see annulus fibrosis calcification?
CPPD
haemochromatosis
hypervitaminosis D
when is transient IVD calcification commonly seen and where?
in children in cervical spine; usually spontaneously regresses
what is a pathological osseous proliferation at tendon or ligament insertion that can be degenerative or inflammatory?
enthesopathy
what is one of the key features differentiating DISH from DDD?
DISH preserves disc height and osteophytes more pronounced (candle wax)
with OPLL what are some of the secondary symptoms?
sensory and motor disturbances- especially legs
progressive difficulty walking
paresthesia and diminished tactile senses
what is the common tx for OPLL?
laminectomy
what percentage of back pain patients suffer from herniation?
5%
what percent of mechanical LBP is from sprain/strain?
70%
what is the lifetime prevalence of mechanical LBP in the US?
60-80%
what is the MC cause of work-related disability in persons under 45 in the US?
mechanical LBP
presence of herniations among asymptomatic population is estimated at what percent?
20-35%
CT is inferior to MRI for ______ but superior for _____
soft tissue (herniations); bone imaging
with a decrease in O2, chondrocytes, proteoglycans and H2O you have an increased risk of?
annular stress which leads to annular fissures and tears
theca =
meninges
what is an area of increased signal intensity on a T2 image usually referring to outer annulus and may reflect fissure or tear?
high intensity zone
what are the 2 types of spinal stenosis?
congenital- achondroplasia
acquired- spondy, spondylolisthesis, lig flav hypertrophy, IVD herniation etc.
what are the 3 spinal canal parameters?
central- spinal canal
neuroforaminal- lateral zone of IVF
lateral recess- medial zone of IVF
cervical and lumbar spine stenosis measurements
cervical- less than 12 mm
lumbar- less than 15 mm
what are the sagittal canal measurements?
anterior line- posterior vertebra
posterior line- spinolaminar line
stenosis under 12mm- disc facet degeneration or herniation
lateral recess stenosis measurement
3mm
what procedure would be done for stenosis?
laminectomy
what are common signs of cervical spine stenosis?
long tract and radicular sx, HA, neck pain, + lhermitte’s
what 2 conditions does cervical spine stenosis mimic?
MS and ALS
what are common sx of lumbar spine stenosis?
radicular s&s, back pain, neurogenic claudication
what is neurogenic claudication?
LE pain and numbness exacerbated by standing and alleviated by flexion; simian stance; alleviation with exercise
DDx: vascular claudication- intermittent and usually in calf
