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Diagnostic imaging exam 3 extra stuff > Extra stuff- DD of the spine > Flashcards

Extra stuff- DD of the spine Flashcards

1
Q

What condition involves degeneration of the annulus with prominent osteophytes that remain at the corners of vertebral bodies?

A

Spondylosis deformans- associated with intercalary ossicles

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2
Q

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?

A

Intervertebral chondrosis

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3
Q

What is Knutson’s phenomenon?

A

Aka Vacuum phenomenon- radiolucent collections of nitrogen gas within annular fissures

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4
Q

Where is Knutson’s phenomenon best seen?

A

Anterior margin of IVD on extension films

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5
Q

What are 4 radiologic findings of DDD?

A

Decreased disc height
Osteophytes
End plate sclerosis
Vacuum phenomenon

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6
Q

What is an increased bone density or thickening of the subchondral layer that may appear exaggerated or mimic an infection or blastic tumor

A

Endplate (subchondral) sclerosis

Hemispheric spondylosclerosis

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7
Q

Which modic change represents marrow edema/ inflammation and where is it most common?

A

Modic type 1

MC in cervicals

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8
Q

What does a modic type 1 change suggest?

A

Hypermobility

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9
Q

Which modic change represents marrow replacement/ fat and where is it more common?

A

Modic type 2

MC in lumbars

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10
Q

Which modic change represents thick woven sclerotic bone?

A

Modic type 3

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11
Q

CT and x-ray represent what type of change?

A

Trabeculation changes

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12
Q

MR reflects what type of change?

A

Marrow changes

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13
Q

If fatty marrow disappears it could mean?

A

More unstable or possible infection

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14
Q

Which radiologic test is best for evaluating obvious defects in the pars?

A

Plain radiographs

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15
Q

What test do we use to evaluate for active spondylolysis or stress reaction in non-fracture pars?

A

SPECT bone scan

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16
Q

What is becoming the gold standard for evaluating spondylolysis and pars defects?

A

MR

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17
Q

What is an abrupt focal radiolucent IVD displacement into the cancellous bone of an adjacent vertebra?

A

Schmorl’s node

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18
Q

Who do you typically see Schmorl’s nodes in?

A

Children- usually insignificant

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19
Q

When you see a schmorl’s node in an adult what does it usually represent?

A

Significant end plate fracture

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20
Q

Where is Scheurermann’s disease typically seen in the spine?

A

T7-T12

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21
Q

What is thoracolumbar scheurermann’s disease called?

A

juevenile discogenic disease

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22
Q

With a posterior subluxation what is the diagnosis?

A

DDD- MC annulus

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23
Q

What is an anterior subluxation?

A

Spondylolisthesis- posterior joint arthrosis MC cause

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24
Q

What is the #1 cause of anterior subluxation in kids?

A

Stress fracture- L5 in females MC

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25
Q

What is the #1 cause of anterior subluxation in adults?

A

Posterior joint arthrosis- females L4 middle age MC

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26
Q

Where is the MC degeneration of the cervicals?

A

C5/6

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27
Q

Where does the MC uncovertebral degeneration occurs?

A

C3-C7

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28
Q

With uncovertebral degeneration, a frontal projection=

A

Bulbous osteophytes

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29
Q

With uncovertebral degeneration, a lateral projection=

A

Pseudofracture **sign of uncinate hypertrophy

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30
Q

Why are nerve roots rarely effected with uncovertebral degeneration?

A

They lie in superior aspect of IVF

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31
Q

If nerve roots are affected with uncovertebral degeneration what is the MC cause?>

A

Facet hypertrophy

32
Q

Where is zygapophyseal degeneration most common?

A

Lower lumbar
Middle cervical
Upper/middle thoracic

33
Q

What is the MC cause of disc calcification?

A

Idiopathic

34
Q

Where is the bifurcation of the aorta?

A

L4/5

35
Q

Sacroilitis is unique to what?

A

Ankylosing spondylitis

36
Q

What percentage of DISH patients will have OPLL?

A

40-50%

37
Q

When the PLL ossifies in the cervical region, their is often a decrease in sagittal canal diameter with resultant ______

A

Myelopathy

38
Q

What is the cause of anterior cord syndrome?

A

Stenosis- OPLL

39
Q

What is the cause of posterior cord syndrome?

A

Compression

40
Q

In the cervical spine, midline herniations create _____

A

Myelopathies

41
Q

In the cervical spine, lateral herniations ______

A

Compress the NR BELOW

42
Q

In the lumbar spine, midline/ paracentral herniations compress _____

A

The NR BELOW

43
Q

In the lumbar spine, foraminal herniations involve the NR _____

A

At the same level

44
Q

The gold standard for imaging for herniations is _____

A

MRI

45
Q

What are the 3 types of annular tears?

A

Circumferential, radial, transverse

46
Q

Natural cohesion of the nucleus is denatured by _____

A

Endplate fracture and blood exposure

47
Q

Herniation only happens if?

A

Annulus pathway is present

48
Q

If no annulus pathway is present then there is?

A

An internal disruption

49
Q

What are the contents of the spinal canal?

A 
Thecal sac
Epidural fat
Internal vertebral plexus 
Ligamentum flavum 
PLL
50
Q

What allows direct drainage from the pelvis via the spinal canal? It is a common site allowing cancer into the canal?

A

Batson’s venous plexus

51
Q

Which types of herniations can be seen on mid-sag MRI cuts?

A

Central and paracentral

52
Q

what is a very dense central/nucleus pulposus disc calcification?

A

onchronosis

53
Q

which conditions do you see annulus fibrosis calcification?

A

CPPD
haemochromatosis
hypervitaminosis D

54
Q

when is transient IVD calcification commonly seen and where?

A

in children in cervical spine; usually spontaneously regresses

55
Q

what is a pathological osseous proliferation at tendon or ligament insertion that can be degenerative or inflammatory?

A

enthesopathy

56
Q

what is one of the key features differentiating DISH from DDD?

A

DISH preserves disc height and osteophytes more pronounced (candle wax)

57
Q

with OPLL what are some of the secondary symptoms?

A

sensory and motor disturbances- especially legs
progressive difficulty walking
paresthesia and diminished tactile senses

58
Q

what is the common tx for OPLL?

A

laminectomy

59
Q

what percentage of back pain patients suffer from herniation?

A

5%

60
Q

what percent of mechanical LBP is from sprain/strain?

A

70%

61
Q

what is the lifetime prevalence of mechanical LBP in the US?

A

60-80%

62
Q

what is the MC cause of work-related disability in persons under 45 in the US?

A

mechanical LBP

63
Q

presence of herniations among asymptomatic population is estimated at what percent?

A

20-35%

64
Q

CT is inferior to MRI for ______ but superior for _____

A

soft tissue (herniations); bone imaging

65
Q

with a decrease in O2, chondrocytes, proteoglycans and H2O you have an increased risk of?

A

annular stress which leads to annular fissures and tears

66
Q

theca =

A

meninges

67
Q

what is an area of increased signal intensity on a T2 image usually referring to outer annulus and may reflect fissure or tear?

A

high intensity zone

68
Q

what are the 2 types of spinal stenosis?

A

congenital- achondroplasia

acquired- spondy, spondylolisthesis, lig flav hypertrophy, IVD herniation etc.

69
Q

what are the 3 spinal canal parameters?

A

central- spinal canal
neuroforaminal- lateral zone of IVF
lateral recess- medial zone of IVF

70
Q

cervical and lumbar spine stenosis measurements

A

cervical- less than 12 mm

lumbar- less than 15 mm

71
Q

what are the sagittal canal measurements?

A

anterior line- posterior vertebra
posterior line- spinolaminar line

stenosis under 12mm- disc facet degeneration or herniation

72
Q

lateral recess stenosis measurement

A

3mm

73
Q

what procedure would be done for stenosis?

A

laminectomy

74
Q

what are common signs of cervical spine stenosis?

A

long tract and radicular sx, HA, neck pain, + lhermitte’s

75
Q

what 2 conditions does cervical spine stenosis mimic?

A

MS and ALS

76
Q

what are common sx of lumbar spine stenosis?

A

radicular s&s, back pain, neurogenic claudication

77
Q

what is neurogenic claudication?

A

LE pain and numbness exacerbated by standing and alleviated by flexion; simian stance; alleviation with exercise

DDx: vascular claudication- intermittent and usually in calf

Diagnostic imaging exam 3 extra stuff (5 decks)

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