ICL 2.1: Imaging of the Spine Flashcards
between X-ray, CT, and MRI which takes the longest?
MRI
what is myelography?
insert a needle into the spinal fluid and inject a dye to see the nerves of the spinal cord
it’s a type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors
followup with a CT scan
what are x-rays good for?
- alignment of the spine (you can put people in different positions to take X-ray)
- degenerative disease
- intervertebral disc spaces
- bone quality
- vertebral fractures
- abnormal curvature
what are x-rays not good for visualizing?
- Spinal cord and nerves
- Intervertebral disc structure
- Muscle and ligaments
what does an x-ray myelogram allow you to see?
adds the ability to see the outline of the thecal sac
within the thecal sac it adds the ability to see the outline of nerve roots (this is better identified on post-myelographic CT images
with the above additions – can potential identify compressive pathology
HOWEVER, it does NOT allow you to identify pathology within the cord like if there was a tumor inside the cord but you would be able to see the outline of the spinal cord so you could probably see that the cord was enlarged/buldging
what is the pars interarticularis?
the portion of bone at the junction of the pedicle and lamina between the superior and inferior articulating processes
pictured as the neck of the “Scotty dog” on X-ray
what is spondylolysis?
pars interarticularis fracture
fracture or defect of the pars interarticularis without slippage of the vertebral bodies
aka a break of Scotty dog neck on X-ray
what is spondylolisthesis?
slippage of one vertebra on another following a fracture of the pars interarticularis
what is ankylosing spondylitis?
spine fuses together
what is a CT scan good for visualizing?
- Alignment of the spine
- Degenerative disease
- Intervertebral disc spaces
- Bone quality
- Blood/hematoma***
- Vertebral fractures
what are CT scans not good at visualizing?
- Spinal cord and nerves
2. Intervertebral disc structure
what is a Jefferson fracture?
a fracture of anterior and posterior arches of C1 in one or more places
usually from axial loading onto the spin or direct impact to the posterior aspect of the neck
patients present with neck pain, +/- neurological deficits
diagnosed with CT or x-ray
how do you treat a Jefferson fracture?
if stable, put patient in cervical collar
if unstable, surgical fixation
if on axial CT, the atlantodental interval (ADI) > 3mm, then transverse ligament is considered torn and fracture is considered unstable
what is a Hangman fracture?
a fracture of both the pedicles or pars interarticularis of C2 vertebra
often caused by falls (especially in elderly), MVA due to hyperextension of neck, or axial loading onto C2 vertebra
treated with cervical collar or surgery
when would you do a CT myelogram?
if the MRI contraindicated (e.g., pacemaker) or patient is too uncomfortable in MRI scanner
you would then inject contrast material into the spinal canal around the spinal cord and nerves
it’s good for visualizing the spinal cord and nerves and IVD spaces
what is an MRI good for visualizing?
- Intervertebral disc structure
- Spinal cord and nerves
- Spinal ligaments
- Soft tissue,
- Blood/hematoma
- Abscess
- Tumor
what is an MRI not as good at visualizing?
dynamic changes in the spine
this is because the person has to lay down and stay still during and MRI
what’s a T1 and T2 MRI?
T1 MRI
- you can’t see the spinal cord well
- black is fluid, gray is muscle, white is fat
T2 MRI
- black is white matter, gray is muscle, white is far, fluid
- can see spinal cord well
obstruction of the artery of adamkiewicz could cause what?
paraplegia
it’s the largest anterior segmental medullary artery so obstruction of the after could result in stroke of the spine because you’d be taking away the spinal cords blood supply
