Imaging Flashcards
What does AP view show?
Possible deviations of the spine (scoliosis), helps to identify which level to treat
What does the lateral view show?
Show spine curvature (lordosis). Helps to identify the level to treat, shows bone spurs, and disc height
What does oblique view show?
Foraminal areas, stenosis to arthrosis
Dynamic films?
Instability of segment, identifying a fused level, height changes in posterior disc
CT Scan
Computer processed xrays Tomographic images (slices) allows user to see inside Views are: Axial Sagittal Coronal
MRI
Good for examining soft tissues. Herniated, bulging discs. Fresh fractures, tumors, hematoma, nerve damage. Views are: Axial Sagittal Coronal
Modic Changes, type 1
Represents bone marrow oedema and inflammation.
Modic changes, type II
Represents normal red haemopoietic bone marrow conversion into yellow fatty marrow as a result of marrow ischaemia.
Modic changes, type III
Represents subchondral bony sclerosis
What are the cervical procedure options?
ACDF CDA/TDR Foraminotomy Hemi laminectomy or bilateral Laminectomy + Lateral mass screw system Laminoplasty
What three materials are used in cages?
Titanium
PEEK
Carbon Fiber
What are the advantages of an ACDF?
Gold Standard Approach Fusion considered best option Good recovery Good stability Good results
What are the disadvantages of an ACDF?
Oversizing can create neck pain Pseudo Disphonia Disphagia Facet pain Adjacent level syndrome due to stiffness
What are the advantages of CDA/TDR?
Same approach as cage
Preserves movement
Preserves normal range of motion
Reduces risk of adjacent level syndrome
What are the disadvantages of CDA/TDR?
Not always easy to insert
Must be perfectly centered otherwise you create another axis of rotation
Many artificial discs become fused after 5 years
Subsidence
Facet pain
What are the posterior surgical options for C3-C7 degenerative disease?
Laminectomy
Laminectomy + Lateral Mass Screws
Laminoplasty
Foraminotomy
What are the advantages of a laminectomy?
Direct decompression of spinal cord
Useful in cases of myelopathy due to posterior compression
Surgeon has the option to use mass screw system or not
What are the disadvantages of a Laminectomy?
Can be complicated Not ideal for older patients Not as useful for single level foraminal-anterior compression No big opening of the foramen Nerve root manipulation Risk of thermal injury
What is a Laminoplasty?
Small section of bone (lamina) is cut into to relieve the compression.
One side cut completely, the other side cut partially, enabling it to swing open in a manner similar to a door.
Creates room decreases compression
Uses titanium spacers or bone graft with plates.
What are the advantages of a Laminoplasty?
Big central canal and spinal cord decompression
Useful in case of myelopathy due to posterior compression
Useful in multilevel myelopathy
What are disadvantages of a Laminoplasty?
Not easy Long surgery Not ideal for older patients Not as useful for single level foraminal-anterior compression No big opening of the foramen Risky
What are the advantages of a foraminotomy?
Good posterior mini access decompression
Fast recovery
What are the disadvantages of a foraminotomy?
Difficult procedure Difficult to remove all bone spurs Selected cases Decompression may be insufficient Nerve root manipulation
What are five common pathologies of the cervical spine?
Degenerative disc disease Disc herniation Stenosis - central / foraminal Myelopathy Facet Syndrome
What are the risk factors for cervical disc herniations?
Aging Trauma Lifestyle - no exercise, poor diet, smoking Poor posture Genetic
What is Myelopathy?
Spinal canal is narrowed by surrounding tissue and creates compression on spinal cord.
Process is chronic and symptoms develop slowly
What are the symptoms of myelopathy?
Difficulty walking Loss of bladder control Loss of fine motor skills Weakness Numbness Tingling Pain Paralysis
