L-Spine Flashcards
ACR scenarios
Trauma
age>/= 16 with blunt trauma criteria met
first image
thoracic and lumbar CT
Trauma
age >/= 16 with positive results for acute Lspine or Tspine injury via x-ray or CT
second image
thoracic and lumbar MRI
Trauma
age <16 with suspected trauma
thoracic and lumbar x-ray
low back pain
acute or chronic w/ or w/o radiculopathy
NO imaging indicated
try conservative approach first
low back pain
subacute/chronic LBP pt thats a surgical or therapeutic candidate who has undergone 6wks of therapy w/o improvement (or inc severity)
lumbar MRI
low back pain
LBP + suspected cauda equina syndrome
MRI
low back pain
LBP w/ Hx of surgery and new s/s
first image
x-ray OR MRI
low back pain
LBP with or without radiculopathy + elderly, osteoporosis risk , steriods, low vel trauma
think Roman/ Henschke’s rules
catch all…
MRI or CT or X-ray
low back pain
LBP +/- radiculopathy and suspected CA/ infection/ immunosuppression
MRI
children
BP in children w/o red flags
not highly recommended (2/9)
children
BP in children w/ red flags
x-ray (8/9)
these are the (2) common routine radiologic exam views of the L- spine
AP
Lateral
these are the (2) common routine radiologic exam views of the SIJ
AP axial
R/L oblique
this x-ray view is preferrred for observing landmarks such as pedicles, spinious processes, lateral borders, disc space, and even psoas muscle abnormalities
AP projection
this x-ray view is preferred for showing landmarks such as the AP border alignment, lat neuroforamen, disc space, postural abnormalities, etc.
lateral projection
this x-ray view is preferred for viewing articulating processes, z-joints and the pars articularis (scotty dog)
which side is demonstrated in the picture?
posterior oblique (right PO pictured in pt pic)
this x-ray view is preferred for viewing the 3 parallel lines (a/p vetebral body and spinous process alignment) , disc spaces, and lumbosacral angles
*typically focused on particular segment
coned lateral view
thix x-ray view is preferred for landmarks such as osseous margins, SIJ symmetry, L5/S1 and the coccyx. It’s typically performed with the body angled at ~30-35deg
AP axial of SIJs
this x-ray view is preferred for SIJ and degenerative change and ankylosing/fibrosis
L/R oblique views of SIJ
basic protocol for lumbar/SIJ CT involves ___viewed via____ and reformatted to sagittal and coronal claims
lower thoracic to SIJ (or less) via axial slices
basic protocol of lumbar/SIJ MRI involves these 2 planes
axial and sagittal
