L spine

Question 1

routine views of lumbar spine

Answer 1

AP
lateral
R and L obliques
lateral L5-S1

Question 2

routine views of the lumbar spine

Answer 2

AP axial

R and L obliques

Question 3

what to note in lumbar spine AP view

Answer 3

• alignment of the frontal plane
• pedicles even
• spinous processes evenly spaced, and in midline
• articular butterfly regular shape
• not a good view to look at disc height bc of curve
• tough to see TP bc thin and not as dense

Question 4

AP lumbar outline

Answer 4

all lumbar vertebrae

• bodies
• spinous processes
• pedicles
• transverse processes
• articular butterfly

sacrum

ilia

Question 5

what to note in lumbar spine lateral view

Answer 5

• square lumbar bodies
• disk heights
• intervertebral foramina
• center of L3 should be over anterior 1/3 of sacral base (WB film)
• lines of alignment (ant. vert. body, posterior body, roof of SC)

Question 6

retrolysthesis

Answer 6

displacement backward

Question 7

lumbar spine lateral view outline

Answer 7

3 lines of alignment

vertebral

• bodies
• pedicles
• laminae
• articular processes
• spinous processes

intervertebral foramina

Question 8

oblique view

Answer 8

“scottie dog” view

good for:

• ipsilateral facet joints
• pars interarticularis

Question 9

spondylosis

Answer 9

degenerative change

Question 10

spondylolysis

Answer 10

bony defect

“collar on scottie dog”/ broken neck

Question 11

spondylolisthesis:

Answer 11

anterior displacement

true one caused by fracture

Question 12

pseudospondylolisthesis

Answer 12

caused by degeneration

Question 13

spinous process sign

Answer 13

to evaluate spondylolisthesis vs. pseudo

look at step off level of slip

above=fracture
below=degeneration

Question 14

grading spondylolisthesis

Answer 14

1=25%
2=50%
3=75%
4=100%
5=spondyloptosis

Question 15

spondyloptosis

Answer 15

vertebral body completely fallen off and displaced

Question 16

oblique view outline

Answer 16

lumbar vertebral bodies
scottie dogs
pedicles
inferior/sup articular processes

Question 17

lateral L5-S1

Answer 17

enlarged view of the lumbosacral junction

• lines of alignment
• disk space, osteophytes
• sacral tilt

Question 18

lateral L5-S1 outline

Answer 18

L4/5 vertebrae

• bodies
• pedicles
• spinous processes

disk space

sacrum

measure sacral tilt

Question 19

measuring sacral tilt

Answer 19

Barge’s angle:
-normal=53 deg

Ferguson’s angle
normal=41 deg

Question 20

what to note on SI joint AP axial

Answer 20

R L symmetry
smooth osseous margins
L5 S1 segment

Question 21

SI joint AP axial outline

Answer 21

L5

• body
• pedicles

sacrum

SI joints

pubic symphysis

Question 22

what to note in SI obliques

Answer 22

named for joint visualize*

joint space margins

• joint space width
• signs of degeneration

Question 23

SI oblique outline

Answer 23

ilium

sacral wing

SI joint

• margins
• width

Question 24

lumbar disk problems

Answer 24

when to refer to MRI, CT and myelography

RED FLAGS:
loss of normal bowel/bladder function

multilevel (more than 1 nerve root)

• decreased muscle strength & tone
• decreased DTR knee and ankle

saddle anesthesia

worsening hard neuro signs

failed 6 week trial of best practice

Question 25

why try PT first?

Answer 25

20-25% of asymptomatic patients have disk herniations

very poor correlation b/w radiologic & clinical findings

risk of pt and clinician placing too much importance on MRI findings that are FALSE POSITIVES leading to UNNECESSARY SURGERY

Question 26

lumbar stenosis

Answer 26

=narrowing/constriction of the spinal canal secondary to adjacent soft tissue or bony enlargement

central
lateral recess
intervertebral foramen

Question 27

most serious complication of spinal stenosis

Answer 27

cauda equina syndrome

• loss of rectal tone
• urinary retention
• saddle anesthesia
• loss of bulbocavernosus reflex

Question 28

spondyloarthropathy

Answer 28

sacroiliitis

ankylosing spondylitis

Question 29

sacroiliitis

Answer 29

1 of many inflammatory arthridities

inflammation of the synovial (lower) portions of the SI joint

• too wide at first (swollen)
• later too narrow (cartilage destruction) w/ osteophytes

Question 30

ankylosing spondylitis

Answer 30

1 of many inflammatory arthridities

symptoms:

• stiffness starts in SI/ low lumbar spine
• gradual spread to upper spine, extremity jts
• can include rub joints –> decreases resp function
• note postural changes at hips and knees

Question 31

guidelines for immediate medical attention

Answer 31

suspect NMS

• bowel/bladder symptoms
• S&S of VBI
• S&S of upper c spine instability