L spine Flashcards
routine views of lumbar spine
AP
lateral
R and L obliques
lateral L5-S1
routine views of the lumbar spine
AP axial
R and L obliques
what to note in lumbar spine AP view
- 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
AP lumbar outline
all lumbar vertebrae
- bodies
- spinous processes
- pedicles
- transverse processes
- articular butterfly
sacrum
ilia
what to note in lumbar spine lateral view
- 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)
retrolysthesis
displacement backward
lumbar spine lateral view outline
3 lines of alignment
vertebral
- bodies
- pedicles
- laminae
- articular processes
- spinous processes
intervertebral foramina
oblique view
“scottie dog” view
good for:
- ipsilateral facet joints
- pars interarticularis
spondylosis
degenerative change
spondylolysis
bony defect
“collar on scottie dog”/ broken neck
spondylolisthesis:
anterior displacement
true one caused by fracture
pseudospondylolisthesis
caused by degeneration
spinous process sign
to evaluate spondylolisthesis vs. pseudo
look at step off level of slip
above=fracture
below=degeneration
grading spondylolisthesis
1=25% 2=50% 3=75% 4=100% 5=spondyloptosis
spondyloptosis
vertebral body completely fallen off and displaced
oblique view outline
lumbar vertebral bodies
scottie dogs
pedicles
inferior/sup articular processes
lateral L5-S1
enlarged view of the lumbosacral junction
- lines of alignment
- disk space, osteophytes
- sacral tilt
lateral L5-S1 outline
L4/5 vertebrae
- bodies
- pedicles
- spinous processes
disk space
sacrum
measure sacral tilt
measuring sacral tilt
Barge’s angle:
-normal=53 deg
Ferguson’s angle
normal=41 deg
what to note on SI joint AP axial
R L symmetry
smooth osseous margins
L5 S1 segment
SI joint AP axial outline
L5
- body
- pedicles
sacrum
SI joints
pubic symphysis
what to note in SI obliques
named for joint visualize*
joint space margins
- joint space width
- signs of degeneration
SI oblique outline
ilium
sacral wing
SI joint
- margins
- width
lumbar disk problems
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
why try PT first?
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
lumbar stenosis
=narrowing/constriction of the spinal canal secondary to adjacent soft tissue or bony enlargement
central
lateral recess
intervertebral foramen
most serious complication of spinal stenosis
cauda equina syndrome
- loss of rectal tone
- urinary retention
- saddle anesthesia
- loss of bulbocavernosus reflex
spondyloarthropathy
sacroiliitis
ankylosing spondylitis
sacroiliitis
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
ankylosing spondylitis
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
guidelines for immediate medical attention
suspect NMS
- bowel/bladder symptoms
- S&S of VBI
- S&S of upper c spine instability
