L-spine Flashcards
How should the entire lumbar spine be aligned in an AP view?
In the frontal plane
How should the pedicles present in an AP view of the lumbar spine?
- Evenly
How should the SP present in an AP view of L-spine?
- Evenly spaced
- In midline
What shape should the atricular processes make in the L-spine?
Butterfly
What feature of the vertebrae in the L-spine will be not be as apparent as in other parts of the spine?
- Transverse processes
What shape should the lumbar bodies be in a lateral view?
Square
How can the disks be assessed in the lateral view?
Spaces between vertebrae
What related to the articular processes are easily visualied in the lateral view of the L-spine?
- Intervertebral foramina
Which part of which vertebrae should align with the sacral base in a WB film?
- Center of L3 over anterior 1/3 of sacral base.
What are the lines of alignment for the lumbar spine?
- Anterior body
- Posterior body
- Posterior spinal canal
Which lumbar view demonstrates the scotty dog view?
- Lumbar spine oblique
What 2 structures are easily visualized in the Scottie dog view of the lumbar spine?
- Ipsilateral facet joints
- Pars interarticularis
What is the pedicle in the scotty dog?
The eye
What forms the feet of the scottie dog?
- The inferior articular processes
What forms the nose of the scottie dog?
- Transverse process
What forms the ears and tail of the scottie dog?
Superior articular processes
What forms the neck of the scotty dog?
The pars interarticularis
What forms the body of the scottie dog?
The lamina and spinous processes
What is a spondylolisis?
Degeneration of the facet joints
What is a spondyloslisthesis?
Anterior or posterior displacements of one vertebra on another
What causes a true spondylolisthesis?
- Fracture
What causes a pseudospondylolisthesis?
- Degeneration
How is a spondylolisthesis differentiated from a pseudospondylolisthesis?
- Spinous process sign
- Fracture steps off at the level above
- Degenerative steps off at the level below
What are the grades of a spondylolisthesis?
1: 25 % overhang
2: 50 %
3: 75 %
4: 100 %
5: Vertebral body completely fallen off and displaced
What is a grade 5 spondylolisthesis called?
- Spondyloptosis
What does the lateral L5 - S1 visualize?
An enlarged view of the lumbosacral junction
What 3 things should be assessed in the L5 - S1 view?
- Lines of alignment
- Disk space, osteophytes
- Sacral tilt
What is a retrolithesis?
Backwards slip
What is an anterolithesis?
I think you know
What 3 things should be assessed in the SI joint AP axial view?
- R vs L symmetry
- Smooth osseous margins
- L5 - S1 segment
How are the R and L SI oblique views named?
For joint space visualized
How should the joint margins of the SI joint be assessed?
- Joint space width
- Signs of degeneration
What are 3 red flags for lumbar disk problems?
- Cauda equina syndrome (Loss of bowel/ bladder function) (Can also affect muscle strength and tone and DTR of knee and ankle) - Saddle anethesia - Worsening hard neuro signs
Besides red flags, why might you want to refer your patient out?
- Failed 6 week trial of best practice conservative therapy
What are “hard” neuro signs?
- Parathesias
- Weakness
- Deep tendon reflex
- Ataxia
What percentage of asymptomatic patients have disk herniations?
20 - 25 %
What is the risk of imaging for a lumbar disk problem?
- False negatives
- Unnecessary surgeries
What is central lumbar stenosis?
Compression of spine in spinal canal; often from disk herniation
What is a Sacrolitiitis?
- Inflammation of synovial portions of the SI joint
How will Sacrolitiitis appear in imaging?
- Joint too wide at first due to swelling
- Then too narrow due to osteophytes
What is ankylosing spondylitis?
- Inflammatory arthridity that results in bony fusion across joints
What are symptoms of ankylosing spondylitis?
- Stiffness starting in SI/ low lumbar spine
- Gradual spread to upper spine, extremity joints
- Can include ribs
Where will ankylosing spondylitis cause postural changes besides the back?
- The hips and knees
What is the effect of ankylosing spondylitis of the thoracic spine?
- Decreased cardiac function
How is the severity and irritability of ankylosing spondylitis?
- Low severity
- Very high irritability
