L-Spine

Question 1

Lumbar spine –routine views

Answer 1

• AP
• Lateral
• R & L obliques
• Lateral L5/S1

Question 2

SI joint – views

Answer 2

AP axial

R/L oblique

Question 3

AP View – note

Answer 3

• pedicles even
• SP evenly spaces
• articular butterfly regular shape

Question 4

Lateral View – note

Answer 4

• square bodies
• disc heights*
• intervertebral foramina*
• center of L3 should be over anterior 1/3 of sacral base (WB film)
• Lines of alignment

Question 5

Lumbar Oblique

Answer 5

• scottie dog

- good far: ipsalateral facets, pars articularis

Question 6

Fracture v. Degenerative Spondylolisthesis

Answer 6

Spinous Process Sign:

• Fx (true): step-off ABOVE level of slip
• Deg (pseudo): step-off BELOW slip

Question 7

Scottie Dog

Answer 7

• Nose = TP
• Eye = pedicle
• Neck = pars
• front leg = inf art process
• ear = sup art process
• tail = sup process opp side
• back leg = inf proccess opp side

Question 8

Sacral Tilt: Barges Angle

Answer 8

• line along sacral base (WB)
• second line parallel to vertical
• inf angle ~53

Question 9

Sacral Tilt: Ferguson’s angle

Answer 9

• line along sacral base (WB)
• second line horizontal to edge of image
• inferior intersecting angle ~41

Question 10

SI Joint – Oblique

Answer 10

• named for jt visualized

- look at jt space margins, signs of degen

Question 11

Red Flags for MRI, CT, and myelography

Answer 11

• Loss of normal bowel/bladder function
• Multilevel (more than one nerve root)
• Decreased muscle strength/tone
• Decreased DTR knee and ankle
• Saddle anesthesia
• Worsening Hard neruo signs
• *also when failed 6 week trial of best practice conservative therapy

Question 12

Hard Neuro Signs (AWARP)

Answer 12

• parasthesisas worsening
• weakened myotome
• ataxia
• abnormal reflexes
• radiculopathy

Question 13

Spondyloarthopathy Sacroiliitis

Answer 13

• inflammatory arthridites
• inflamm of synovial (lower) portions of SI jt
• too wide at first (swollen), later too narrow (cartilage destruction) with osteophytes