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7 Imaging > L2 Spine > Flashcards

L2 Spine Flashcards

1
Q

When to order lumbar films

A
  • plain x-rays are not for routine eval of acute LBP within the 1st month of s/s unless certain red flags are present
  • chronic conditions persisting beyond 4-6 weeks of conservative intervention can use imaging, specifically a/p or lateral
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2
Q

Red flags for Acute LBP

A
  • recent significant trauma at any age
  • recent mild trauma > 50 yo
  • > 70 yo
  • hx of prolonged steroid use or osteoporosis
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3
Q

Oblique images should be ordered when

A

there is medical hx, physical exam, or other images suggest spondylolisthesis or spondylolysis

they do cause increased radiation risk

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4
Q

L-spine positioning

A

A/P = supine
Lateral = sidelying
L5-S1 = sidelying
Oblique = twisted in sidelying

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5
Q

Columns of TL spine

A

Anterior = stable
Middle = possibly unstable
Posterior = unstable

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6
Q

Most common fractures of lumbar spine are

A
  • wedge compression fx
  • compression burst fx with fragments
  • pars interarticularis or vertebral body
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7
Q

Wedge Compression Fracture

A

occurs in anterior column

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8
Q

Compression Burst Fracture

A

entire vertebra is crushed in all directions

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9
Q

Chance Fracture

A
  • Known as seat belt injury
  • flexion and distraction injury, usually in L1-L2
  • CTs are best vs X-ray
  • up to 50% will have associated blunt trauma injuries to organs
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10
Q

Spondylolysis and Spondylolisthesis

A

lolysis = breakdown or fracture of pars interarticularis

listhesis = slipping forward of vertebral bone

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11
Q

Degenerative changes in lumbar spine

A

often shows loss of disk space, osteophystes, disc calcification, herniated discs

MRI is best for detecting this

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12
Q

Spinal Infections

A
  • occur in diabetic or post op patients
  • destructive process that involves or crosses disc space
  • MRI is best
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13
Q

Spinal Neoplasms

A
  • most common is mets from cancer
  • lesions can have altered bone density
  • increased/sclerotic: prostate/breast cancer
  • decreased/lytic: lung, renal, breast cancer
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14
Q

Sign of neoplasm

A

winking owl or pedicle erosion

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15
Q

Mets occur arise most commonly in

A

red marrow –> skull, ribs, spine, pelvis, humerus, femur

it is best to use body scan to detect them

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16
Q

Indications for bone scan

A
  • initial staging of lung, breast, or prostate cancer
  • bone pain
  • elevated alkaline phosphatate
  • to evaluate the response to chemotherapy
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17
Q

Ankylosing Spondylitis

A
  • occurs in young adult males
  • often associated with ulcerative colitis
  • bamboo appearing spine caused by calcifications bridging over disc spaces
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18
Q

Osteoporosis

A
  • primary = age related, estrogen deficiency
  • secondary = results from other diseases
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19
Q

Indications for DEXA scan

A
  • osteopenia on plain films
  • nontraumatic fracture in postmenopausal female
  • suspected osteopenia due to metabolic disorder
  • loss of height >2.5 in
  • chronic disease
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20
Q

DEXA

A

helps to detect osteoporosis/osteopenia. measures bone density

anything greater than 2.5 std deviations below mean is considered osteoporosis

21
Q

Thoracic Spine positioning for imaging

A

A/P = supine
Lateral = sidelying

22
Q

Common thoracic spine conditions

A
  • compression fx
  • schmorl’s nodes
  • osteoporosis
  • osteophytes
  • pedicle irregularity
  • scheuermann’s disease
23
Q

scheuermann’s disease

A

AVN or steroid use

involves both inferior and superior end plates

24
Q

Trauma in thoracic spine

A
  • usually result of MVA or osteoporosis
  • AP shows alignment, lateral for subluxation
25
Q

Hyperflexion of thoracic spine

A

can result in compression burst fractures with bony fragments projecting into spinal canal

26
Q

Compression fx of middle/lower thoracic are due to

A

osteoporosis

27
Q

Vertebral compression fx occur in

A

25% of women over 65 yo
40% of women over 85 yo

28
Q

Predictors of osteoporotic compression fracture

A
  • age > 52
  • BMI <22
  • female
  • absence of LE pain
  • lack of regular exercise

2 or fewer signs = can rule out
4 or more = can rule in

29
Q

Most common degenerative changes in thoracic spine

A
  • spurs
  • calcification of anterior spinal ligament
  • calcification of intervertebral disc (usually what causes issues/pain)
30
Q

Osteophyte spurs

A
  • seen at T10 to L1
  • common throughout spine
  • not usually clinically significant
31
Q

Diffuse idiopathic skeletal hyperostosis (DISH)

A

due to excessive bone formation at skeletal sites subject to normal or abnormal stresses, generally where tendons and ligaments attach to bone

32
Q

Disc Calcification

A

usually due to trauma, however if present in more than one disc may be due to hypercalcemia or other pathology

33
Q

High risk factors in Canadian c-spine rule

A
  • age > 65 yo
  • paresthesias in extremities
  • dangerous MOI such as MVA, bike collision, fall from height
34
Q

Low risk factors allowing assessment of cervical spine

A
  • able to sit in ER
  • ambulatory at any time
  • onset of neck pain not immediate
  • absence of midline tenderness in c-spine
  • patient can rotate neck 45°
  • MVA that does not involve push into traffic, hit by bus, rollover, high speed vehicle
35
Q

High risk of c-spine injury (modified rules)

A
  • posterior midline cervical tenderness
  • evidence of intoxication
  • reduced level of consciousness
  • focal neuro deficits
  • painful distracting injuries
36
Q

C-spine views

A
  • lateral = alignment
  • A/P = oblique fx
  • Odontoid = C1-C2
  • Oblique = foraminal narrowing
  • Swimmer’s view = C7-T1
37
Q

Alantodental Interval

A
  • > 3.5 mm = instability
  • 7mm = disruption of transverse ligament
  • > 9-10 risk of neuro injury, requires injury

normal is 8 mm in adults

38
Q

Causes of increased ADI

A
  • trauma
  • down syndrome
  • RA
  • arthritis
39
Q

George Line

A
  • lateral view, connects posterior vertebral bodies
  • should be a smooth curve
  • can show instability, dislocation, ligamentous laxity
40
Q

Cervical Gravity Line

A
  • vertical line drawn from apex of dens
  • line should pass through 7th cervical body
  • allows for gross assessment of gravitational stresses
41
Q

Soft tissues in cervical

A
  • C2-C5 = 7 mm or less
  • C5-C7 = 20 mm or less
42
Q

Cervical Spinal Fractures

A
  • most common sites are C1-C2, C5-C7
  • trauma are usually the cause, most likely MVA
  • Jefferson, Hangman, Clay-shoveler’s, Odontoid are common
43
Q

Jefferson Fracture

A
  • burst of the ring of C1
  • due to axial loading of the head being compressed onto the spine
44
Q

Odontoid Fracture

A

fracture of the odontoid process of C2

usually hyperextension of the cervical spine

45
Q

Hangman’s fracture

A
  • fracture of posterior aspects of C2
  • hyperextension injury
  • through pars interarticularis or pedicles
  • spinal cord compromise
  • subluxation of C2 over C3
46
Q

Clay-shoveler’s fracture

A
  • fracture of posterior spinous process
  • occurs at c6-t2
  • hyperflexion injury
47
Q

C-Spine Degenerative Changes

A
  • C4-C7 common areas, appear by age 30-40
  • shows up as decreased disc space, sclerosis, spurring of margins of vertebral bodies
  • oblique pain will show narrowing of foramina
  • MRI is good for herniated dic or neurological deficit
48
Q

Metastatic Lesion in C spine

A
  • presents as rapidly worsening weakness of arms and legs
  • causes compression of the cord
49
Q

Lines of Life

A
  • four lines, should be roughly parallel and spatial relationship should remain constant
  1. anterior borders of vertebral bodies
  2. posterior borders of vertebral bodies
  3. spinolaminar lines
  4. posterior spinous process of C2-C7

7 Imaging (4 decks)

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