L8 Imagining of the spine Flashcards
MRI can be used to visualise the spinal cord soft tissue and the nerve roots but also what can it look at
the bone marrow
also radiography and CT for trauma and
Other techniques including myelography where contrast is injected into the vertebral Canal in order to display the nerve roots.
There is also nuclear medicine and in specific circumstances ultrasound
what travels through the vertebral foramen
Spinal cord and its meninges,
Spinal nerve roots and blood vessels
what travels through the transverse foramen
Vertebral artery and vein
Sympathetic nerve plexus
C1, C2, C7 ( vertebrae prominens) T1, T11, T12 L5 are all
atypical vertebrae
what vertebrae No vertebral body. anterior and posterior arches paired lateral masses paired transverse processes. and articulates with base of skull
C1-atlas
what vertebrae
odontoid peg
Important role in head rotation
Majority of movement occuring around the dens and at the atlanto axial joint
C2 -axis
atlantoaxial joint
Important role in head rotation
Majority of movement occuring around the dens and at the atlanto axial joint
c1-2
odontoid peg held in place b this and transverse ligaments
intevertebral foramen allows what to exit
The intervertebral foramen transmits exiting nerve roots and can be affected by a number of different abnormalities including vertebral osteophytes, intervertebral discs or the linings of the vertebral Canal such as a ligament. The ligamentum flavum runs posteriorly along the pedicles and this can be hypertrophied narrowing the vertebral canal or foramina and all of these can impinge upon the exiting nerve roots.
sliped disc
The intervertebral disc has a central nucleus pulposus a peripheral annulus fibrosus. So the nucleus pulposus is composed of fluid or jelly like substance and the annulus is more fibrous as the name suggests. Sometimes what can happen is that there can be a fissure that allows the nucleus pulposus to herniate out narrowing the vertebral Canal or neural exit foramen with subsequent compression of neural structures and symptoms the patient might develop.
the nat longitudinal ligament lies along ant spec of vertebral bodies
posterior is poster
on the posterior arch what ligament flavum
what is the function of ligament
Ligaments assist the vertebral column in maintaining stability
Trauma may result in ligamentous damage
Best illustrated on MR- appear dark
ABCS: Alignment (& Adequacy) Bone Cartilage Soft Tissue
always look at lungs too
If there is a suspicion of Spinal injury either on the plain film or clinically then ordinarily we would proceed to a
CT
what disease can have vertebral body osteophytes
Osteoarthritis is most common in the knees, hips, spine and small joints of the hands and base of the big toe. As the joints become increasingly damaged, new bone may form around the joints. These bony growths are called osteophytes.
in general another thing when you get older can be that the intervertebral disc space is not preserved
kyphoscoliosis - scoliosis and kyphosis
what is spondylolistesis
Spondylolisthesis is where one of the bones in your spine, known as a vertebra, slips out of position. It’s most common in the lower back
pain, numbness or a tingling feeling down leg
steroid injection into leg
what is a disc prolapse
So in disc prolapse as I’ve briefly discussed earlier, there’s loss of disc water and degeneration of the outer disk, which is the annulus fibrosus and either prolapse of water material causing a bulge or a protrusion or extrusion outside this fibrosis and that can impinge upon the thecal sac within the vertebral canal and can impinge on the nerve Roots themselves and cause symptoms, in this circumstance within the leg if compressed.
bulges out
keyhole sign
he keyhole sign is an ultrasonographic sign seen in boys with posterior urethral valves
in slipped disc
what is a myelography
Contrast injected into the sub dural space
Myelography is a technique which is much less frequently obtained nowadays because of MRI, but in patients who can’t undergo MRI for certain reasons, we could consider injecting some contrast into the vertebral canal in order to outline the nerve roots and see whether any are compressed. But obviously it’s invasive, involves a lumbar puncture. It involves intrathecal administration of contrast and so it’s not without its risks.
at what junction using ultrasound can you look at the spinal canal content in neonates
what is ultrasound good for looking for
Spinal canal contents can be seen in neonates on ultrasound from the craniocervical junction to the sacrum.
up to 3 months
ultrasounds can still get through
Ultrasound can be useful for looking for congenital abnormality such as spina bifida or a tethered or low-lying cord and other abnormalities associated with those conditions.
nuclear medicine is good as it taken up by what
highlighting any metastases
highly active osteoblastic abnormalities
disciitis
most common pathogen
Discitis is a disease, as the “itis” would indicate, of infection of the discs between the vertebra of the spine. Like appendicitis, discitis is usually a bacterial infection but may be viral.
staphylococcus aureus followed by E.coli
cauda equina syndome
Caused by compression of the nerve roots below the level of the spinal cord
Diagnostic and surgical emergency
normally disc prolapse
Bilateral lower limb pain
Altered perineal sensation
Change in bladder habit
lower limb weakness
saddle anaesthesia - loss of sensation
urinary and bowel problems such as retention or incontinence
managing spinal cord injuries
ABCDE chart
back pain red flags
Major trauma - Fall from height/RTA
History of Malignancy- spinal metastases
Unexplained weight loss
Fever
Immunosuppression/Immunodeficiency
IV Drug Use
Saddle Anaesthesia
Sphincter dysfunction
Progressive Neurological Deficit
nocturnal pain
Spondiolisthesis
Is defined as vertebra, slipping out of position.
It’s most common in the lower back,
dexa scan t score
above -1 normal
A normal T-score falls between +1 and -1. Scores between -1 and -2.5 indicate low bone density, also called osteopenia. A T-score of -2.5 or lower indicates an established case of osteoporosis.
OP treatment
- Avoid risk factors
- Vitamin D
- Calcium Replacement
- Osteoclast Inhibition (Bisphophonates)
- eg Olendronate
- Selective oestrogen receptor modulators (SERMs)
- eg Raloxifene
- Rank Receptor inhibition
- eg Denosumab
