L9 Imaging of the Spine

Question 1

parts of the lumbar spine

Answer 1

• bones: scaffoling
• joints: allows for movement
• discs: shock absorber
• spinal cord and nerves in thecal sac
• canal: conduit
• foramina: exiting nerves

Question 2

lumbar spine symptoms

Answer 2

• Pain
  
  • localised: joints and bones
  • referred to butt or legs - “sciatica”: nerves
  • car be from disc, joints, bone or nerves
• deformity
  
  • scoliosis
  • can be acquired or congenital
• loss of neurological function
  
  • compressive effect: bone or disc, radiculopathy, myelopathy

Question 3

imaging modalities and features for spine imaging

Answer 3

• X-Ray (radiography): just bones
• CT: more detailed bones (fine fractures), not good for soft tissue
• US: good for children
• MRI: best for all soft tissue and nerves
• NM: leaks

Question 4

number of vertebrae

Answer 4

• cervical: 7
• thoracic: 12
• lumbar: 5 (or 6)
• sacral: 5 (or 4)
• coccyx: variable
• total: 29 + ?

can vary due to genetics

Question 5

segmentation and congenital anomalies of the spine

Answer 5

• variable, esp. in lumbosacral regions
• total is usually 29
• 11/12/13 ribs
  
  • cervical rib
  • lumbar rib
• 4-6 lumbar
• 4-6 sacral
• block and/or hemi vertebrae

Question 6

zygo-apophyseal joints

Answer 6

• for flexion and extension of the spine
• also acts to limit forward movement
• shingle effect (shingels of the roof)

Question 7

spondylolisthesis grades

Answer 7

• I: first quarter of disc exposed
• II: half of disc exposed
• III: three quarters of disc exposed
• IV: all of disc exposed

Question 8

dessication of nucleus

Answer 8

• process of extremem drying
• proteoglycans of nucleus are like coconut
• age-related dessication: premature is abnormal
• can be painful

Question 9

disc herniation

Answer 9

• dessication of nucleus leads to annular cracks
• defect in annulus allows nucleus to squeeze through
• (imagine toothpaste)

Question 10

disc bulge

Answer 10

• broad based: fibrous structure becomes saggy and baggy
• common
• generalised weakness of annulus

Question 11

protrusion (herniation)

Answer 11

• STAGE II (Stage I is a slight bulge)
• broad based, focal extension, neck breadth > depth

Question 12

extrusion (herniation)

Answer 12

• stage III
• more extreme extension
• neck breadth < depth

Question 13

sequestration (herniation)

Answer 13

• stage IV
• disc fragment has become detached

Question 14

spondylitis/spondylosis

Answer 14

• degenerative arthritis of the spine
• disc dessication
  
  • loss of disc height
  • 2° arthritis
• osteophyte formation

Question 15

thecal sac

Answer 15

• within the spinal canal
• outer layer is tought - dura
• surrounded by fat (epidural space)
• contains spinal cord and nerve roots