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Imaging II > Lumbar > Flashcards

Lumbar Flashcards

1
Q

What are the goals for a radiographic examination of the lumbar spine?

A

To identify or exclude anatomic abnormalities or disease processes of spine

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2
Q

What are the routine projections for the lumbar spine?

A

AP and lateral

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3
Q

What are the additional views that can be used to view the lumbar spine?

A

R/L Oblique

Coned lateral view of lumbosacral articulation (L5-S1)

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4
Q

Which direction do posterior and anterior oblique views view facet joints?

A 
Posterior = downside
Anterior = upside
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5
Q

What notable feature is evident in the oblique view?

A

Scottie Dog

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6
Q

Which image is best used to evaluate trauma?

A

CT, Radiographs may be used to help localize images. MRI not indicated if CT exam normal, ligamentous strains are rare in lumbar spine

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7
Q

When is an MRI indicated for a trauma injury?

A

If there is neural compromise, used to evaluate cord edema, contusion, epidural hematoma, ligamentous disruption, or nerve root invovlement

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8
Q

What is the most predominant site for vertebral fractures?

A

T11-T12 because they are transitional vertebrae

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9
Q

What does spondylolysis defect?

A

pars intetarticularis

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10
Q

What are the causes for spondylolysis?

A

Congential (rare)
Traumatic
Stress fracture caused by chronic strain (most common)

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11
Q

What type of displacement does spondylolisthesis cause?

A

Forward displacement of one vertebrae upon stationary vertebra beneath it

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12
Q

What percent, and what age group is often affected by spondylolisthesis?

A

5-10%, children and adolescents (especially those involved in athletic activities)

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13
Q

Where does spondylolisthesis usually manifest in the spine?

A

Lower lumbar levels (L4-L5 and L5-S1)

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14
Q

What can cause spondylolisthesis?

A

Spondylolysis
Congenital or developmental aberrations
Pathological processes
Degenerative changes

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15
Q

How does spondylolisthesis present?

A

Pain after athletic activities or physical labor
Decreased pain with lumbar flexion (which reduces displacement)
Palpable step-off SP, rotation SP

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16
Q

Where is the SP step-off in degenerative spondylolisthesis? Fracture?

A 
Degenerative = below level of slip
Fracture = above level of slip
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17
Q

What is the treatment for spondylolisthesis?

A

Conservative = PT, restriction of activities that load spine in extension
Analgesics, bracing
Surgical fusion

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18
Q

DDD Characteristics

A

Dehydration of the disk
Nuclear herniation
Annular protrusion
Fibrous replacement of annulus
Intraverterbral herniation of nuclear material
Accumulation of nitrogen gas in fissures of disk

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19
Q

DDD Radiologic Findings

A

Decreased disk space height
Osteophytes at vertebral endplates
Schmori’s nodes
Vacuum phenomenon

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20
Q

DJD Characteristics

A 
Affects facet joints
Articular cartilage thinning
Subchondral bone sclerosis
Eburnation
Osteophytosis
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21
Q

DJD Radiologic Findings

A

Decreased facet joint space
Scelorsis
Osetophytosis

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22
Q

Spondylosis Characteristics

A

Formation of osteophytes at the vertebral endplates in response to DDD

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23
Q

Spondylosis Radiologic Findings

A

Osteophytes visible

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24
Q

Spondylosis Deformans Characteristics

A

A or AL disk herniation resulting in A or AL vertebral endplate osteophytosis

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25
Q

Spondylosis Deformans Radiologic Findings

A

Claw like spurs cupping toward IVD

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26
Q

DISH Characteristics

A

Rheumatological abnormality

Characterized by proliferation of bone at osseous sites of ligamentous and tendinous attachments, notably at the ALL

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27
Q

DISH Radiologic Findings

A

Flowing ossification of at least 4 vertebrae
Preservation of disk height and absence of DDD findings
Absence of sacroilitis or facet joint DJD

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28
Q

What is lumbar stenosis?

A

Narrowing or constriction of spinal canal secondary to adjacent soft tissue or bony enlargement

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29
Q

What structures can be affected by spinal stenosis?

A

spinal cord, thecal sac and dural membranes

30
Q

How is lumbar stenosis classified?

A 
By etiology (congenital or acquired)
By anatomic region involved (central spinal canal, IVF, lateral recesses)
31
Q

What is the incidence for spinal stenosis?

A

1/4 of asymptomatic adults under age 40

32
Q

What spinal region is spinal stenosis most prevalent?

A

L4

33
Q

What are some of the acquired mechanisms for spinal stenosis?

A 
Osteophytes
Hypertrophy of pedicles, lamniae, facet joints
IVD bulging
Spondylolisthesis
Thickening of ligamentum flavum
34
Q

What is the normal AP diameters of the spinal canal in the spine?

A

C3-C5 = 17-18 mm
C5-C7 = 12-14 mm
T spine = 12-14 mm
L spine = 15-27 mm

35
Q

What is a major complication for cervical spinal stenosis?

A

Central cord syndrome (loss of motor function of UE, variable sensory sparing)

36
Q

What is cervical spine stenosis associated with?

A

Long tract and radicular signs
Headaches
Pain
Radiating electric-shock sensations elicited with c spine flexion

37
Q

What are the presentations for concurrent cervical and lumbar spinal stenosis?

A

Gait disturbance
Myelopathy
Radiculopathy

38
Q

What is the clinical presentation for lumbar spinal stenosis?

A

Unilateral or bilateral LBP and or LE pain
Numbness
Weakness
Symptoms aggravated with standing walking, relieved with sitting
Symptoms aggravated with lumbar extension, relieved with flexion

39
Q

What is neurogenic claudication?

A

Congestion of blood vessels at stenotic level. It inhibits nerve conduction and results in leg pain, numbness and weakness

40
Q

What is the difference between neurogenic and vascular claudication?

A 
Neurogenic = exacerbated by standing and spinal extension
Vascular = exacerbated by exercise and improved with standing
41
Q

How is spinal stenosis differentiated from disk herniations?

A

Pain from herniations are aggravated by sitting, flexion, lifting and valsalva maneuvers, relieved by walking. Pain from stenosis not affected by above and aggravated with walking

42
Q

What are the radiologic findings for spinal stenosis?

A

Severe degenerative changes at a spinal segment. Radiographs lack specificity

43
Q

What advanced imaging can be used to view spinal stenosis?

A

CT
Myelography shows constriction of thecal sac
MRI views thecal sac and contents
SPECT discriminates between stenosis and medical disease, infection and tumors

44
Q

What is the treatment for spinal stenosis?

A

Analgesics
NSAIDs
Epidural steroid injections
PT

45
Q

What are intervertebral disk herniations?

A

extension of NP through AF and beyond adjacent vertebral margins

46
Q

What is the indicidence of IVDHs?

A

25-45 year olds
men > women
smokers, obese, vehicular vibration

47
Q

Where are IVDHs most common?

A

90% occur at L4-L5

48
Q

What causes IVDH?

A 
Degenerative changes in vertebral joints that impose excessive axial, shear or rotational forces which contribute to degeneration of AF
Acute trauma (compression fracture or endplate fracture)
49
Q

How is IVDH presented?

A

LBP and referred or radicular pain
Usually exacerbated with active flexion, prolonged sitting, valsalva
Loss of muscle strength, decreased DTR and parestheia
Cauda equina syndrome can develop

50
Q

Why are imaging studies unnecessary in first 4-6 weeks following onset of IVDH symptoms?

A

20-35% asymptomatic adults have them
Most improve significantly with conservative treatment in 4-6 weeks
May reveal preexisting abnormalities that will confuse situation

51
Q

When is imaging indicated for IVDH?

A

when conservative treatment fails or those exhibiting cauda equina syndrome

52
Q

Prognosis for IVDH

A

Good with conservative management (PT, analgesics, short-term bedrest, restricted activities)
Some require surgery

53
Q

What are the radiographic hallmarks of DJD at SIJ?

A

decreased joint space
subchondral sclerosis
osteophyte formation at joint margins
(in advanced cases joint space may not be well visualized because osteophytes bridge joint space)

54
Q

Which portion of the joint space represents the synovial portion of the joint?

A

Lower halves, upper are syndesmotic

55
Q

What is ankylosing spondylitis?

A

chronic, progressive inflammatory arthritis characterized by joint sclerosis and ligamentous ossification

56
Q

How is ankylosing spondylitis manifested?

A

first in stiffness of SIJs, later extends to lumbar and thoracic spines

57
Q

Who is affected by ankylosing spondylitis?

A

men 7x more likely

onset in 20s

58
Q

What are the radiologic findings of ankylosing spondylitis?

A

Abnormal narrowing of upper half of SIJs (eventual joint fusion)
Squaring off of anterior borders of vertebral bodies
Syndesmophytes form bridging vertebral bodies (bamboo spine)

59
Q

What radiologic findings distinguish degenerative and fracture spondylolisthesis?

A

spinous process sign

60
Q

What occurs in degenerative spondylolisthesis?

A

Entire vertebra slips forward as a unit

Step-off is below level of slip

61
Q

What occurs in fracture spondylolisthesis?

A

Bilateral spondylosis results in forward slip of vertebral body, pedicles and superior articular processes. Inferior articular processes, laminae and spinal process remain in normal position.
Step-off is above level of slip

62
Q

Nose

A

transverse process

63
Q

Eye

A

pedicle

64
Q

Ear

A

superior articular process

65
Q

Neck

A

Pars interacularis

66
Q

Foreleg

A

Inferior articular process

67
Q

Body

A

Lamina and spinous process

68
Q

Tail

A

Superior articular process of opposite side

69
Q

Hind leg

A

inferior articular process of opposite side

70
Q

What are the grades for spondylolisthesis?

A 
1 = 25%
2 = 50%
3 = 75%
4 = 100%
5 = completely fallen off

Imaging II (9 decks)

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