Lumbar spine Flashcards
What z joints will you see during L posterior oblique views? R posterior oblique views?
LPO - L z joints
RPO - R z joints
What z joints will you see during R anterior oblique views? L anterior oblique views?
RAO - L z joint
LAO - R z joint
nose of scotty dog
transverse process
ear of scotty dog
superior articular process on the side we are looking at
front leg of scotty dog
inferior articular process on the side we are looking at
tail of scotty dog
superior articular process on the other side of view
lower leg of scotty dog
interior articular process on the other side of view
collar of scotty dog (if present)
= spondylolysis
eye of scotty dog
pedicle
dogs body of scotty dog
lamina
What is normal Barge’s angle?
~53 deg
What is normal Ferguson’s angle?
~41 deg
What is the best view of the SI joint?
R and L oblique views
suspected spine trauma - initial imaging for adult over 16 after blunt trauma who meets criteria for thoracic and lumbar imaging
- CT thoracic and lumbar
Suspected spine trauma - suggested criteria for imaging of thoracolumbar spine
- signs of injuries - visual cues or tenderness
- neuro issues
- ED outcomes - GCS < 15, major distracting injury, intoxication
suspected spine trauma - next imaging study for adult over 16 w/ acute thoracic or lumbar spine injury detected on radiographs or noncontrast CT, neurological abnormalities
MRI
suspected spine trauma - initial imaging for child under 16, suspected thoracolumbar spine trauma
radiography thoracic and lumbar spine
LBP - initial imaging for acute low back pain w/ or w/o radiculopathy, no red flags, no prior management
imaging is not appropriate
LBP - initial imaging for subacute or chronic LBP w/ or w/o radiculopathy, no red flags, no prior management
imaging is not appropriate
red flags for cancer or infection as cause of LBP
- hx of cancer
- unexplained weight loss
- immunosuppression
- urinary infection
- intravenous drug use
- prolonged use of corticosteroids
- back pain not improved w/ conservative management
red flags for spinal fx as cause of LBP
- hx of significant trauma
- minor fall or heavy lift in a potentially osteoporotic or elderly individual
- prolonged use of steroids
red flags for cauda equina or other severe neurologic conditions of LBP
- acute onset of urinary retention or overflow incontinence
- loss of anal sphincter tone or fecal incontinence
- saddle anesthesia
- bilateral or progressive weakness in the lower limbs
LBP - inital imaging for subacute or chronic LBP w/ or w/o radiculopathy, surgery or intervention candidate w/ progressive symptoms during or following 6 weeks of optimal medical management
MRI
LBP - initial imaging for LBP w/ suspected cauda equina syndrome
MRI
LBP - initial imaging for LBP w/ hx of prior lumbar surgery and w/ or w/o radiculopathy, new or progressing symptoms or clinical findings
- radiography lumbar spine
- MRI
LBP - initial imaging for LBP w/ or w/o radiculopathy, one or more of the following: low-velocity trauma, osteoporosis, elderly individual, or chronic steroid use
- radiography lumbar spine
- MRI
- CT lumbar
LBP - inital imaging for LBP w/ or w/o radiculopathy, one or more of the following: suspicion of cancer, infection, or immunosuppression
MRI
Child back pain - initial imaging for child w/o red flags: NO to constant pain, night pain, radicular pain, pain lasting > 4 weeks, abnormal neuro exam
no imaging appropriate
Child back pain - initial imaging for child w/ back pain and 1 or more red flags: YES to constant pain, night pain, radicular pain, pain lasting > 4 weeks, abnormal neuro exam
- x-ray spine area of interest (BEST - usually appropriate)
- MRI (may be appropriate)
