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633: Human Imaging II > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

What are the 4 lumbar spine views?

A
  • anteroposterior (AP)
  • lateral
  • Right and left oblique views
  • Coned lateral view of lumbosacral articulation (L5–S1)
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2
Q

What do posterior oblique views image?

A

“downside” facet joints closest to image receptor

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3
Q

What do anterior oblique views image?

A

“upside” facet joints farther from image receptor

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4
Q

In the formation of the Scottie dog in the oblique lumbar images what does the nose represent?

A

transverse process

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5
Q

In the formation of the Scottie dog in the oblique lumbar images what does the eye represent?

A

pedicle

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6
Q

In the formation of the Scottie dog in the oblique lumbar images what does the ear represent?

A

superior articular process

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7
Q

In the formation of the Scottie dog in the oblique lumbar images what does the neck represent?

A

pars interarticularis

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8
Q

In the formation of the Scottie dog in the oblique lumbar images what does the foreleg represent?

A

inferior articular process

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9
Q

In the formation of the Scottie dog in the oblique lumbar images what does the body represent?

A

lamina and spinous process

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10
Q

In the formation of the Scottie dog in the oblique lumbar images what does the tail represent?

A

superior articular process of opposite side

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11
Q

In the formation of the Scottie dog in the oblique lumbar images what does the hind leg represent?

A

inferior articular process of opposite side

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12
Q

What is the imaging procedure of choice for evaluating trauma at the lumbar spine?

A

Computed tomography (CT)

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13
Q

Why are AP and lateral radiographs also obtained in trauma patients?

A

to help localize injuries

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14
Q

If the CT exam is normal is MRI indicated? Why or why not?

A

No, because isolated ligamentous injuries are rare in the lumbar spine

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15
Q

What areas of the lumbar spine are predominant sites of vertebral fractures? Why?

A

Thoracolumbar junction (T11-L2) because these vertebrae are transitional region between relatively fixed thoracic spine and mobile lumbar spine

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16
Q

What is Spondylolysis?

A

A defect of the pars interarticularis

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17
Q

What are 3 things that may lead to Spondylolysis?

A
  • Congenital
  • Traumatic
  • Stress fracture caused by chronic strain (most common)
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18
Q

What is Spondylolisthesis?

A

A forward displacement of one vertebra upon stationary vertebra beneath it

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19
Q

What is Spondylolisthesis aka?

A

anterolisthesis

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20
Q

What does the term retrolisthesis refer to?

A

Posterior displacement of one vertebra upon stationary vertebra above it

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21
Q

-% of people have spondylolisthesis

A

5-10

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22
Q

Who are typically affected by spondylolisthesis?

A

Children and adolescents, especially those involved in athletic activities

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23
Q

Which vertebral levels are most often involved in spondylolisthesis?

A

Lower lumbar levels (L4–L5 and L5–S1)

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24
Q

Spondylo______ can be consequence of spondylo_____.

A

Spondylolisthesis

Spondylolysis

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25
Q

What are 3 other things that spondylolisthesis can result from?

A
  • Congenital or developmental aberrations
  • Pathological processes
  • Degenerative changes
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26
Q

What are the clinical presnetations of spondylolisthesis?

A

Patient c/o pain after athletic activities or physical labor

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27
Q

What usually reduces pain in patients with spondylolisthesis? Why?

A

Lumbar flexion, because it reduces the displacement

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28
Q

Palpation of the spinous processes in patients with spondylolisthesis can reveal what?

A

Either rotation or deep depression

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29
Q

Rotation of the spinous processes can be correlated with what?

A

An asymmetrical slip which is often the result of unilateral spondylolysis

30
Q

Palpable depression over the spinous processes is indicative of what?

A

It is a classic sign of spondylolisthesis

31
Q

What are the 2 types of spondylolistheses?

A

Degenerative or Fracture

32
Q

Upon reviewing radiographic findings, how can you tell the difference between degenerative and fracture spondylolistheses?

A
  • In degenerative spondylolisthesis the step off is below the level of the slip
  • In fracture spondylolisthesis the step off is abovethe level of the slip
33
Q

How is spondylolisthesis treated?

A
  • PT
  • Restriction of activities that load spine in extension
  • Stretching lumbar joints into flexion
  • Analgesics and bracing that reduces loads to lumbar spine
  • Surgical fusion
34
Q

What are 2 degenerative pathological conditions typically associated with the lumbar spine?

A

Spinal stenosis and intervertebral disk herniations

35
Q

What are 4 other degenerative conditions of the lumbar spine?

A
  • Degenerative joint disease (DJD)
  • Degenerative disk disease (DDD)
  • Spondylosis deformans
  • Diffuse idiopathic skeletal hyperostosis (DISH)
36
Q

What are the radiologic findings of DDD?

A
  • decreased disk space height
  • osteophytes at vertebral endplates
  • Schmorl’s nodes
  • vacuum phenomenon
37
Q

What are the radiologic findings of DJD?

A
  • decreased zygapophyseal joint space
  • sclerosis
  • osteophytes at joint margins
38
Q

What are the radiologic findings of spondylosis?

A
  • osteophytes visible as radiodense irregularities at vertebral joint margins
39
Q

What are the radiologic findings of spondylosis deformans?

A
  • claw-like spurs cupping toward intervertebral disk present at more than one level
40
Q

What are the radiologic findings of DISH?

A
  • flowing ossification of at least 4 contiguous vertebrae
  • preservation of disk height and absence of DDD findings
  • absence of sacroilitis or zygapopyseal joint DJD
41
Q

What is spinal stenosis defined as?

A

A narrowing or constriction of the spinal canal secondary to adjacent soft tissue or bony enlargement

42
Q

Spinal stenosis can be classified by what 2 things?

A

Either by etiology or by anatomic region involved

43
Q

Etiologically, spinal stenosis can be divided into what 2 types

A

congenital or acquired

44
Q

Anatomically, spinal stenosis divided into what 3 regions?

A
  • Stenosis of central spinal canal
  • Stenosis of intervertebral foramen (IVF)
  • Stenosis of subarticular or lateral recesses (distance b/w thecal sac and IVF)
45
Q

Spinal stenosis accounts for up to __% of asymptomatic population under age 40

46
Q

Does spinal stenosis affect men or women more?

A

men > women

47
Q

Spinal stenosis is most common in which spinal regions?

A

cervical and lumbar

48
Q

Central canal narrowing is most prevalent at L_

49
Q 
Norma AP diameter of spinal canal adult men as follows:
Cervical spine C3–C5: \_\_-\_\_ mm
Cervical spine C5–C7: \_\_-\_\_ mm
Thoracic spine: \_\_-\_\_ mm
Lumbar spine: \_\_-\_\_ mm
A

17 to 18 mm

12 to 14 mm

12 to 14 mm

15 to 27 mm

50
Q

Concurrent cervical and lumbar spinal stenosis can present with what 3 things?

A
  • Gait disturbance
  • Myelopathy
  • Radiculopathy
51
Q

Symptoms of spinal stenosis are increased with lumbar ______ and decreased with lumbar ______.

A

extension

flexion

52
Q

Describe the simian stance

A

It is a position in which spinal stenosis patients attempt to relieve symptoms in which the trunk, hip, and knee are in flexion
(leaning on a shopping cart)

53
Q

What is neurogenic claudication?

A

Congestion of blood vessels at a stenotic level that inhibits nerve conduction and results in poorly defined leg pain, numbness, and weakness

54
Q

How can you tell the difference between neurogenic and vascular claudication?

A
  • Neurogenic claudication is exacerbated by standing and spinal extension
  • Vascular claudication is exacerbated by exercise and is improved with standing
55
Q

How can you tell the difference between spinal stenosis and disk herniation?

A
  • Pain from disk herniation is aggravated by sitting, flexion, lifting, and valsalva maneuvers and often relieved with walking
  • Pain from spinal stenosis is not affected by any of those maneuvers and is aggravated with walking
56
Q

How is mild to moderate spinal stenosis managed?

A

With:

  • Analgesic medications
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Epidural steroid injections
  • PT for strengthening and flexibility exercises
57
Q

What is the most frequent pathologies affecting the diskovertebral junction?

A

Intervertebral disk herniation

58
Q

Intervertebral disk herniations are most common in what age group?

A

in 25 to 45 year-old age group

59
Q

Do IVD herniations affect men or women more?

60
Q

What are 3 other predisposing factors to IVD herniations?

A
  • smokers
  • the obese
  • those exposed to vehicular vibration
61
Q

Were are IVDH most common?

A

in the lumbar spine

62
Q

90% of all IVDH occur at what level?

A

L4–L5

- small percentage occur at L3-L4

63
Q

__-__% of asymptomatic individuals have disk herniations

64
Q

What are the radiographic hallmarks of DJD at SIJ?

A
  • Decreased joint space
  • Subchondral sclerosis
  • Osteophyte formation at joint margins
65
Q

Evaluation of DJD confined to ____ half of radiographic joint space. Why?

A

lower

Because only the lower halves of joint space image represent synovial portion of joints.

The upper portions of joints are syndesmotic

66
Q

What is ankylosing spondylitis?

A

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

67
Q

Where does ankylosing spondylitis usually manifest first? Where does it extend to later?

A

First in stiffness of the SIJs and later extends to lumbar and thoracic spines

68
Q

Does ankylosing spondylitis affect men or women more?

A

Men, 7 times more than women

69
Q

When is onset of ankylosing spondylitis?

A

in the 20s

70
Q

What are the radiographic characteristics of ankylosing spondylitis?

A
  • Fusion of joint spaces
  • Squaring-off of anterior borders of vertebral bodies
  • Syndesmophytes form bridging vertebral bodies
  • Trolley track sign

633: Human Imaging II (11 decks)

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