Lumbosacral Spine Flashcards
S2Q1
LS: Views - AP
beam level, SP describe (2) + unless 1=1=1, SI joints check what, facets describe
psoas shadow - from, shape, if missing (2 + d/t what)
- beam: L3-L4
- SP: midline & equidistant unless torn PLL = spine collapse ant = wider space
- SI joints: compare (B) joint thickness
- facets: butterfly shadow
PSOAS SHADOW
- from TP & anterolateral bodies diagonally
- if missing = hematoma or abscess d/t pott’s disease (spinal infection)
LS: Views - Lateral
lines - must be what, space between what is what & if missing then what condition, (3)
body - shape, finding + indication
pedicle - describe, finding + indication
IV disc space - shape, compare levels
IV foramen - shape/describe, compare levels
VERTEBRAL LINES
- must be aligned
- space between 2&3: spinal canal, if disrupted = canal stenosis
- line 1: ant vertebral body line
- line 2: pos
- line 3: spinolaminar
- body: boxlike; osteophytes = degeneration
- pedicle: superimposed, only one visible unless curved spine
- IV disc space: wedged, L5-S1 > L3-L4
- IV foramen: radiolucent oval; L1-L5 are seen, L5-S1 are narrower
LS: Views - R&L Oblique
scottie dog - (8)
- nose: TP
- eyes: pedicles
- ears: SAP
- neck: between SAP & IAP
- foreleg: IAP
- body: lamina & SP
- tail: other SAP
- hindleg: other IAP
LS: Views - Lateral L5-S1
other term
lines - must be what, finding + indication (3)
IV disc space - finding = what u call this = indication (2)
L5 angle - ferguson vs. barge where + normal
- conal lateral radiograph
VERTEBRAL LINES
- must be smooth continuous transition into L5
- step off = fx, dislocation, spondylolisthesis
IV DISC SPACE
- lucency = vacuum phenomenon = OA & spondylosis
- ferguson’s angle: sacral base & horizontal line of ant edge of sacrum; 41
- barge’s angle: sacral base & vertical; 53
LS:
indications (3)
kids: hip pain, don’t WB, limp
LS: Anatomy - Lumbar
pedicle (2), lamina (2), SP (4), TP (1), facets (1.1), IV disc (1)
- pedicle: short, circular
- lamina: short, broad
- SP: large, blunt, horizontally inclined, tear drop
- TP: slender
- facets: sagitally oriented except L5 (coronal)
- IV disc: wedge (thicker ant)
LS: Anatomy - Sacral
what, base, apex, ala, sacral hiatus
ant surface vs. pos - describe (2.1), has what (1.2)
SIJ - primary support (2) + if boogsh then what in what, secondary (2) + purpose
- fused
- base: superior end
- apex: inferior end
- ala: wings, large bone lat to body
- ant surface: smooth, concave, has 4 ant sacral foramina
POS SURFACE
- rough
- has 4 pos foramina
- median sacral crest: fused SP
- sacral hiatus: failed to fuse of 5th sacral lamina
SI JOINT
- primary: ant & pos sacroiliac ligament; if boogsh = pelvic brim instability in pelvic fx
- secondary: sacrospinous & sacrotuberous ligament = turn sciatic notch into greater & lesser sciatic foramen
LS: CT Scan
level, # of slices, views
- T12-S1
- 20-30 slices per vertebra
- axial but can be converted to sagittal coronal 3D
LS: CT Scan
alignment - views (2)
bone density - 2 examples
canal space - (2) on (2) = (1) = (2), free fragments d/t (2)
disk integrity - check (2), view
soft tissue - check (1), view
fx - view
ALIGNMENT & ANATOMY
- sagittal & coronal
BONE DENSITY
- cortical (pos ring structure) > cancellous (vertebral body)
CANAL SPACE
- narrowing or encroachment on canal or lat recess = neural impingement = sciatica or radicular sx
- free fragments = d/t fx or extruded disc
DISK INTEGRITY
- check pos & poslat in axial since herniations alter pos contour
SOFT TISSUE
- prevertebral edema on axial
FX
- view: coronal
LS: CT Scan
axial plane - normal canal space (2) + pathologic, pos contour of disc must what
sagittal plane - check (5)
coronal plane - check (5)
AXIAL PLANE
- normal canal: 15mm AP 20mm transverse (<12 = stenosis)
- pos contour of disc: must not boogsh canal & foramen
SAGITTAL PLANE
- configuration of body, disc height & space, patency of canal, facet joint appearance
CORONAL PLANE
- fx
LS: MRI
level, views, T1 vs. T2, contraindications (6)
- T12-S1
- axial sagittal > coronal
- T1: anatomy T2: physiologic
CONTRAINDICATIONS
- pacemaker, ferromagnetic clip
- neurostimulator, cochlear implant
- extensive tattoos, nonremovable piercings
LS: MRI
alignment - view
canal space - view, finding + d/t (5)
disk - check + views (2G)
soft tissue - check (1)
ALIGNMENT & ANATOMY
- sagittal view
CANAL SPACE
- sagittal & axial
- effacement of thecal sac: d/t pos vertebral endplate, disc, arthritic facet joint, thickened ligament, free fragments
- effacement: indentation of adjacent structure
DISK INTEGRITY
- pos margin (axial & sagittal), poslat (axial)
SOFT TISSUE
- paravertebral edema
LS: MRI
axial plane - three levels, IV disc contour (1), IV foramen (1), spinal canal, facet joints (2), ligament what + (1=1)
sagittal plane - body, epidural space, spinal canal, ligament what (2) + (sx if 2)
AXIAL PLANE
- low (black) intermediate (gray) high (white)
- IV disc contour: bulging
- IV foramen/nerve roots: no obstruction
- spinal canal: cauda equina on white CSF
- facet joints: hypertrophy, osteophytes
- ligamentum flavum: thickened = stenosis
SAGITTAL PLANE
- body: groove of basi-vertebral vein
- epidural space: dark line (dura mater) separating CSF & epidural fat pad
- spinal canal: conus medullaris til L2
- ALL & PLL: elevated if herniation or degenerative endplates
LS: Trauma
fx - epidemiology (level + d/t), CT x-ray MRI
- T11-L2 d/t fixed thoracic mobile lumbar
- CT: highly sensitive, detailed
- x-ray: localize lesions
- MRI: not really if normal CT since rare ligamentous injury in LS
LS: Trauma
spondylolysis - structure, etiology (3), epidemiology (level), oblique CT MRI SPECT
- pars interarticularis
- eti: congenital, trauma, chronic strain = stress fx
- epi: L4-L5, L5-S1
- oblique view: scottie
- CT: find level first since challenging pars
- MRI: edema on T2 weighted
- SPECT: best but rare & expensive
