Radiologic Eval of Lumbosacral Spine Flashcards
List radiologic views of the Lumbar spine that may be used during a routine exam
- AP
- Lateral
- R/L Oblique
- Coned lateral view L5-S1
- Lateral view standing flexion and extension
list radiologic views of the SIJ that may be used during a routine exam
- AP axial
- R/L Oblique view
- Lateral view: coccyx
what can be observed with a R/L Posterior Oblique projection at the Lumbar spine? (4)
- articulating process
- Z-joints
- Pars interarticularis
- Scotty dog
what can be seen with a coned lateral view of L5-S1? (3)
- can still observe 3 parallel lines of vertebral bodies (like with lateral view)
- disc spaces preserved
- lumbosacral angles
- Barge’s
- Ferguson’s
what can be observed with an AP axial view of the SIJ? (5)
- Articular surfaces are superimposed
- smooth osseous margins
- symmetry of SIJs
- L5/S1
- Coccyx
which view allows a better appreciation of the SIJ?
L/R Oblique view of SIJ
list general indications for CT of the spine (5 important ones)
- Acute trauma (adults)
- degenerative conditions
- post-op assessment
- infection
- image guided intervention procedures
- neoplasms
- inflammatory lesions
- congenital/developmental conditions
- Cord syrinxes/masses (with MRI contraindicated)
notes about CTs of lumbar spine
what is a CT of the spine great for viewing?
- CT great for viewing bone
- Basic protocol
- lower thoracic to SIJs (or less)
- Axial slices; reformatting to sagittal and coronal planes
- Other CTs
- CT myelogram
- CT with contrast (tumor, infection)
- Abdominal/Pelvic CT
list general indications for MRI of the spine (3 important ones)
- acute trauma with suspected cord encroachment
- DDD
-
neoplasm
- diagnosis and intervention f/u
- intrinsic spinal cord pathology
- pre and post-op assessment (soft tissues, vertebroplasty)
- meningeal abnormalities
- infection
- disc space infections
- epidural abscess
list incidental imaging findings in the lumbar spine region
- disc protrusion → high prevalence rates in asymptomatic populations (20-30%)
- spondylolysis → pars defect reported in asymptomatic vs symptomatic populations
- 7-10% in asymptomatic
- 9% in symptomatic
- spondylolisthesis → 3-4 mm anterior slippage advocated as a threshold for clinical instability
characteristics of a bulging disc
- these are not herniations
- involve 50-100% circumference
- described as either symmetric or asymmetric
what are the 2 types of herniations?
protrusions and extrusions
describe protrusions and extrusions
- Protrusion
- broad-based = 25-50% (total of 90-180 degrees)
- focal = <25% (less than 90 degrees)
- Extrusions
- narrower neck
- sequestered or free fragment
how are herniation locations described?
- by plane
- axial plane divided into zones
- sagittal plane divided into levels
list ACR appropriateness criteria to consider in the lumbar spien
- Suspected spine trauma
- Suspected spine trauma-child
- low back pain
- back pain - child
- chronic back pain: suspected sacroilitis/spondyloarthropathy
- stress (fatigue/insufficiency) fracture, including sacrum, excluding other vertebrae
what initial imaging study is most appropriate for a patient that is age greater than or equal to 16 years with blunt trauma meeting criteria for thoracic and lumbar imaging?
CT thoracic and lumbar spine
for a pt age greater than or equal to 16 years what next imaging study is most appropriate if acute thoracic/lumbar spine injury has been detected on radiographs or noncontrast CT with neurologic abnormalities?
MRI thoracic and lumbar spine
what initial imaging study is most appropriate for a child (younger than 16) with suspected thoracolumbar spine trauma?
Radiography thoracic and lumbar spine
what initial imaging study is most appropriate for a patient with acute low back pain with/without radiculopathy, no red flags and no prior management?
no imaging
what initial imaging study is most appropriate for a pt with subacute or chronic LBP with/without radiculopathy, no red flags, and no prior management?
no imaging
what initial imaging study would be most appropriate for a pt with subacute or chronic LBP with/without radiculopathy? Additionally, they are a surgical or intervention candidate with persistent or progressive symptoms during/following 6 weeks or optimal medical management.
MRI lumbar spine
What initial imaging study is most appropriate for a pt with LBP with suspected cauda equina syndrome?
MRI lumbar spine
What initial imaging study is most appropriate for a pt with LBP and a history of prior lumbar surgery with/without radiculopathy. They have new or progressing symptoms or clinical findings
Radiography lumbar spine
MRI lumbar spine
what initial imaging study is most appropriate for a pt with LBP with/without radiculopathy. Along with one or more of the following: low-velocity trauma, osteoporosis, elderly individual, or chronic steroid use.
radiography lumbar spine
MRI lumbar spine
CT lumbar spine
what initial imaging study is most appropriate for a pt with LBP with/without radiculopathy. Along with one or more of the following: suspicion of cancer, infection, or immunosuppression.
MRI lumbar
for a child with back pain and none of the following clinical red flags (constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neuro exam), what initial imaging is most appropriate?
no imaging
What makes up the nose of the scotty dog?
Transverse process
What makes up the feet of the scotty dog?
inferior articular processes
What makes up the tail of the scotty dog?
superior articular process
What makes up the ear of the scotty dog?
superior articular process
What makes up the body of the scotty dog?
lamina and spinous process
