Radiology - Spinal Disorders

Question 1

Pathology seen in spine imaging

Answer 1

Degenerative disease
Infl disease
Osteoporosis
Neoplastic disease

Question 2

Imaging techniques for the spine

Answer 2

Plain films 
Nuclear medicine 
CT 
MRI 
Bone densitometry

Question 3

Plain films for spinal imaging

Answer 3

Readily available

Provides structural info

Question 4

Structural info about spine seen on plain films

Answer 4

Vertebral collapse
Spondyloisthesis
Scoliosis

Question 5

Limitations of plain films for spinal imaging

Answer 5

Insensitive to early disease – visualisation of destructive lesion requires loss of 80% of medullary bone
Unable to distinguish between acute vs chronic and benign vs malignant
Dose of radiation

Question 6

DEXA scans

Answer 6

Dual-energy X-rays 
Differential absorption 
Comparison with a population dataset 
Dependent of bone density 
Provides structural info

Question 7

Limitations of DEXA scans

Answer 7

No info about other disease processes

Question 8

Nuclear medicine - ‘bone scans’

Answer 8

‘Functional scan’
Sensitive not spp
Radiation

Question 9

Advantages of CT

Answer 9

Widely available

Access for pt. unable to have MRI

Question 10

Disadvantages of CT scans

Answer 10

Radiation

May be falsely reassuring

Question 11

MRI for spinal imaging

Answer 11

Allows us to look at bone, bone marrow and soft tissue structures
Preferred investigation for the diagnosis of most spinal disorders

Question 12

When is spinal imaging required

Answer 12

When LBP is persistent (6 weeks+) to excl sinister pathology – malignancy, infection, vertebral collapse

Question 13

Issues picked up by MRI and not plain film

Answer 13

Acute pars stress oedema
Early spondylo-arthropathy or disc infection
Neurogenic tumour
More accurate info about vertebral fracture number

Question 14

Timeframe for using imaging

Answer 14

Presentation 
Hx
Examination 
Special investigations* 
Diagnosis 
Treatment 
Special investigations

Question 15

Chronic impact of osteoporotic vertebral compression fractures

Answer 15

Once you get one, more prone to get more

Question 16

Downward spiral of osteoporotic vertebral compression fractures

Answer 16

Spinal deformity 
Impaired physical function 
Decreased pulmonary function 
Loss of appetites 
Chronic pain 
Sleep problems 
Decreased activity 
Psychosocial consequences

Question 17

Vertebroplasty

Answer 17

Involves injecting PMMA cement into a collapsed vertebral body

Question 18

Kyphoplasty

Answer 18

Employs a balloon tamp to create a cavity in a vertebral body and to restore vertebral body height

Question 19

indications of vertebroplasty and kyphoplasty

Answer 19

Vertebral compression fractures secondary to:

• Osteoporosis
• Osteolytic metastases
• MM
• Vertebral haemangioma

Question 20

Clinical consequences of vertebral crush fractures

Answer 20

Pain, deformity and loss of function 
Mortality  
Reduced pulmonary function 
Impaired functional status 
Quality of life

Question 21

What does the mortality of vertebral crush fractures increase with

Answer 21

Number of fractures

Degree of kyphosis

Question 22

Radiofrequency tumour ablation

Answer 22

Cures benign tumours e.g. osteoid sarcoma

Palliation for malignant tumours e.g. inoperable 1’ bone tumours, myeloma or metastases