Spinal Disorders - Radiology Flashcards
List the imaging techniques used to image to spine
- Plain flims
- Nuclear medicine
- CT
- MRI
- Bone densitometry
Describe the advantages and limitations of using plain films to image the spine
Advantages
- Readily available
- Provides structural infromation - e.g., vertebral collapse, spondyliosthesis, scoliosis
Limitations
- Insensitive to early disease
- Unable to distinguish between acute vs chronic
- Unable to distinguish benign from malignant collapse
- Dose of radiation
Describe how a bone densitometry (DEXA) works and also the advantages and limitations of using a DEXA to image the spine
How it works
- Dual-energy CX-rays
- Differential absorption
- Comparison with a population dataset
Advanatages
- Provides structural information about bone density to diagnose osteoporosis/osteopenia
Limitations
- No information about other disease processes
What are the advantages and limitation of nuclear medicine (bone scan) to image the spine?
Advantages
- ‘Functional scan’
Limitations
- Sensitive but not specific - does not tell us what the cause of an increase of bone turnover is
- Uses radiation
What are the advantages and limitations of using a CT scan to image the spine?
Advantages
- Widely available
- Access for patients unable to have MRI
Limitations
- Uses radiation
- May be falsely reassuring
What are the advantages and limitations of using a MRI scan to image the spine?
Advanatges
- Allows us to look at one, bone marrow and soft tissue structures
- Better detection/disease classification and allows appropriate triage
Limitations
- Expensive
What issues are picked up by MRI and not plain x-ray?
- Acute pars stress oedema
- Early spondyloarthroathy or disc infection
- Neurogenic tumour
- More accurate information about vertebral fracture number
When is imaging required for low back pain? and what is the aim of this?
Imaging required when low back pain is persistent (6 weeks+)
The aim is to exclude sinister pathology e.g., malignancy, infection, verterbral collapse
What are the benefits of using an MRI for diagnosis?
- Decreased hospital referrals
- Decrease expenditure on other tests
- Earlier return to work
- Better QOL
What are the chronic impact of osteoporotic vertebral compression fractures
- Once you get one, more prone to get more
- Spinal deformity
- Impaired physical function
- Decreased pulmonary function
- Loss of appetites
- Chronic pain
- Sleep problems
- Decreased activity
- Psychosocial consequences
Decsribe the treatments for osteoporotic vertebral compression fracture?
Vertebroplasty - involves injecting PMMA cement into a collapsed vertebral body
Kyphoplasty - employs a balloon tamp to create a cavity in a vertebral body and to restore vertebral body height
What are the indications of a vertebroplasty and kyphoplasty
Verterbral compression fractures secondary to:
- Osteoporosis
- Osteolytic metastases
- Multiple myeloma
- Vertebral haemangioma
What are the clinical consequences of a vertebral crush fractures
- Pain, deformity, and loss of function
- Mortality increases with: number of fractures, degree of kyphosis
- Reduced pulmonary function
- Impaired functional status
- Quality of life reduced
Describe the use of facet joint injections
- For facet joint cysts
- Done by pain anaesthetist
- May be done under fluroscope or CT guided
Describe the use of peri-neural injections
- For back pain that is referred to leg
- Diagnostic/therapeutic procedure
- Done by pain anaesthetist/radiologist
- May be done under flurosocope guidance or CT guided
- Done when there’s anatomy/failed fluro injections
