spinal imaging

Question 1

What are the pros of using X-ray imaging of the spine

Answer 1

Readily available, structural information (vbertebral collapse, spondylolisthesis, scoliosis)

Question 2

What are the cons of using X-ray imaging for back pain

Answer 2

Insensitive to early disease, visualisation of destructive lesion needs loss of >80% medullary bone

Question 3

What does plain film mean

Answer 3

X-ray

Question 4

What does DEXA stand for

Answer 4

Dual energy x-ray absorptiometry

Question 5

What do DEXA scans do

Answer 5

Dual energy x rays show differential absorption dependent on bone density. . Shows bone density and structure only, no info about other disease processes

Question 6

What does a nuclear medicine “bone scan” do?

Answer 6

shows abnormal osteoblastic activity, but doesnt show exactly what the problem is. Sensitive but not specific. Think pagets

Question 7

WHat are the pros of using CT scans to image the spine?

Answer 7

Very precise in terms of identifying bone. Alternative for patients unable to have an MRI (pacemaker, etc)

Question 8

What are the cons of using CT scans to image spine?

Answer 8

High radiation dose, poor at identifying soft tissues like nerve roots. May be falsely reassuring

Question 9

What are the pros of using MRIs while imaging back pain?

Answer 9

Gold standard unless patient cant have them (pacemaker etc). Generally better at imagign soft tissues than plain films

Question 10

What are the cons of using MRIs while imaging back pain

Answer 10

X-rays as an alternative to MRIs decreases hospital referrals and expenditure on other tests, and also takes upm less time of patient.

Question 11

How are the majority of LBP cases treated

Answer 11

With conservative treatment, no imaging needed.

Question 12

When is imaging required regarding LBP

Answer 12

when sinister pathology is to be excluded (malignancy, infection, vertebral collapse)

> 6/52 persistent low back pain, usually plain film first

Question 13

What conditions are closely linked to collapsed vertebral bodies?

Answer 13

Osteoporosis, osteolytic metastases, multiple myeloma, vertebral haemangioma

Question 14

What is a vertebroplasty

Answer 14

Injection of PMMA cement into a collapsed vertebral body.

Question 15

WHat is a kyphoplasty?

Answer 15

Balloon tamp creates a cavity in vertebral body to restore it to original height

Question 16

What is ablation therapy

Answer 16

a minimally invasive procedure that uses electrical energy and heat to destroy cancer cells. The radiologist uses imaging tests to guide a thin needle through the skin or through an incision and into the cancer tissue.

Question 17

When are malignant tumour ablations performed

Answer 17

Inoperable primary bone tumours, myeloma or metastases as a palliative care procedure

Question 18

How are facet joints treated to ease pain

Answer 18

Injected by pain anaesthetisy, can be done by flouroscopy (continuous x-ray) or guided by CT.