Spine Flashcards
Modalities for spine imaging.
Plain films
CT
MRI
Myelography
What is when contrast is put in the spinal canal?
CT myelogram
what can happen with neck chiropractic manipulation?
Dissection of vertebral arteries
how many views should you get for trauma?
At least 2 views
For a cervical spine, what spinal levels should you get imaging done to at least
T1
What is the views for cervical spine usually?
cross table lateral to top of T1
AP
open mouth odontoid (C1 and C2)
If you cant see T1 what should you do?
Pull down the shoulder (gently) Swimmers view (have pts arm up so you can see C1 and C2)
A cross tabel lateral x-ray will show how much of cervical spine injuries?
85-90%
In alignment of cervical spine, where does the first line merge?
With the anterior aspect of the peg
In alignment of cervical spine, where does the second line merge?
With the posterior aspect of the peg
What should the distance b/w the anterior arch of C1 and the odontoid peg be in adults?
3 mm in adults
What should the distance b/w the anterior arch of C1 and the odontoid peg be in children?
5 mm in children
What is the name for the ring of C1?
Harris ring
Distances between spinous processes should be what?
Roughly equal
What can mimic a fracture on the base of the peg? (Mach effect)
Incisors
Occiput
Soft tissues
When should you use the swimmer’s view?
when the shoulders limit evaluation of the lower C spine and it’s relationship with T1
What type movement causes a odontoid fracture?
Hyperflexion
What are the 5 unstable fractures?**
Jefferson fracture Hangman’s fracture Flexion teardrop Extension teardrop Bilateral locked facets.
What is an avulsion fracture of spinous process of C6 or C7 called?
Clay Shoveler’s Fracture
How does a clay shoveler’s fracture occur?
Results of rotation of trunk relative to neck
What causes a Jefferson fracture?
Axial loading force on occiput of the head
Ex- diving into a shallow pool
usually not associated w/ neurologic defect
What is a hyperextension injury most common at C2. Not associated w/ neurologic deficit.
Hangmans fracture
What type of liagmentous injury is an unstable fracture?
Locked facets (50% subluxation)
What is a visual sign of a unilateral locked facet?
Spinous processes do not line up on a frontal film
What are the three types of odontoid fractures?
Type 1- Tip
Type 2- waist
Type 3- base
(Type 2 and 3 are unstable)
What causes a flexion teardrop fracture?
Combination of flexion and compression
fragment comes from the anteroinferior aspect of the body
What causes an extension tear drop fracture?
Hyperextension causes a triangular fragment to be avulsed off the antero-inferior corner of the vertebral body
Which teardrop fracture is associated with neurological damage?
flexion- teardrop fracture
When is an injury to the thoracic spine considered unstable?
An injury to the thoracic spine is unstable if two of the three columns are disrupted.
If middle is involved, anterior or posterior often is too
What is a wedge fracture?
Vertebral body that is compressed and looks like a wedge
Where do most wedge fracture occur?
T11, T12, L2
although verbally he said it is more likely L1 and L2
In what type fracture are there Vertebral body explodes outward
Loss of concavity of the posterior vertebral cortex
burst fracture
Is there neurological deficit with a burst fracture?
yes, high probability
What causes chance fracture?
Seat belts w/o shoulder aspect
Horizontal fracture though vertebral body, laminae, pedicles, and spinous process
if you find a fracture in one part of the cervical spine is there a possibility that you could have a second fracture?
yes
These are all things you should look for after what?
Loss of height or wedging
Fragments of bone detached from the anterior Aspect of a vertebral body
More than one abnormality
Posterior cortex should be slightly concave
MVA
What is a procedure that supports a compressed vertebral body?
Vertebroplasty (super glue)
kyphoplasty (balloon)
What is this type of pain: sharp, shooting and confined pain confined to a narrow band. Originates from a irritation of the spinal nerve or its roots.
Radicular
What is a conduction block associated with numbness or weakness in the nerve roots distribution?
randiculopathy
What is this- “deeper and broader with an aching quality. Difficult to localize. Different senory neurons are involved for what ever reason. Use pain diagram?”
referred pain
What is a good imaging place to start with degenerative changes?
X-rays
What is myelography mostly used for now?
Individuals who can’t undergo an MRI
bony things are better seen with what type of imaging technique?
CT
What is your imaging of choice for degenerative changes?
MRI
what is when a “marshmallow is squeezed and pushed out” Annular fibers have gotten lax and the marshmallows expands
Disc bulge
What is when there is a focal part of a disc bulge?
Disc protrusion
What is where the length of the disc material extending beyond its margin is greater than the waist?
Disc extrusion
Do nerve roots like to be touched?
No
What is the name of this syndrome; Bilateral lower extremity symptoms
Pain and/or weakness
Saddle anethesis
Urinary incontinence
Cauda equina syndrome
What may cause cauda equina syndrome?
Disc herniations
What do you do for cauda equina syndrome?
Immediate imaging and treatment!!
Fracture than maybe acute or chronic that extends from the inferior facet across the pars interarticularis to the superior facet
Spondolysis
Forward displacement of the vertebra upon one another.
Spondolisthesis
What improves spinal stenosis?
Flexion, sitting, riding a bike, walking up hill
When is spinal stenosis worse?
Extension
What is the clinical presentation of spinal stenosis?
Back pain and sciatica
Why do you often image a post operative spine?
no relief of symptoms
patient didn’t get the results they expected (not operated at on right level)
Lawsuits
What 4 problems are associated with neurological deficit?
flexion teardrop fracture
locked facets (85% neurologic deficits)
Unilateral locked facets (30% neurologic deficits)
Burst Fracture
What are 2 key things in identifying whiplash?
sprain or intervertebral disk injury WITHOUT fracture/dislocation
Normal curvature reduced/reversed
Is a posterior neural arch fracture more likely to occur bilaterally or unilaterally?
bilaterally
What don’t you do an oblique view for the cervical spine trauma?
because the patient has to turn their head
Whats the main difference between flexion teardrop and extension teardrop?
flexion is associated with neurological deficit (70%) and extension is not
What can a burst fracture sometimes be mistaken for?
anterior wedge fracture
In plain films, what are oblique radiographs good for evaluating?
foraminal stenosis
What imaging technique is good for spinal canal stenosis?
myelography
What are some causes of disc degeneration?
disk space narrowing, dehydration, annular fissures, subchondral marrow changes, osteophyte formation
T/F: Spondolysis never leads to spondylolisthesis.
False: spondolysis may lead to spondylolisthesis