Spine Flashcards
Solitary collapsed vertebra
- Osteoporosis
- Neoplastic disease
- metastases (breast, lung, prostate, RCC, thyroid)
- multiple myeloma/plasmacytoma - Infection (spondylodiscitis and osteomyelitis)
- LCH (vertebra plana in childhood)
5.Paget’s disease - Benign tumors of spine (hemangioma, GCT/ABC)
Multiple collapsed vertebrae
- Osteoporosis
- Neoplastic disease: mets, MM, leukemia/lymphoma
- Trauma
- Infection
- Scheuermann’s disease
- LCH
- Sickle cell anaemia (H-shaped)
Erosion/destruction or absence of a pedicle
- Metastasis.
- Multiple myeloma*.
- Neurofibroma
- TB – uncommonly. With a large paravertebral abscess.
- Benign bone tumour – aneurysmal bone cyst or giant cell
tumour. - Congenital absence – ± sclerosis of the contralateral pedicle.
Enlarged vertebral body
Generalized:
1. Gigantism.
2. Acromegaly*.
Local (single or multiple):
1. Paget’s disease.
2. Benign bone tumour
(a) Aneurysmal bone cyst – typically purely lytic and expansile. Involves the anterior and posterior elements more commonly than the anterior or posterior elements alone. Rapid growth ± fluid–fluid levels.
(b) Haemangioma* – with a prominent vertical trabecular pattern.
(c) Giant cell tumour* – involvement of the body alone is most common. Expansion is minimal.
3. Hydatid – over 40% of cases of hydatid disease in bone occur in vertebrae
Squaring of one or more vertebral bodies
- Ankylosing spondylitis*.
- Paget’s disease*.
- Psoriatic arthropathy*.
- Reiter’s syndrome*.
- Rheumatoid arthritis*.
Squaring of one or more vertebral bodies
- Ankylosing spondylitis*.
- Paget’s disease*.
- Psoriatic arthropathy*.
- Reiter’s syndrome*.
- Rheumatoid arthritis*.
IVORY VERTEBRAL BODY (single or multiple very dense vertebrae)
- Metastases.
- Paget’s disease*.
- Lymphoma* – more frequent in Hodgkin’s disease than the other
reticuloses. - Low-grade infection.
- Haemangioma.
Atlantoaxial subluxation
Trauma arthritides
1. Rheumatoid arthritis* – in 20–25% of patients with severe
disease. Associated erosion of the odontoid may be severe enough to reduce it to a small spicule of bone.
2. Psoriatic arthropathy* – in 45% of patients with spondylitis.
3. Juvenile idiopathic arthritis* – most commonly in seropositive juvenile onset adult rheumatoid arthritis.
4. Systemic lupus erythematosus.
5. Ankylosing spondylitis – in 2% of cases. Usually a late feature.
Congenital:
1. Down’s syndrome* – in 20% of cases. ± Odontoid hypoplasia. May, rarely, have atlanto-occipital instability.
2. Other skeletal dysplasias
Infection:
Retropharyngeal abscess in a child.
Intervertebral disc calcification
- Degenerative spondylosis – in the nucleus pulposus. Usually confined to the dorsal region.
- Alkaptonuria*.
- Calcium pyrophosphate dihydrate deposition disease*.
- Ankylosing spondylitis*.
- Juvenile idiopathic arthritis*.
- Haemochromatosis*.
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Gout*.
- Idiopathic
- Following spinal fusion.
Posterior scalloping of vertebral bodies
- Spinal canal tumors (ependymomas, dermoid, lipoma, neurofibroma, meningioma, )
- Dural ectasia of Neurofibromatosis, multiple lateral meningoceles can enlarge the intervertebral foramina
- Acromegaly
- syringomyelia
- Achondroplasia and skeletal displasias
- Dural ectasia from Ehlers Danlos or Marfan’s
Anterior scalloping of vertebral bodies
- Aortic aneurysm – intervertebral discs
remain intact. Well-defined anterior
vertebral margin. ± Calcification in the
wall of the aorta. - Tuberculous spondylitis – with
marginal erosions of the affected
vertebral bodies. Disc-space
destruction. Widening of the
paraspinal soft tissues. - Lymphadenopathy – pressure
resorption of bone results in a welldefined
anterior vertebral body margin
unless there is malignant infiltration of
the bone. - Delayed motor development – e.g.
Down’s syndrome.
Extradural spinal masses
- Prolapsed or sequestrated intervertebral disc
- Metastases, myeloma and lymphoma deposits – common; look for associated vertebral infiltration. Most common sites of primary tumours are prostate, breast and lung. Thoracic spine is the most common site affected.
- Neurofibroma – solitary, or multiple in neurofibromatosis. Lateral indentation of theca at the level of the intervertebral foramen.
- Neuroblastoma and ganglioneuroma – tumours of childhood arising in adrenal or sympathetic chain, close to spine: direct invasion of spinal canal may occur.
- Meningioma – may be extradural, but most are largely intradural
- Haematoma – may be due to trauma, dural AVM, anticoagulant therapy. Long-segment extradural mass on
MRI, which may show signal characteristics of blood. - Abscess.
Intradural extramedullary spinal masses
- Meningioma – as above commonly thoracic, mainly in middleaged females. Occasional calcification.
- Schwanomma / Neurofibroma – usually extradural, but intradural neurofibromas occur, especially in cauda equina.
- Metastases – from remote primary tumours, or due to CSF seeding in CNS tumours, e.g. pineal tumours, ependymoma, medulloblastoma and PNET.
- Lymphoma may also occur intradurally, particularly in lumbosacral canal.
- Subdural empyema.
Intramedullary spinal masses
Bilateral symmetrical sacroilitis
Bilateral symmetrical
1. Ankylosing spondylitis*
2. Inflammatory bowel disease – ulcerative colitis, Crohn’s disease and Whipple’s disease. Identical appearances to ankylosing spondylitis.
3. Psoriatic arthropathy* – ankylosis is less frequent than in
ankylosing spondylitis. Occurs in 30–50% of patients with
arthropathy. Less commonly is asymmetrical or unilateral.
4. Osteitis condensans ilii
5. Hyperparathyroidism*
6. Paraplegia
Bilateral asymmetrical sacroilitis
- Reiter’s syndrome*.
- Psoriatic arthropathy* – this pattern in 40% of cases.
- Rheumatoid arthritis* – rare. Minimal sclerosis and no significant bony ankylosis.
- Gouty arthritis (see Gout*) – large well-defined erosions with surrounding sclerosis.
- Osteoarthritis – the articular margins are smooth and well defined. Joint-space narrowing, subchondral sclerosis and anterior osteophytes are observed.
UNILATERAL SACROILITIS: INFECTION
