spine Flashcards
which muscle attaches to the ASIS
sartorius muscle
which muscle attaches to AIIS
rectus femoris
what is shenton’s line
runs anatomically along the medial edge of the femoral neck and the inferior edge of the superior pubic ramus
interruption of shenton’s line may suggest a NOF fracture in adults or DDH in children
type of stable fractures
iliac wing fracture
sacrum fracture
superior and inferior pubic ramus fractures
type of unstable fracture
lateral compression fracture with the pelvis pushed inward
anterior-posterior compression fracture
vertical shear fracture with one half of the pelvis shifted upward
normal SI joint anatomy
width approx equal
inferior margin of iliac bone lines up with the inferior aspect of sacral part of the joint on both sides
normal SP anatomy
no widening (<5mm)
superior margins at about the same level
types of intra-capsular fractures
located at the NOF
- subcapital
- transcervical
- basicervical
type of extra capsular fractures
located below the intertrochanteric line
- intertrochanteric
- subtrochanteric
cervical spine AP peg view checklist
- alignment of the lateral margins of C1 with the adjacent lateral margins of C2
- equal spaces on each side of the peg
- any fracture line across base of the peg
common conditions and injuries of the lumbar spine
spondylolisthesis
spondylosis
spondylolysis
ankylosing spondylitis
wedge fracture
burst fracture
chance fracture
spinal metastases
what does the anterior column of spine consist of
- anterior longitudinal ligament
- anterior annulus fibrosis
- anterior 2/3 vertebral body
what does the middle column of spine consist of
- posterior longitudinal ligament
- posterior annulus fibrosus
- posterior 1/3 vertebral body
what does the posterior column of spine consist of
posterior elements
- pedicles, facets
- lamina
- spinous process
posterior ligaments
what is considered stable spinal fracture
affects one column only
what is considered unstable fracture
affect 2 or more columns
what is spondylolisthesis
displacement of vertebra over another
caused by trauma, natural degenerative changes (spondylosis))
grading
- grade I: displacement up to 25%
- grade II: 25-50%
- grade III: 50-75%
- grade IV: 75-100%
what is spondylolysis
- fracture of the pars interarticularis
- most common in lower lumbar vertebrae
- may develop spondylolisthesis
what is spondylosis
osteoarthritis of spine
narrowing of the intervertebral disc space
osteophytes
intervertebral foramina stenosis
what is ankylosing spondylitis
form of arthritis which causes inflammation of the spine
calcification of anterior and posterior longitudinal ligaments and intervertebral discs
fusion of spine
what is spine metastases
spread of malignant cancer cells to the spine
lytic or sclerotic lesion
“winking owl sign”
- destruction of the pedicles
at what age do ASIS apophysis appear and fuse to skeleton
appear: 13-15
fuse: 21-25
at what age do AIIS apophysis appear and fuse to skeleton
appear: 13-15
fuse: 16-18
at what age do iliac crest apophysis appear and fuse to skeleton
appear: 13-15
fuse: 21-25
at what age do ischial tuberosity apophysis appear and fuse to skeleton
appear: 13-15
fuse: 20-25
at what age do greater trochanter apophysis appear and fuse to skeleton
appear: 2-3
fuse: 16-17
at what age do lesser trochanter apophysis appear and fuse to skeleton
appear: 11-12
fuse: 16-17
difference between male and female pelvis
male:
narrower and less flared
oval or heart shaped
angle of pubis arch is <90deg
female:
broader
has round pelvic inlet
angle of pubic arch is >90deg
what landmarks can be seen in a judet’s view
ilioischial line (posterior column)
anterior acetabular wall
roof of acetabulum
iliac crest
what landmarks can be seen in an obturator oblique view
iliopectinal line
posterior acetabuluar wall
roof of acetabulum
obturator foramen
what are the blood supplies to the capsule of femur
deep femoral artery –> medial and lateral circumflex femoral artery
risk factors of pelvic injuries
osteoporosis
ageing
excessive alcohol consumption
physical inactivity
visual impairment
female
causes of fractures of pelvis
high energy trauma
bone insufficiency
avulsion fracture
how should the assessment of AP pelvis be
- scrutinise both the inner and outer contours of the main pelvic ring
- two small rings forming the obturator foramina
- widths of SI joints should be equal
- superior surfaces of the body of each pubic bone should align; width should not exceed 5mm
- sacral foramina and arcuate lines should have smooth surface
- region of acetabulum
- check apophyses in adolescents and young adults
pitfall of acetabulum
Os acetabuli
- small bone ossicle at the superior margin of the acetabular rim is a common finding
- represents either unfused ossification centre or an impingement effect from a longstanding injury
how to assess a lateral cervical spine
- technical quality - include C1-7
- C1 to C2 articulation
- superior surface of T1 - identify the anterior arch of C1
- position of anterior cortex of odontoid and the coffee bean
- alignment of
- anterior cortex of peg with anterior cortex of C2
- posterior cortex of peg with posterior cortex of C2 - normal
- Harris’ ring
- posterior arches of C1 and C2
- C3 to C7
- 3 main contour lines
- pre-vertebral soft tissues
how to assess AP thoracic and lumbar spines
- alignment of vertebral bodies and spinous process
- check for loss of vertebral height
- check the vertebral disc spaces
- check the vertebral end plates
- trace the posterior elements
- pedicles
- laminae
- spinous processes - ensure the vertebral and spinous processes are intact
- no visible paraspinal line
- check for fracture of transverse process
what is the width of pre-vertebral soft tissue in the cervical
C1-4 = 7mm
C5-7 = 22mm
any bulge or local increase in width suggest of haemorrhage
what is the normal measurement of the alantodental interval
<3mm un adults
<5mm in children
how does normal C3 to C7 look like
- fairly uniform in square or rectangle shape
- anterior and posterior vertebral body should be about the same height
how does a normal harris ring look like
appears slightly incomplete at its inferior and superior aspects
disruption in anterior or posterior ring is suggestive of either fracture of the base of peg or C2 body fracture
how to assess AP cervical spine
alignment of lateral margins of C1 with adjacent lateral margins of C2
equal spaces on each side of the peg
check for any fracture line across the base of peg
alignment of spinous process should lie mid-line and have equal amount of space between
the lateral masses of the vertebra should be aligned smoothly
how to assess lateral lumbar and thoracic spine
- height of vertebral body
- check 3 columns
- fragment of bone detached from the anterior aspect of a vertebral body
- check for more abnormalities
3 main contour lines to assess lateral cervical xray
anterior vertebral line
posterior vertebral line
spinolaminar line
(extra: posterior spinous line)
