Spine Flashcards
What are the NICE guidelines for assessing for T/L spinal injury?
Risk factors:
- 65 or older with T/L pain
- dangerous mechanism of injury (fall greater than 3m or axial load to head or base of spine [falls landing on feet/buttocks, lap belt restraint, horse riding, high speed collision, bicycle collision)
- pre-existing spinal pathology or known risk of OP (e.g. Steroid use) –> look for in stem
- suspected spinal fracture elsewhere in spine
- abnormal neurological symptoms
O/E:
- midline bony tenderness on percussion
- new deformity
- midline bony tenderness on palpating
- midline spinal pain coughing
- abnormal neurological signs
What is the additional view used in T/L spine XRs? What is it good for?
Oblique view
Shows Scotty dog! Good for assessing of fracture of pars interarticularis
What are the NICE guidelines for CT/MRI imaging the spine?
1: perform CT in 16+ if:
- Canadian C spine indicates imaging
- OR there is strong suspicion of T/L injury
- OR perform MRI if neurological abnormalities can be attributable to spinal cord injury
2: suspected T/L column injury only (children and adults):
- perform XR w/ suspected T1-L3 column injury W/OUT neuro signs
- perform CT if XR abnormal or are clinical signs of spinal column injury
- if confirmed spinal column fracture –> image rest of spine
3: whole body CT in adults with MAJOR BLUNT TRAUMA and suspected multiple injuries
What is phase in MRI?
When the RF pulse is applied it causes the H nuclei have synchronised spinning
What is T1 MRI a measure of?
How quickly H nuclei relax after the RF pulse is applied
What is T2 MRI a measure of?
It represents H nuclei desynchronisation after RF pulse is removed
What are the 2 indications for imaging the T/L spine?
- Suspected/rule out fracture (assess using NICE)
2. Atraumatic back pain - rule out bony pathology
How can you manipulate MRI images?
Proton density
Fat suppression
STIR (short-tau inversion recovery)
FLAIR –> suppresses CSF (SAH)
