Spine imaging Flashcards
what test for suspected vertebral fracture from trauma?
Ct w/o contrast
which imaging:
Chronic back pain, degenerative changes, radiculopathy
MRI w/o contrast
test alternatives if MRI is contraindicated
CT wo contrast or CT myelogram (contrast put into CSF)
which imaging:
Mass/tumor
Infection (discitis—disc space, spinal abscess, osteomyelitis of vertebrae)
MRI w/ and w/o contrast
which imaging: trauma with possible spinal cord injury
MRI
which imaging: Bulging/herniated discs Spinal cord impingement Spinal cord injury/edema/compression Tumor/masses Infection of the spine or spinal cord
MRI
3 xray views to order for cervical spine
AP, lateral, odontoid
what are the 4 lines on a cervical lateral xray?
anterior vert, post vert, spino-laminar, post spinous
what is the most important line on a lateral cervical xray?
posterior vertebral line
Burst fracture of the atlas. Causes widening of C1 odontoid space bc atlas burst apart. Dens more mobile.
Jefferson fracture
high risk complications from jefferson fracture
HIGH RISK for vertebral artery injury, extracranial nerve injury
Severe axial/flexion injury of the cervical spine
Diving or deceleration injury
Often associated with rupture of anterior longitudinal ligament
“Teardrop sign” on xray
Displaced triangular bone fragment
flexion teardrop fracture
what sign: Destruction of lumbar pedicle due to malignancy or bony oncologic dz
winking owl sign
3 lumbar lines from lateral xray and contents
Anterior column Anterior longitudinal ligament Anterior 2/3 vertebral body Anterior 2/3 of intervertebral disc Middle column Posterior 1/3 vertebral body Posterior 1/3 intervertebral disc Posterior Longitudinal ligament Posterior column Pedicles Facet joints and articular processes Ligamentum flavum Neural arch and connecting ligaments
unstable lumbar fracture involves ___ columns
2-3
do compression fracutres disrupt the curves or 3 columns?
no
3 most common vert for compression fractures
T12, L1, L2
Stress fracture through the pars interarticularis
Fracture of L5 most common
spondylolysis
scottie dog sign indicates what
spondylolysis
Bilateral pars fractures + slipping forward
Spondylolisthesis
Fracture of BILATERAL interarticularis of C2
hangman’s fracture
red flags for lower back pain
Trauma
Cauda Equina Syndrome (Urinary retention leading to incontinence, fecal incontinence, saddle anesthesia (lack of sensation in perineum))-Get urgent MRI
Neurologic deficits
Hx of Malignancy + new back pain
Fever (infx)
Immunosuppression (higher risk of infx)
IV drug use (think infx; higher risk for S aureus / MRSA)
Surgery or procedures + new/worsening back pain
preferred imaging for lower back pain w/ hx of steroid use
lateral spinal xray
preferred imaging for LBP: failed conservative treatment
MRI w/o contrast
preferred imaging for LBP: neurologic symptoms
MRI lumbar spine w/o contrast
preferred imaging for LBP: Cancer, infection or immunosuppresion
MRI spine w/ and w/o contrast
nexus criteria is for what?
cervical spine trauma. No imaging needed if all criteria are negative
