Spine imaging Flashcards
what are the Canadian C-Spine Rules?
can rule out by Snout get CT images if >65 yrs dangerous mechanism extremity paraethesia cant rotate 45* Dont if simple rear end sittin gin ER ambulatory at any time delayed pn onset no TTP at midline
Canadian C-Spine Rule sensitive or specific ?
very sensitive
what do C-Spine plain films include?
AP
- Lateral
- Oblique
- odontiod
- Swimmer
what can you see in a AP view of a cervical x ray
- Lower 5 cervical vertebral bodies
- Upper 2-3 thoracic vertebral bodies
- Interpediculate spaces
- Intervertebral disc spaces
- Superimposed transverse processes and articular pillars
- Spinous processes
what could possibly be seen on a AP view of the neck?
- Fractures:
- Vertebral bodies C3-C7
- IVD space abnormalities
- Uncovertebral joint abnormalities
what can you see in a lateral view of a cervical x ray
dens @ C2
posterior arch of C1
•Cervical vertebral bodies and interspaces
•Articular pillars
•Lower 5 facet joints
•Spinous processes
•C7-T2 may be visualized with enough shoulder depression
- ZPJ joints seen below each transverse foramina
what could possibly be seen on a lateral view of the neck?
•Occipito-cervical dislocation
- Fractures:
- Anterior and posterior arches of C1
- Odontoid process
- Vertebral bodies of C2-7
- Spinous processes
- Hangman’s fracture
- Burst fracture
- Teardrop fracture
- Clay-shoveler’s fracture
- Compression fracture
- Unilateral and bilateral locked facets
- IVD space and Atlanto-odontoid space abnormalities
what specialized stx does the oblique cervical view offer? what can you see
- Special cervical views to compare IV foramina
- pt is postioned 45* angle
- pedicles, IV formaina and VB can be seen
what could possibly be seen on a oblique view of the neck?
•Intervertebral (neural) foramina abnormalities
like spondy lysis/thesis
•Apophysial joint abnormalities
what can you see in a open mouth view of a cervical x ray ? what special view does it offer?
•Special cervical view to assess atlas and axis
what could possibly be seen on a open mouth view of the neck?
- Fractures:•Lateral masses of C1
- Odontoid process
- Vertebral body of C2
- Jefferson fracture
- Atlantoaxial joint abnormalities
what special view does a Swimmer’s Projection offer?
•Special cervical view used when shoulder superimposition obscures C7 on a lateral view
what could possibly be seen on a swimmers view of the neck?
•Lateral projection of Cervicothoracic vertebrae (C7-T2) between the shoulders
- Demonstrates:
- Fractures of C7, T1, and T2
which lines can be seen in a lateral view of the neck?
- Anterior line (anterior to VB)
- posterior line (posteriro to VB)
- Spinolaminal line (posterior to laminae and before SP)
- Spinous Processes
Hangmans Fx
Fx of posterior aspects of C2
-MOA hyperextension and distraction injury
Clay shovelers fx
Fx of the spinous process of C6, C7, T1 or T2.
-MOA powerful flexion injury, or MVA
Jefferson Fx
burst fx of C1
MOI: blow to vertex of head causign c1 to shatter in bilateral, symytrical way of the past/ant arches and ligament disruption
Tear drop Fx
avulsion of anterior vertebral body with posterior subluxation into SC
•Most severe and most unstable cervical injury
- different from hang mans bc tear drop displaces post andhang mans is anterior displacement
Odontoid fxs
Fx of odontoid process of C2
•MOI: typically hyperflexion injuries and high impact
what can be seen in a whiplash injury
anterolisthesis seen in mid c-spine
-main point: loss of lordosis 2/2 mus spasm
George’s line
.
Chance fxs
- Flexion distraction injury (L1-L2)
- AKA/ Seat belt fracture
- Usually occur in rear seat passengers with lap belts. •Horizontal fracture with splitting of the spinous process, lamina, pedicles, and vertebral body in 1/2 top/bottom
- Up to 50% have associated blunt trauma injuries (bowel, pancreas, kidney, liver )
- CT more sensitive than X-ray
Most common sites of spinal fractures are
C1-C2, C5-C7 and T9-L2
mostly 2/2 MVA
What is the Odontoid Fracture Classification?
type 1: Stable Fx of upper part of odontoid
type 2: Unstable Transverse fx through the odontoid base
Type 3: stable Transverse fx through the odontoid base
What is cosidered a degenerative change?
- Decreased disk space
- sclerosis
- spurring of the margins
- oblique plain film can often show narrowing of the foramina.
- disc protrusion
- MRI is indicated for evaluation of a suspected herniated disk or neuological deficit
what is considered normal on a T1 MRI
- High signal bodies
- Low signal cortical bone
- Intervertebral disks; well seen
- Spinal cord; grey
- CSF;dark signal
What is normal on T2 MRI
Low signal bodies •Low signal cortical bone •Intervertebral disks-dark •Spinal cord- light grey •CSF -light
what could be MRI finding of disk pathology?
- Decrease hydration & proteoglycan content, increased collagen & fibrosis = decreased T2 signal and disk height.
•Annular tears = focal increase T2 and diffuse disk bulge.
•Nuclear herniation
what are 6 different types of Disc Nomenclature
- normal disc
- diffuse bulge: > 50% circumference
- broad based protrusion- 20-50% circumference
- focal protrusion <25%circumference
- extrusion border of bulge is larger than popout point
- sequestration
what is the Cervical Myelopathy CPR?
3 or more= very likely 99% specific but with 1/5 present very unlikely to be present
- gait deviation
- hoffman
- inverted supinator
- babinski
- > 45
what is the Cervical Myelopathy CPR?
3 or more= very likely 99% specific but with 1/5 present very unlikely to be present
- gait deviation
- hoffman
- inverted supinator
- babinski
- > 45
what does a Thoracic Spine Typical plain film series include
AP and Lateral views
why should the swimmer view be used to see the t-spine? is it standard
he upper thoracic vertebrae are often difficult to see on the lateral view due to the shoulders.
- not standard
What is normal on a AP tspine view ?
•Block head •head is body •eyes are pedicles •nose is spinous process •ears are trans process •Disk space• Vertebral body irregularity (4) •Compression fracture•Schmoral nodes•Osteoporosis•Osteophytes
what is the “winking owl sign” ?
•Pedicle irregularity•Should be 2. If only 1 called the “winking owl sign”.
-Metastatic disease selectively attacks pedicle and will cause anterior and posterior body fracture.
When the t-spine has undergone trauma and has imaging, what shoud you look for?
•Usually the result of an MVA or osteoporosis.
•The AP view should be evaluated for alignment a
- lateral view evaluated for subluxation (anterior or posteriro lysthesis)
•Hyperflexion injuries can result in compression burst fractures with bony fragments projecting into the spinal canal.
•Compression fractures of the middle and lower thoracic spine are common due to osteoporosis.
what are the Three most common degenerative changes in the thoracic spine:
- spurs
- Calcification of the anterior spinal ligament
- Calcification of an intervertebral disk
are Plain X-rays recommended for routine evaluation of acute LBP
no
Plain X-rays are not recommended for routine evaluation of acute LBP within the first month of symptoms unless any of the following red flags are present:
•Recent significant trauma (any age)
•Recent mild trauma (age 50 or greater)
•over 70
•History of prolonged steroid use or osteoporosis
when can chronic lower back conditions by diagnosed ?
beyond four to six weeks of conservative intervention can be diagnosed with X-rays, bone scans, or laboratory findings
are routine use of oblique views recomended?
no, is not recommended due to increased radiation exposure
- is warrented for a spondylolisthesis or spondylolysis suspicion.
- AP and lateral plain X-ray views may be ordered.
When should a bone scan of the l-spine be ordered ?
•Bone scan can detect physiologic reactions to suspected spinal tumor, infection, or occult fracture.
Typical plain films series include
- AP
- Lateral
- Oblique
- L5-S1
what is Napoleon’s Hat sign?
•Spondylolisthesis (inverted Napoleon’s Hat sign in AP view
in which view of the lumbar spine can you see the scottie dog?
-Oblique L-Spine Projection
-•Lumbar vertebral bodies and interspaces
•Articular processes on side closest to table
•Zygapophysial joints on side closest to table•“Scottie Dog”
what conditions can you see on a Oblique L-Spine Projection
- Articular process / facet abnormalities
- Pars interarticularis abnormalities
- Scottie Dog configuration
- Spondylolysis
what can be ID’s in each column of the t-spine?
- Anterior:
- Ant 2/3 vertebral bodies and Annulus Fibrosis , ALL
- Usually stable
- Middle:
- Post 1/3 vertebral bodies and AF, PLL
- Potentially unstable
- Posterior:
- Post arch, facet joint and capsule, post ligament complex, and Lig Flavum
- Unstable
The most common fractures of the lumbar spine are
Wedge compression fractures
•Compression burst fractures with fragments that are retropulsed
-•Fracture of the pars interarticularis (spondylolysis) which if bilateral may cause a subluxation of the vertebral body (spondylolisthesis)
what is a Wedge Compression Fracture
•Failure of anterior column under compression force
- AP view:
- Buckling of lateral cortices
- Decreased body height
- Lateral view:
- Decrease anterior body height
- Posterior body height maintained
what is a Wedge Compression Burst Fracture ?
- Failure of anterior and middle columns due to axial compression forces
- AP view:•Vertical laminar fracture•Increase distance between pedicles•Splaying of posterior facet joints
- Lateral view:•Decreased anterior and posterior body height•Comminution of vertebral body•Fragments may be retropulsed into spinal canal
a Spinous process sign or Step-off deformity is sue to what anatomic defect?
loss of ant/post elements and a fx of the pars inticularis and level slip off
what are indicators of LBP infmalation or Ankylosing Spondylitis AS
- Am stiffness > 30 mins improved with exercise and activity
- not better with rest
-night pain
-alternating but pain
-pain lasting >3 months
increased sus is young adn fam hx, psorisis - will appear glasslike and flattened curve
when do Plain films show osteopenia
until bone loss is more than 30%.
what can 1 year of chronic steroid use do to the spine?
Osteoporosis
what can 1 year of chronic steroid use do to the spine?
Osteoporosis
is MRI more sensitive and specific than other imaging tests for detecting infections or malignancies causing back pain?
yes
when would a ct or MRI be done for the spine?
CT or MRI:
•considered for sciatica or symptoms of spinal stenosis not improved in 6 weeks
•equally accurate for diagnosing herniated discs or spinal stenosis.
•done immediately (with surgical evaluation) in patients with symptoms of the cauda equina syndrome.
when do spinal infections occur and who is at risk?
- diabetic or post-operative patients, IV drug abusers
- Appears as a destructive process that involves or crosses a disk space.
- compared to a tumor which does not involve the disk space.
- MRI preferred over a CT scan if possible. Indicated if localized pain, elevated ESR, fever, elevated WBC’s, or + blood culture.
what is the most Most common neoplasm found in the spine?
Most common neoplasm in the spine is metastatic disease from cancer somewhere else in the body.
The best study to look for bone metastases is a
bone scan.
•Indications for a bone scan:
•Initial staging of lung, breast or prostate CA
•Bone pain
•Elevated alkaline phosphatate
•To evaluate the response to chemotherapy
The best study to look for bone metastases is a
bone scan.
•Indications for a bone scan:
•Initial staging of lung, breast or prostate CA
•Bone pain
•Elevated alkaline phosphatate
•To evaluate the response to chemotherapy
