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Applied Radiographic Pathology 2 > Spine Pathologies > Flashcards

Spine Pathologies Flashcards

1
Q

What are the pathologies of the spine?

A

Prolapsed inter-vertebral disc (PID)
Degenerative disc disease (DlD)
Spinal stenosis
Tumour /metastases
Infections
Multiple sclerosis (MS)
Spina bifida
Osteopenia/ Osteoporosis

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2
Q

What does the cause and level of the injury / pathology have an impact on?

A

Pain (localised /neurological Pathway)
Neurological symptoms e.g. numbness, bturning, pins/ needles
Mechanical symptoms, function/ dysfunction

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3
Q

What are the vertebral levels?

A

Cervical : C1-C7
Thoracic: T1- T12
Lumbar: L1- L5
Sacral: S1-S5

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4
Q

What are the spinal nerve root functions upon rest and digest ?

A

The vagal nerve is stimulated this is called parasympathetic

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5
Q

What are the spinal nerve root functions upon fight on flight?

A

The vagal nerve is inhabited this is called Sympathetic

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6
Q

What are some Sympathetic nerve root functions?

A

Pupil dialates
Bronchi relaxes
Heart accelerates
Stimulates glucose release by liver

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7
Q

What are some Parasympathetic nerve root function?

A

Pupil constricts
Bronchi constricts
Stimulates gallbladder
Relaxes rectum

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8
Q

What is prolapsed Intervertebral Disc (PID)?

A

Herniation of the nucleus Pulpous within the annulus fibrosus causing Protrusion of the annulus fibrosus into the neural canal

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9
Q

What is the most common cause of spinal Cord and/ or nerve root compression?

A

Prolapsed intervertebral Disc (PID)

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10
Q

Where is PlD most common in?

A

Lumbar region especially between L2-S1 and therefore affects nerve roots only
If cervical or thoracic, spinal cord may also be compressed

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11
Q

What Part of the vertebra is the Annulus fibrous and NucIeus Pulposus?

A

The nucleus pulposus is the center and the Annulus fibrous is the outer part

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12
Q

What are the characterisation of a disc bulge?

A

Asymmetric Bulging
Diffuse Bulging

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13
Q

What are the characteristics of a Disc Herniation?

A

Protrusion- Annulus fibrosus is still wide at the sides of the protrusion
Extrusion - Annulus fibrosus is tight at the sides of the protrusion

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14
Q

How likely is a PID to occur?

A

May occur acutely (suddenly) at any age during strtenuous exercise or exertion
Can also occur progressively in older people with bone disease or disc degeneration /dehydration leads to rupture during minimal exercise

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15
Q

What does a PID hernia cause?

A

It may be one-sided causing Pressure/ damage to nerve root, or midline- compressing anterior Spinal artery, the spinal cord and possibly and possibly bilateral nerve roots

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16
Q

What are the different types PID?

A

Median /paramedian
Foraminal
Extra-foraminal

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17
Q

What are the Sign and Symptoms of PID?

A

Depends on the size of hernia and length of time pressure is applied
Small herniations cause local pain, due to pressure on nerve endings
Large herniations

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18
Q

What does small and large herniations cause?

A

Small herniations - cause local pain, due to pressure on nerve endings
Large herniations - Unilateral/ bilateral paralysis
- Acute or chronic Pain in the area supplied by the compressed sensory nerve (Leg or foot)
- Local muscle spasm, due to pressure on motor nerves
- Ischaemia and possibly necrosis of the cord, If the spinal artery is compressed

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19
Q

What is the relationship between Aging and degeneration?

A

Older patients often present with more Chronic or recurrent symptoms of degenerative spinal disease

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20
Q

What are the different types of degeneration?

A

Progressive narrowing of the spinal canal may occur alone or in combination with either gradual disc dehydration or acute disc herniations
Congenital and acquired spinal stenoses place the patient at a greater risk for acute neurologic injury

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21
Q

What is Degenerative Disc Disease (DDD)?

A

Degenerative Disc Disease is one of the most common causes of low back pain
The disc basically degenerates losing water and changing it’s Composition of proteins which causes the disc to be less ‘spongy’ and so it cannot act as a shock absorber

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22
Q

What develops when people reach their 6th decade?

A

They develop tears in the annulus fibrosis

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23
Q

What signs and symptoms and factors of DDD ?

A

Common LBP (not all will have it)
Typically associated with aging
During the aging process, intervertebral discs, like other joints in the body, can degenerate and become problematic - 1a natural process, as the body deals with years of strain overuse and maybe even misuse
Can be hereditary
Sedentary lifestyle
Obesity

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24
Q

What is the disease process of DDD?

A

Process means discs lose flexibility, elasticity, and shock absorbing characteristics
Disc becomes dehydrated and less ‘spongy’
This sees them change from a supple state that allows fluid movement to a stiff and rigid state that restricts movement and causes pain
Because of disc changes, the vertebrae can be affected, example - formation of osteophytes due to increased friction as the spine tries to adjust to the intervertebral disc changes
Discs become thinner as they dehydrate, resulting in Joint space narrowing
Common in lumbar and cervical spine
C. spine incidence: C5-6 most common then C6-7 then C4-5
Very rare in thoracic spine
About 90% of all lumbar disc herniations occur at the L4-5 and L5-S1 levels
Nearly all are inside the spinal canal

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25
Q

How to comment on a DDD image.

A

T2-weighted MRI Sagittal Lumbar spine
Discs at L3/4 and L4 /5 are dehydrated and narrowed
These discs are also protruding Posteriorly into the spinal canal
Loss of alignment of the L spine posteriorly at L4/5 (L5 is slipped forward)
The discs are pressing into the spinal cord

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26
Q

What is spinal stenosis?

A

Narrowing of the spinal canal resulting in compression of the spinal cord and nerves usally due to te common occurrence of spinal degeneration that occurs with aging
Can be developmental or familial
Can also be caused by disc herniation, Osteoporosis, bone disease (e.g paget’s) or a tumour

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27
Q

What some causes of spinal stenosis?

A

Can be caused by disc herniation, Osteoporosis, bone disease (e.g paget’s) or a tumour
May affect the cervical, thoracic or lumbar spine

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28
Q

What are some results of lumbar stenosis?

A

Low back Pain
Pain or abnormal sensations in the legs, thighs, feet or buttocks, or loss of bladder and bowel Control

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29
Q

What are extradural tumours?

A

They are the most common spinal tumours and are usually of metastatic origin

30
Q

What are the most common kind of intramedullary tumour?

A

Ependynomas

31
Q

Where does Intradural tumors originate?

A

They arise from the epandyma, a tissue of the central nervous system

32
Q

Where is the most common place for an Intradural tumour to form?

A

They are most common in the Intracranial for peads, while in adults it is spinal

33
Q

What is the responsible for the 40-60% of all intramedullary spinal tumours?

A

Ependynomas - with an average age of presentation being 35-40 years

34
Q

Where does most Meningioma occur in?

A

In the brain with about 12% located in the spine

35
Q

What is a meningioma?

A

Second most common tumour in the intradural- extramedullary location
Meningiomas account for approximately 25% of all spinal tumours

36
Q

Are most intradural spinal tumors benign or malignant?

A

They are benign and potentially resectable
The Prognosis after surgical resection is excellent

37
Q

What are the % associated with each location of a meningioma?

A

Approximately 80% are located in the thoracic spine, followed by Cervical spine (15%), Iumbor spine (3%), and the foramen magnum (2%)

38
Q

What is a syrinx?

A

A fluid- filled cavity that develops in the spinal cord - Syningomyelia
This is a rare condition

39
Q

What is the Prevelance of a syrinx?

A

In about 50%, it is present at birth, and then for poorly understood reasons, It enlarges during teen or young adult years

40
Q

What is likely to happen to children who are born with Syrinx?

A

They also have other structural abnormalities of the brain, spinal cord, or Junction between the skull and spine

41
Q

What are the main causes of syrinxes that are developed later in life?

A

Injuries or tumours

42
Q

What happens to 30% of tumors that originate in the spinal card?

A

The eventually produce a syrinx

43
Q

What are the first thing affected by syrinxes that grow in the spinal card?

A

First affects nerve fibres that carry information about pain and temperature from the body to the brain Then later it affects fibres that carry signals from the brain to stimulate muscle movement

44
Q

What happens to the spinal cord when a syrinx grows from within?

A

The syrinx presses on it from the inside

45
Q

Where in the spinal cord does a syrinx occur?

A

It can occur anywhere along the lengt of the spinal Cord, but they often begin in the neck and may extend downward to affect the entire cord

46
Q

What happens to the syrinx that do not grow inside the spinal cord?

A

Syrinxes that extend into or begin in the lower part of the brain stem may compress Pathways of the spinal cord and cranial nerves (which lead directly from the brain to other parts of the head and neck)

47
Q

How does a syrinx appear on a TI and T2 weighted Images?

A

T1 (with contrast)- Hyperintense
T1- Hypointense
T2 - HyperIntense

48
Q

What are two types of spinal Infections?

A

Discitis - disc space infection
Osteomyelitis - bony origin

49
Q

What is the prevalence and Incidence of spinal infections?

A

1 case per 100,000 -250,000 population
More common in children and middle aged
More common in males than females

50
Q

What are spinal infections?

A

Epidural abscess
Associated fever

51
Q

How does a spinal infection occur?

A

Through a direct infection/ blood route
20-30% caused by remote infection
It can occur anywhere in the spine but more common in the lumbar region

52
Q

Are true primary infections common?

A

No, they are uncommon

53
Q

How an osteomyelitis & discitis pathology described? (Sample answer)

A

Destimation of the 23-4 disk space with the adjacent endplate and for vertebral body
L3 and L4 T2 signal, Indicating oedema and for infarction
Also shown is a retropulsion of debris, which compresses the subdural space and spinal cord

54
Q

What is multiple sclerosis (MS)?

A

It is a Neurological autoimmune Condition with a wide range of Symptoms

55
Q

What is the Aetiology of MS?

A

It is not fully understood - combination of environmental and genetic factors

56
Q

What image modality is the most effective in revealing demyelinationg plaques?

A

MRI as it is the most sensitive diagnostic imaging modality
MRI also shows abnormalities in 95% of Patients with clinically definitive MS

57
Q

What is the % of patients with MS develop spinal lesions at some point as it progresses?

A

55-75%

58
Q

How are MS visualised on an MRI?

A

On unenhanced T1w images, depending on their age, MS plaques may appear as nodules, ring, or arcs and generally are less than 2 vertebral bodies In length

59
Q

What contrast agent is added in an MRI imaging to demonstrate prompt enhancement of plaques?

A

The administration of a gadolinium - based agent which usually indicates active disease
The enhancement may last 2-8 weeks

60
Q

What type of lesions do not demonstrate contrast enhancement?

A

Classic Chronic lesions

61
Q

How is MS visualised on a T2w MRI?

A

Most plaques appear hyperintense on T2w images1

62
Q

In a T2w image why can the spinaI cord may or may not be focally enlarged?

A

Enlargement of the card is usually seen with active disease
Larger active lesions may have extensive oedema with associated cord expansion
Chronic lesions often demonstrate focal cord atrophy

63
Q

What lesions are usually associated with brain lessions?

A

Spinal lesions

64
Q

What is the % of spinal MS lesions that are Isolated?

A

20%

65
Q

What is spinal cord narrowing caused by?

A

Due to atrophic changes that is Present in 10% of patients with spinal cord involvement

66
Q

What is spinal bifida?

A

It is an open defect, neural tube defect
It occurs mostly in the lumbar spine

67
Q

What is a myelomeningocele?

A

It is a cystic Swelling of the dura and arachnoid
It protrudes through the spinal bifida defect in the vertebral arch

68
Q

What happens to the thoracic vertebrae of spina bifida?

A

There is no fusion of the pedicle and the spinous process leaving the foramen exposed

69
Q

What are the risks factors for spina bifida?

A

Lack of folic acid
Family history
Medication
Genetic

70
Q

What are the rates of live births of spina bifida?

A

It varies - 1-5 per 10,000 live births

Applied Radiographic Pathology 2 (7 decks)

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