Thoracic and Lumbar Flashcards

Question

What is the Lumbosacral Disc Angle?

Answer 1

Identify presence of disc herniation 2 lines are drawn: 1. Line parallel and through sacral base 2. Line parallel and through L5 inferior endplate Acceptable range for measurement = 10-15° An increase can also indicate a weight bearing shift posteriorly onto the facets, which can lead to additional wear and tear on these joints

Answer 2

Distance between the pedicles on frontal/coronal imaging narrowed widened Useful for assessing spinal canal width > identifying stenosis

Answer 3

What is it? “the fusion of thoracic vertebrae is less common and comparatively rare” failure of separation of 2 or more adjacent vertebral bodies. Sacrum is a normal block vertebra What causes them? Congenital How are they diagnosed? X-ray : combined vertebrae may be of normal height, short, or tall. Partial/complete fusion of cortex and bony matrix is continuous. Disc space is frequently absent or extremely small Clinical significance: Associations: hemivertebra or absent vertebrae Klippel-Feil Syndrome and can cause angulation of the spine

Answer 4

What is it? The failure of fusion of the lateral halves of the vertebral body What causes them? Congenital How are they diagnosed? X-ray : 2 lateral wedge-shaped halves; mid-line sagittal cleft; widened interpedicular distance; larger pedicles; superior and inferior segments’ endplate change shape to accommodate the butterfly; scoliosis or kyphosis common Clinical significance: Associations: anterior spina bifida +/- anterior meningocele may be part of the Alagille syndrome Jarcho-Levin syndrome VACTERL association 2

Answer 5

What is it? Failure of ossification of one half of a vertebra m/c = Lateral hemivertebra Highest incidence = thoracic spine What causes them? Congenital How are they diagnosed? X-ray : wedge-shaped half vertebra Clinical significance: Common cause of scoliosis. Vertebrae essentially acts as a wedge - causes curvature away from side where it is present Associations: Aicardi syndrome; cleidocranial dysostosis; gastroschisis; Gorlin syndrome; foetal pyelectasis; Jarcho-Levin syndrome; OEIS complex; VACTERL association; mucopolysaccharidosis

Answer 6

What is it? Herniation of disc material into the vertebral body through adjacent endplate What causes them? Not fully understood – one thought is after spinal trauma M > F Not present in 1st decade of life How are they diagnosed? X-ray : Small nodular lucent lesions at the endplate of thoracic and lumbar vertebrae, may have a sclerotic margin Best seen on CT or MRI Clinical significance: Should not be confused/misdiagnosed as Spondylodiscitis or Malignancy

Answer 7

What is it? also known as notochordal persistence subtle, gradual inward defects of the endplates that tend to involve most of the endplate What causes them? Disputed Lack of growth cartilage at site Notochord regresses embryologically How are they diagnosed? X-ray : concave deformity in a lateral radiographic projection. cupid’s bow appearance: AP radiographic Clinical significance: Misdiagnosed for something sinister (?)

Answer 8

What is it? Unilateral or bilateral m/c single, unilateral ossicle of the inferior articular processes of the lumbar spine can also occur at the superior articular process What causes them? non-union of a secondary ossification centre of the articular process How are they diagnosed? X-ray : circular and corticated osseous density in the location of the inferior articular process Clinical significance: Ddx: articular process fracture

Answer 9

What is it? Malformation of one or more vertebrae What causes them? Congenital, arises during fetal development. Mildest form of spina bifida, neural tube defect How are they diagnosed? X-ray : Usually an incidental finding on x-ray/MRI. Structural malformation  midline bony defect at the posterior arch. Clinical significance: Usually asymptomatic Those with extensive SBO (more than one vertebrae); foot deformity, leg weakness, numbness, clumsiness, bladder/bowel dysfunction, tethered cord

Answer 10

What is it? the slippage of one vertebra relative to the one below. What causes them? Hereditary congenital in children can affect any one of any age can be caused by rapid growth those who play sports are more at risk if repetitively over stretching and straining lower back How are they diagnosed? X-ray : anterior displacement of a vertebral body on comparison to the VB directly below. Clinical significance: Graded and classification Asymptomatic or symptomatic

Answer 11

Well corticated unfused secondary ossification centre, usually of the antero-superior vertebral body corner What causes them? secondary to herniation of the nucleus pulposus through the vertebral body endplate beneath the ring apophysis How are they diagnosed? X-ray : Well corticated with a sclerotic margin; triangular shaped; Fragment will not fit gap on vertebrae like a fracture fragment would Lateral view = best visualised Clinical significance: Generally asymptomatic and incidental finding Misdiagnosed as a fracture (limbus or teardrop), degeneration or infection

Answer 12

What is it? A vertebra that has characteristics that are typical of the adjacent spinal segments. What causes them? Congenital Clinical Significance Usually asymptomatic Can be associated with back pain. Spinal arthritis, vertebral disc abnormalities & cord compression can be present in affectedvertebral levels MOST COMMON = Lumbar transitional vertebra Lumbarisation of S1: Assimilation of S1 to Lumbar spine, ~2% population, usually identified by presence of 6 rib free lumbar vertebrae Sacralisation of L5: Assimilation of L5 to the Sacrum, more common than Lumbarisation, ~17% population, usually identified by 4 rib free lumbar vertebrae

Answer 13

Assimilation of S1 to Lumbar spine, ~2% population usually identified by presence of 6 rib free lumbar vertebrae

Answer 14

Assimilation of L5 to the Sacrum, m/c than Lumbarisation, ~17% population usually identified by 4 rib free lumbar vertebrae

Answer 15

What is it? Focal dilation of the abdominal aorta measuring >3cm diameter 10th m/c cause of death in western world, m/c in males, >65 years What causes them? Athersclerosis High BP Blood vessels diseases; infection in Aorta Trauma How are they diagnosed? X-ray : Curvilinear calcification in paravertebral region on abdominal or lumbar films Clinical significance: CAN PRESENT AS LOW BACK PAIN! Need to assess risk of rupture Mortality HIGH from ruptured AAA