Thoracic/Lumbar Spine Flashcards
Sheuermann’s disease
- AVN or steroid use
- Involves inferior and superior end plates
Thoracic Kyphosis
- Draw right angles on T1 and T12 (superior end plate T1 and inferior endplate T12_
- Normal range
o 7-40ª adult males
o 30-56ª Older males
o 13-48º adult female
o 32-66º older female
Common Trauma with T spine
- MVA or OP
Hyperflexion Thoracic
compression burst fractures w/ bony fragments into spinal canal
Lumbar Acute injury + Red Flags
- X rays not recommended for acute LBP w/in first month of symptoms
- Red Flags
o Recent significant trauma
o Mild trauma (age 50 or greater)
o Patient over 70
o History of prolonged steroid use or OP
Lumbar chronic injury
- Conditions beyond 4-6 weeks of conservative intervention
- Oblique views for spondylothesis or spondylolysis
Spondylolisthesis
= inverted napoleons hat sign
- Spinous process or step off sign
Oblique L spine projection
- Scottie Dog
o Interarticuarlis fx = neck of dog
o Posterior translation of body/tail of dog = spinous process
Anterior Column Thoracolumbar spine
- Ant 2/3 of vertebral bodies and AF, ALL
- Usually stable disruptions
- WEDGE Fx
Middle Column Thoracolumbar spine
- Posterior 1/3 vertebral bodies AF PLL
- Potentially unstable
- Compression/Burst Fx
Posterior column
- Post Arch, facet joints, capsule, post lig complex, lig flavum
- Unstable
- Fx pars articularis (spondylosis) bilateral subluxation (spondylolisthesis)
Wedge compression Fx
- Anterior column Compression (compression forces – anterior or lateral flexion)
- Loss of disc height
Compression Burst Fx
- Failure of anterior and middle column from compression
- CT or MRI are essential
Chance Fx
- Flexion distraction injury of L1-2
- Seat Belt Fx for rear passenger
- Horizontal Fx splitting spinous process, lamina, pedicles and vertebral body
Spondylosis
pars interarticularis w.o separation
Spondylolisthesis
less stable and translation of columns anteriorly or posterior slide
Primary Osteoporosis
- Age related disorder in which density of bone is reduced (aging and estrogen deficiency)
Secondary Osteoporosis
- Other causes: hyperparathyroidism, excess glucocorticoids, malabsorption, multiple myeloma
Best imaging for osteoporosis
DEXA
Scoliosis
- Severe >50 w/ asymmetry of trunk
Spine metastases
Bone scan - Indications o Staging of lung, breast, prostate o Bone pain o Elevated alkaline phosphate o Elevate the response to chemotherapy
