Thoracic/Lumbar Spine

Question 1

Sheuermann’s disease

Answer 1

• AVN or steroid use

- Involves inferior and superior end plates

Question 2

Thoracic Kyphosis

Answer 2

• 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

Question 3

Common Trauma with T spine

Answer 3

• MVA or OP

Question 4

Hyperflexion Thoracic

Answer 4

compression burst fractures w/ bony fragments into spinal canal

Question 5

Lumbar Acute injury + Red Flags

Answer 5

• 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

Question 6

Lumbar chronic injury

Answer 6

• Conditions beyond 4-6 weeks of conservative intervention

- Oblique views for spondylothesis or spondylolysis

Question 7

Spondylolisthesis

Answer 7

= inverted napoleons hat sign

- Spinous process or step off sign

Question 8

Oblique L spine projection

Answer 8

• Scottie Dog
  o Interarticuarlis fx = neck of dog
  o Posterior translation of body/tail of dog = spinous process

Question 9

Anterior Column Thoracolumbar spine

Answer 9

• Ant 2/3 of vertebral bodies and AF, ALL
• Usually stable disruptions
• WEDGE Fx

Question 10

Middle Column Thoracolumbar spine

Answer 10

• Posterior 1/3 vertebral bodies AF PLL
• Potentially unstable
• Compression/Burst Fx

Question 11

Posterior column

Answer 11

• Post Arch, facet joints, capsule, post lig complex, lig flavum
• Unstable
• Fx pars articularis (spondylosis) bilateral subluxation (spondylolisthesis)

Question 12

Wedge compression Fx

Answer 12

• Anterior column Compression (compression forces – anterior or lateral flexion)
• Loss of disc height

Question 13

Compression Burst Fx

Answer 13

• Failure of anterior and middle column from compression

- CT or MRI are essential

Question 14

Chance Fx

Answer 14

• Flexion distraction injury of L1-2
• Seat Belt Fx for rear passenger
• Horizontal Fx splitting spinous process, lamina, pedicles and vertebral body

Question 15

Spondylosis

Answer 15

pars interarticularis w.o separation

Question 16

Spondylolisthesis

Answer 16

less stable and translation of columns anteriorly or posterior slide

Question 17

Primary Osteoporosis

Answer 17

• Age related disorder in which density of bone is reduced (aging and estrogen deficiency)

Question 18

Secondary Osteoporosis

Answer 18

• Other causes: hyperparathyroidism, excess glucocorticoids, malabsorption, multiple myeloma

Question 19

Best imaging for osteoporosis

Answer 19

DEXA

Question 20

Scoliosis

Answer 20

• Severe >50 w/ asymmetry of trunk

Question 21

Spine metastases

Answer 21

Bone scan 
-	Indications
o	Staging of lung, breast, prostate
o	Bone pain
o	Elevated alkaline phosphate
o	Elevate the response to chemotherapy