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NYCC Bone & Joint > Thoracic & Lumbar Vertebral Anomalies > Flashcards

Thoracic & Lumbar Vertebral Anomalies Flashcards

1
Q

What is the diagnosis?

A

Congenital fusion/block

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2
Q

What is the diagnosis?

A

Congenital fusion/block

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3
Q

What is a butterfly vertebrae?

A

Two lateral hemivertebrae at the same level

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4
Q

What is a hemivertebrae?

A

Half of a vertebrae

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5
Q

What is the diagnosis?

A

Lateral hemivertebrae

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6
Q

What is the diagnosis?

A

Butterfly vertebrae

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7
Q

How can you differentiate a burst fracture from a butterfly vertebrae?

A

Burst Fx would have posterior elements destroyed & not smooth well rounded corticated margins

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8
Q

What 2 diagnoses is a butterfly vertebrae often associated with?

A

Kyphoscoliosis
Klippel Feil

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9
Q

What are the 3 types of hemivertebrae?

A

Lateral
Dorsal
Ventral
(Must be specific)

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10
Q

Ventral hemivertebrae are associated with what abnormal spinal curve?

A

Angular lordosis

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11
Q

Dorsal hemivertebrae are associated with what abnormal spinal curve?

A

Angular kyphosis

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12
Q

What is the most common type of hemivertebrae?

A

Lateral

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13
Q

Lateral hemivertebrae are associated with what abnormal spinal curve?

A

High curve scoliosis

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14
Q

What is the diagnosis?

A

Butterfly vertebra

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15
Q

What is the diagnosis?

A

Dorsal hemivertebra

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16
Q

What is the diagnosis?

A

Ventral hemivertebra

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17
Q

What is the term for multiple hemivertebrae?

A

Scrambled spine syndrome

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18
Q

What are 2 common radiographic varieties/signs of lateral hemivertebrae?

A
  • 1 vertebra w/ 3 pedicles
  • Y or V shaped disc
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19
Q

What is the diagnosis?

A

Lateral hemivertebra
(1 vertebra w/ 3 pedicles)

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20
Q

What are Schmorl nodes?

A

Intravertebral disc herniation through a weak point in the endplate

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21
Q

Describe the appearance of Schmorl nodes.

A

Sharp indentation of vertebral endplate

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22
Q

When do Schmorl nodes occur?

A
  • MC during pubescent growth (adolescents)
  • can be traumatic
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23
Q

When would Schmorl nodes be painful?

A

If acute/traumatic
(No pain if chronic)

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24
Q

What is a Hahn venous cleft?

A

Horizontal linear lucencies in the vertebral bodies
(Normal, not a patho Fx)

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25
Q

What does the Hahn venous cleft represent?

A

Passage of basivertebral vein or Batson’s venous plexus

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26
Q

What is the diagnosis?

A

Schmorl nodes

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27
Q

What is the diagnosis?

A

Schmorl nodes

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28
Q

What is the diagnosis?

A

Hahn venous cleft

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29
Q

What is a limbus bone?

A

Herniated nuclear material separates a portion of the ring apophysis and heals non-union creating a small, triangular fragment
(Variant of Schmorl nodes)

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30
Q

What are the 3 types of limbus bones?

A

Anterior (MC)
Lateral
Posterior

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31
Q

What is the clinical significance of posterior limbus bones?

A

Central stenosis

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32
Q

What is the diagnosis?

A

Limbus bone

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33
Q

What is the diagnosis?

A

Nuclear impression

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34
Q

What is the diagnosis?

A

Limbus bone

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35
Q

What is an Oppenheimer ossicle?

A

Un-united ossicles of the articular process tips

36
Q

What are the 3 forms of Oppenheimer ossicles?

A

Round
Oval
Triangular

37
Q

What sign is visible on an AP lumbar spine radiograph of nuclear impressions?

A

Cupids bow sign/deformity

38
Q

What is the diagnosis?

A

Oppenheimer ossicle

39
Q

What sign is this?

A

Cupids bow sign

40
Q

What is the diagnosis?

A

Oppenheimer ossicle

41
Q

What is congenital pedicle agenesis?

A

Failure of ossification within the neural arch

42
Q

What is on your DDx list for a missing pedicle?

A
  1. Agenesis (most likely)
  2. Metastatic disease (most concerning)
43
Q

What are the radiographic findings of pedicle agenesis?

A

Stress hypertrophy of contralateral pedicle, or sometimes pedicles above and below the segment

44
Q

You notice your 18-year-old patient is missing a pedicle on x-ray, and the pedicle on the other side looks larger than normal. What is the most likely diagnosis?

A

congenital pedicle agenesis
(unlikely to be mets in younger pt)

45
Q

You notice your 18-year-old patient is missing a pedicle on x-ray, and the pedicle on the other side looks larger than normal. What is your next step?

A

compare with previous imaging if available
(MRI not necessary for young pt.)

46
Q

You notice your 53-year-old patient with a history of colon adenocarcinoma is missing a pedicle on x-ray, and the pedicle on the other side looks normal. What is the most likely diagnosis?

A

Metastasis

47
Q

You notice your 53-year-old patient with a history of colon adenocarcinoma is missing a pedicle on x-ray, and the pedicle on the other side looks larger than normal. What is your next step?

A

MRI (or bone scan) to R/o mets

48
Q

What is the most likely diagnosis?

A

Congenital pedicle agenesis

49
Q

70-year old female presents with a breast lump and back pain, and no history of malignancy. What is the likely diagnosis?

A

Metastasis

50
Q

70-year old female presents with a breast lump and back pain, and no history of malignancy. What is the likely diagnosis?

A

Metastasis

51
Q

What is the diagnosis, including spinal level?

A

SBO at S1

52
Q

What is the diagnosis, including spinal level?

A

SBO at L5

53
Q

What is the diagnosis?

A

SBO (T2-T3)

54
Q

How common are L/S transitional vertebrae (LSTV)?

A

4-30% of population

55
Q

What is the clinical significance of a LSTV?

A

concern for DJD or IVD herniation above

56
Q

Your patient with a LSTV presents with low back pain. What is the diagnosis?

A

Bertolotti Syndrome

57
Q

What radiographic views are best to see LSTV?

A

Ferguson (AP angulated LS spot)

58
Q

What is the name of the classification system for LSTV?

A

Castellvi classification

59
Q

What does “spatulation” mean regarding LSTV?

A

TP is >19mm in height

60
Q

What does castellvi 1 classification describe?

A

Spatulation without articulation

61
Q

What does castellvi 2 classification describe?

A

Spatulation with articulation

62
Q

What does castellvi 3 classification describe?

A

Complete fusion

63
Q

What does castellvi 4 classification describe?

A

Combined fusion with accessory joint

64
Q

What does the A or B mean in Castellvi classification?

A

A = unilateral
B = bilateral

65
Q

What is a LSTV Type 1A?

A

Unilateral spatulation

66
Q

What is a LSTV Type 1B?

A

Bilateral spatulation

67
Q

What is a LSTV Type 2A?

A

Spatulation with unilateral articulation

68
Q

What is a LSTV Type 2B?

A

Spatulation with bilateral articulation

69
Q

What is a LSTV Type 3A?

A

Unilateral fusion

70
Q

What is a LSTV Type 3B?

A

Bilateral fusion

71
Q

How can you tell the difference between congenital fusion and LSTV on a radiograph?

A

LSTV has hypoplastic disc but no wasp waist deformity

72
Q

Which type of LSTV is considered a true synovial joint?

A

LSTV type 2A

73
Q

What is the clinical significance of a LSTV type 2A?

A

^incidence of disc herniation at disc above

74
Q

Where would pain be located in a symptomatic patient with a LSTV type 2A?

A

accessory joint or contralateral facet

75
Q

Patient presents with low back pain. What is the diagnosis?

A

Bertolotti syndrome
(LSTV type 2A + pain)

76
Q

What is the diagnosis?

A

LSTV type 2B

77
Q

What is the diagnosis?

A

LSTV type 3A

78
Q

What is the diagnosis?

A

LSTV type 1A

79
Q

What is facet tropism?

A

Asymmetrical orientation of facets, where one is more coronal, and one is more sagittal

80
Q

What modality is best to view facet tropism?

A

CT or MRI

81
Q

What modality is used?

A

CT

82
Q

What is the clinical significance of facet tropism?

A

Strongly debated (none)

83
Q

What is clasp knife syndrome?

A

SBO at S1 + megaspinous at L5

84
Q

What soft tissue is implicated in clasp knife syndrome?

A

Thecal sac is compressed in extension

85
Q

What radiographic view should never be used to diagnose clasp knife syndrome?

A

Ferguson view

86
Q

What is the diagnosis?

A

Clasp knife deformity
(Syndrome if pain associated)

87
Q

What is the diagnosis?

A

Agenesis of articular process

NYCC Bone & Joint (20 decks)

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