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Imaging II > Thoracic spine > Flashcards

Thoracic spine Flashcards

1
Q

What do articulations of the thorax allow?

A

flexibility to accommodate actions of respiration and trunk mobility

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2
Q

What does the thorax provide stability for?

A

movements of neck and upper extremities

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3
Q

What is the goal of t-spine radiographic examination?

A

identify or exclude anatomic abnormalities or disease processes of spine

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4
Q

What is the sternum examined for?

A

assess fracture, inflammatory processes, or other pathology

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5
Q

What is the SC joint examined for?

A

assess joint separation or other pathology of joint

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6
Q

What are the routine projections for thoracic spine?

A

AP

lateral

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7
Q

Swimmer’s lateral view of upper thoracic region:

A

Lateral view with patient’s arm placed overhead, to remove superimposition of shoulder from obscuring lower cervical and upper thoracic vertebrae

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8
Q

Oblique views:

A
  • Demonstrate facet joints

- Not included in routine projections, b/c thoracic facet joints rarely involved in pathology

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9
Q

Thoracolumbar or other coned views:

A
  • Coned view close-up view of designated area

- Cone refers to circular aperture attachment on x-ray tube which limits exposure field

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10
Q

How is radiographic evaluation of the ribcage done?

A

in sections- only those sections where history and symptoms define region are radiographed

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11
Q

How are rib sections radiographed?

A

AP or PA

Oblique

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12
Q

AP or PA of ribs:

A

projection for posterior or anterior ribs

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13
Q

Oblique view of ribs:

A

projections for axillary ribs

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14
Q

Why is a PA chest film often included in trauma?

A

to rule out possible pneumothorax or hemothorax

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15
Q

What does the AP view of the thorax view demonstrate?

A 
thoracic vertebral bodies
IVD spaces
Alignment of pedicles
Spinous processes
Transverse processes
Articular processes
Costovertebral joints and posterior ribs
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16
Q

What is the interpedicular distance?

A

width b/w opposing paired pedicles

normally 20mm in t-spine

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17
Q

Spinous process interval:

A

Intervals b/w each spinous process from vertebra above vertebra below compared

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18
Q

What can an increase in interval distance at one level indicate?

A

torn posterior ligament complex

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19
Q

What does the lateral thoracic spine view demonstrate?

A

thoacic vertebral bodies
IVD spaces
intervertebral foramina

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20
Q

What does the anterior vertebral body line represent?

A

connected anterior borders of vertebral bodies forms smooth, continuous curve

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21
Q

What does the posterior vertebral body line represent?

A

connected posterior borders of vertebral bodies, forms continuous curve parallel to ALL

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22
Q

What does the spinolaminar line represent?

A

junctions of laminae at spinous processes forms continuous curve parallel to ALL and PLL

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23
Q

Why is t-spine the most commonly injured?

A

b/c of flexion forces

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24
Q

Where are the most commonly injured sites?

A

transitional vertebrae
C to T
T to L

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25
Q

Why are the transitional sites predisposed to injury?

A

b/c they are junctions b/w relatively immobile thoracic spine and more flexible cervical/lumbar spines

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26
Q

Where is incidence of acute injury highest?

A

in T/L vertebrae

12th thoracic and 1st lumbar

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27
Q

What injury is most common in T/L vertebrae?

A

compression fractures and fracture-dislocations

28
Q

Neurological injury complicate what percentage of fractures at T/L level?

A

15-20%

29
Q

MRI is the primary modality to evaluate what?

A

degree of neural compromise, cord edema, cord contusion, epidural hematoma, nerve root involvement, or ligamentous disruption

30
Q

What is the most common spinal injury detectable on radiographs in all age groups?

A

anterior compression fractures

31
Q

What accounts for 90% of compression fractures?

A

flexion forces

32
Q

What percentage do lateral bending forces account for in compression fractures?

A

10%

33
Q

When a person lands in feet from great height, what force results/

A

hindfoot fracture that can travel up kinetic chain and also cause fracture in T/L vertebrae

34
Q

In older adults, what is a significant factor in vertebral body collapse?

A

pre-existing osteoporosis

35
Q

What is deformed in anterior compression fractures?

A

anterior vertebral body

36
Q

What is intact in an anterior compression fracture?

A

posterior body, vertebral arches, and posterior ligaments

37
Q

Are anterior compression fractures considered stable or unstable and why?

A

stable

b/c only anterior column involved

38
Q

When can an anterior compression fracture potentially become unstable?

A

Anterior vertebral body compression fracture with torn posterior ligament complex. Two columns involved means this injury has potential to be unstable

39
Q

What fractures increase in incidence with age?

A

compression fractures

Decreases in shock-absorbing qualities increase degree of trauma suffered at vertebrae

40
Q

What does demineralization of bone do to vertebrae?

A

renders vertebrae less elastic, more brittle, and prone to fracture

41
Q

What does dehydration of NP due to disk?

A

NP renders disks less resilient to compression

42
Q

What are the radiographic signs of compression fracture include:

A
  1. step defect
  2. wedge deformity
  3. linear zone of impaction
  4. displaces endplates
  5. loss of IVD height
  6. paraspinal edema
43
Q

What is a step defect?

A

Anterior cortex of vertebral body first structure to undergo strain and suffer greatest stress
best seen on lateral view

44
Q

What is a wedge deformity?

A

Collapse of anterior vertebral body creates triangular or trapezoidal body (apparent on lateral view)

45
Q

What can a wedge deformity result in?

A

kyphosis

scoliosis

46
Q

What percentage of loss of vertebral body height required for deformity to be present on radiograph?

A

30%

47
Q

What is the linear zone of impaction?

A

white band of condensation): Linear band of increased density apparent beneath involved endplate

48
Q

What is displaced endplates?

A

Anterior shearing of IVD may avulse bony rim of endplate or displace it anteriorly

49
Q

Loss of IVD height:

A

Intact disk inferred from well-preserved potential space b/w vertebrae and proper alignment of vertebrae

50
Q

What may herniation of disk cause?

A

decrease in potential space and possibly misalignment of adjacent vertebrae

51
Q

Paraspinal edema:

A

Paraspinal soft tissue edemas or hematomas often associated with compression fractures

52
Q

How is paraspinal edema best viewed?

A

Best seen on AP view increased areas of density adjacent to either side of spin

53
Q

How do vertebral body fractures heal?

A

endosteal and periosteal callus formation

54
Q

How long does union when healing occur?

A

3-6 months

55
Q

Why may cause a delayed union?

A

extensive disk herniation into fracture site, interrupted nutrient vessels, or general poor health and advanced age

56
Q

What may happen to mildly damaged disks?

A

may re-vascularize and function normally

57
Q

What may happen to severely torn disks?

A

may calcify and form bony ankylosis at that segment

58
Q

When do most severe symptoms resolve in an anterior compression?

A

10-14 days

59
Q

Why is hospitalization often required in an anterior compression fracture?

A

control pain and fit patient for thoracolumbar spinal orthosis (TLSO)

60
Q

Why does bracing trunk in extension relieve pain?

A

by unloading anterior vertebral bodies

61
Q

How long does bracing last in an anterior compression fracture?

A

4-6 weeks

62
Q

What does rehabilitation involve in an anterior compression fracture?

A

management of TLSO, isometric back muscle strengthening, and ambulatory devices as needed

63
Q

What are the classic radiolofic hallmarks of osteoporosis?

A

increased radiolucency
cortical thinning
trabecular changes

64
Q

Increased radiolucency:

A

Increased radiolucency first evidenced at cancellous vertebral bodies
Results in “empty box” appearance of vertebral body

65
Q

Thinning of cortical margins:

A

Thinning of cortices first noted at vertebral body margins, especially at endplates, where cortical outline normally relatively thick
Cortical margins of vertebral arches also become thinned

66
Q

Alterations in trabecular patterns:

A

Trabecular changes within vertebral bodies often leave distinct vertical striations

Imaging II (10 decks)

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