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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
Why are the transitional sites predisposed to injury?
b/c they are junctions b/w relatively immobile thoracic spine and more flexible cervical/lumbar spines
26
Where is incidence of acute injury highest?
in T/L vertebrae | 12th thoracic and 1st lumbar
27
What injury is most common in T/L vertebrae?
compression fractures and fracture-dislocations
28
Neurological injury complicate what percentage of fractures at T/L level?
15-20%
29
MRI is the primary modality to evaluate what?
degree of neural compromise, cord edema, cord contusion, epidural hematoma, nerve root involvement, or ligamentous disruption
30
What is the most common spinal injury detectable on radiographs in all age groups?
anterior compression fractures
31
What accounts for 90% of compression fractures?
flexion forces
32
What percentage do lateral bending forces account for in compression fractures?
10%
33
When a person lands in feet from great height, what force results/
hindfoot fracture that can travel up kinetic chain and also cause fracture in T/L vertebrae
34
In older adults, what is a significant factor in vertebral body collapse?
pre-existing osteoporosis
35
What is deformed in anterior compression fractures?
anterior vertebral body
36
What is intact in an anterior compression fracture?
posterior body, vertebral arches, and posterior ligaments
37
Are anterior compression fractures considered stable or unstable and why?
stable | b/c only anterior column involved
38
When can an anterior compression fracture potentially become unstable?
Anterior vertebral body compression fracture with torn posterior ligament complex. Two columns involved means this injury has potential to be unstable
39
What fractures increase in incidence with age?
compression fractures | Decreases in shock-absorbing qualities increase degree of trauma suffered at vertebrae
40
What does demineralization of bone do to vertebrae?
renders vertebrae less elastic, more brittle, and prone to fracture
41
What does dehydration of NP due to disk?
NP renders disks less resilient to compression
42
What are the radiographic signs of compression fracture include:
1. step defect 2. wedge deformity 3. linear zone of impaction 4. displaces endplates 5. loss of IVD height 6. paraspinal edema
43
What is a step defect?
Anterior cortex of vertebral body first structure to undergo strain and suffer greatest stress best seen on lateral view
44
What is a wedge deformity?
Collapse of anterior vertebral body creates triangular or trapezoidal body (apparent on lateral view)
45
What can a wedge deformity result in?
kyphosis | scoliosis
46
What percentage of loss of vertebral body height required for deformity to be present on radiograph?
30%
47
What is the linear zone of impaction?
white band of condensation): Linear band of increased density apparent beneath involved endplate
48
What is displaced endplates?
Anterior shearing of IVD may avulse bony rim of endplate or displace it anteriorly
49
Loss of IVD height:
Intact disk inferred from well-preserved potential space b/w vertebrae and proper alignment of vertebrae
50
What may herniation of disk cause?
decrease in potential space and possibly misalignment of adjacent vertebrae
51
Paraspinal edema:
Paraspinal soft tissue edemas or hematomas often associated with compression fractures
52
How is paraspinal edema best viewed?
Best seen on AP view increased areas of density adjacent to either side of spin
53
How do vertebral body fractures heal?
endosteal and periosteal callus formation
54
How long does union when healing occur?
3-6 months
55
Why may cause a delayed union?
extensive disk herniation into fracture site, interrupted nutrient vessels, or general poor health and advanced age
56
What may happen to mildly damaged disks?
may re-vascularize and function normally
57
What may happen to severely torn disks?
may calcify and form bony ankylosis at that segment
58
When do most severe symptoms resolve in an anterior compression?
10-14 days
59
Why is hospitalization often required in an anterior compression fracture?
control pain and fit patient for thoracolumbar spinal orthosis (TLSO)
60
Why does bracing trunk in extension relieve pain?
by unloading anterior vertebral bodies
61
How long does bracing last in an anterior compression fracture?
4-6 weeks
62
What does rehabilitation involve in an anterior compression fracture?
management of TLSO, isometric back muscle strengthening, and ambulatory devices as needed
63
What are the classic radiolofic hallmarks of osteoporosis?
increased radiolucency cortical thinning trabecular changes
64
Increased radiolucency:
Increased radiolucency first evidenced at cancellous vertebral bodies Results in “empty box” appearance of vertebral body
65
Thinning of cortical margins:
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
Alterations in trabecular patterns:
Trabecular changes within vertebral bodies often leave distinct vertical striations

Imaging II (10 decks)

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