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Imaging II > Thoracic spine II > Flashcards

Thoracic spine II Flashcards

1
Q

Classic radiologic hallmarks of osteoporosis:

A

increased radiolucency
cortical thinning
trabecular changes

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2
Q

Increased radiolucency of vertebrae:

A

first evidenced at cancellous vertebral bodies

empty box appearance of vertebral body

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3
Q

Thinning of cortical margins:

A

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

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4
Q

Alterations in trabecular patterns:

A

Trabecular changes within vertebral bodies often leave distinct vertical striations

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5
Q

Wedge deformity in osteoporosis:

A

Structurally weakened vertebral bodies often collapse under flexion or axial compressive forces

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6
Q

What happens in severe osteoporosis?

A

vertebral compression fractures may be due to relatively minor or normal everyday forces
Preponderance toward fracture directly related to severity

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7
Q

What do chronic microfractures produces?

A

biconcave appearance of vertebral body

Configuration results from structural weakness and expansile pressures of disk

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8
Q

What does a single traumatic event result in?

A

vertebra plana

flat appearing vertebra

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9
Q

Endplate deformities in osteoporosis:

A

Smooth indentations seen in endplates centrally, in region of NP

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10
Q

Sclerosis along endplates most common where?

A

thoracic and lumbar spines

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11
Q

Schmorl’s nodes in osteoporosis?

A

Focal intrusion of nuclear material into vertebral body through structurally weakened endplates results in these radiolucent “nodes”

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12
Q

How is bone mineral density measured?

A

DEXA scan

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13
Q

Early treatment for osteoporosis:

A

improvement of posture via strengthening and flexibility exercises and improvement of general conditioning via weight-bearing activities and ambulation

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14
Q

Treatment for later stages osteoporosis:

A

rehabilitation important in providing adaptive modifications to preserve functional independence in ADL’s and ambulation

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15
Q

What is scoliosis?

A

lateral deviation of spine from mid-sagittal plane combined with rotational deformities of vertebrae and ribs

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16
Q

Pathological changes due to compressive forces on concave side of curvature include

A

Narrowed disk spaces
Wedge-shaped vertebral bodies
Shorter/thinner pedicles and laminae
Narrowed IVF and spinal canal spaces

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17
Q

Pathological changes on convex side of curvature include

A

Widened rib spaces

Posteriorly positioned rib cage (resulting in deforming “rib hump”)

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18
Q

Curves over 5 degrees appear in:

A

5% of population

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19
Q

Curves over 10 degrees appear in:

A

2-4% of population

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20
Q

Curves over 25 degrees occur in:

A

1.5/1000 individuals

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21
Q

How many children will develop scoliotic curves large enough to warrant treatment?

A

3-5 out of 1000

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22
Q

What percentage of scoliosis cases are idiopathic?

A

80%

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23
Q

What are the three types of idiopathic scoliosis:

A
  1. infantile
  2. juvenile
  3. adolescent
24
Q

Infantile scoliosis:

A

appears before age 3 and may include neurological involvement
Many cases resolve spontaneously, although some progress to severe deformity

25
Q

Juvenile scoliosis:

A

appears b/w ages 3-10, more often in girls, and presents high risk for progression

26
Q

Adolescent scoliosis:

A

appears b/w age 10 and skeletal maturity at 7:1 female:male ratio

27
Q

What are the distinct patterns of curvature in scoliosis:

A
  1. right thoracic curve
  2. right thoracolumbar curve
  3. left lumbar curve
  4. left lumbar, right thoracic curve
28
Q

Right thoracic curve:

A

Most frequently seen curve is right convex thoracic curve
Major curve extends from T4–T6 to T11–L1
Secondary/minor curves seen above and below major curve as compensatory curves that aid in balancing spine and keeping eyes oriented to horizontal

29
Q

Right thoracolumbar curve:

A

Major curve longer, extending from T4–T6 to L2–L4

It can appear to either side, but right is most common

30
Q

Left lumbar curve:

A

Curve extends from T11 or T12 to L5

It also can appear to either side, but left is most common

31
Q

Left lumbar, right thoracic curve:

A

Double major curve consists of 2 structural curves of equal prominence
This pattern may be end result of what began as major thoracic curve with compensatory secondary lumbar curve, but progressed into 2 structural curves

32
Q

What is the most definitive diagnostic modality in management of patient with scoliosis?

A

radiographs

33
Q

What purpose do radiographs serve?

A
  1. To determine or rule out various etiologies of scoliosis
  2. To evaluate curvature size, site, and flexibility
  3. To assess skeletal maturity or bone age
  4. To monitor curvature progression or regression
34
Q

What are the projections to diagnose and evaluate scoliosis?

A

Erect AP
Erect lateral
Erect AP lateral flexion views of spine
PA left hand

35
Q

What radiograph is taken in addition to spinal films for scoliosis?

A

left hand and wrist

36
Q

Why is the left hand and wrist compare for scoliosis?

A

provide accurate assessment of skeletal age

37
Q

What is skeletal age?

A

refers to physiological stage of skeletal maturity and differs from chronological age

38
Q

What are the two other indicators of skeletal maturity seen on spine radiographs?

A

fusion of vertebral ring apophyses

fusion of iliac crest apophysis

39
Q

What is Risser’s sign?

A

Process of skeletal maturity as reflected in radiographic appearance of apophyses of iliac crests

40
Q

Where do apophyses first appear?

A

at ASIS and progress over a year’s time posteromedially to PSIS

41
Q

1 plus of Risser’s value:

A

indicates excursion of apophysis over 25% of crest

42
Q

2 plus of Risser’s value:

A

means 50% of crest is “capped”

43
Q

3 plus of Risser’s value:

A

75% capped

44
Q

4 plus of Risser’s value:

A

100% capped

45
Q

5 plus of Risser’s value:

A

indicates osseous fusion is complete

46
Q

What views are seen with the Cobb method?

A

frontal plane, based on AP radiograph

47
Q

Cobb method:

A

Identify uppermost involved vertebra of curve that tilts significantly toward concavity and draw line along its superior endplate
Identify lowermost involved vertebra of curve that tilts significantly toward concavity and draw line along its inferior endplate
Draw perpendicular lines through those two lines and measure resulting intersecting angle

48
Q

What is treatment in adolescent idiopathic scoliosis determined by?

A

Patient’s skeletal age
Curve magnitude
Curve location
Potential for curve progression

49
Q

Who is at risk for a high curve progression?

A

Patients with curves of significant magnitude prior to onset of their adolescent growth spurt

50
Q

Treatment for patients with minimal magnitude:

A

No active treatment but close observation for months or years to determine whether curve progressing

51
Q

Treatment for patients with curves between 20-40 degrees:

A

Spinal bracing combined with exercise for several months or years until skeletal maturity reached

52
Q

Treatment for patients with curves over 50:

A

surgical fixation

53
Q

What is the primary goal of bracing:

A

stop progression of curve

any correction considered a bonus

54
Q

What is the most effective treatment in children who have significant growth remaining:

A

bracing

55
Q

What surgical procedure is most often used to correct adolescent idiopathic scoliosis?

A

posterior spinal fusion with paravertebral rods and bone grafts:

56
Q

What is the goal of surgery?

A

to prevent curve progression and to diminish spinal deformity

Imaging II (10 decks)

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