Vertebral column radiography Flashcards
Name the parts of the spine.
(numbers of vertebrae etc.)
(Atlas, axis)
Cervical part C1-C7
Thoracic part T1-T13
(T11 is anticlinal)
Lumbar part L1-L7
Sacrum S1-S3
Caudal – variable (6-23)
What is the meaning of anticlinal vertebra?
The 11th thoracic vertebra is also known as the anticlinal vertebra.
The anticlinal vertebra is the point at which vertebral anatomic features change and the spinous process becomes perpendicular to the body and the preceding vertebra incline caudally.
Exception can be some small dogs in which T10 is the anticlinal vertebra.
Describe lateral x-ray views for the vertebral column.
Most common view for spine.
Vertebral column parallel to tabletop/ cassette.
You have a Good position if you have superimposition of:
- Wings of atlas
- C6 transverse processes
- Rib origins
- L transverse processes
- Iliac wings
Describe normal Vertebral body features regarding
L3 & 4
and
C7 and L7
that should not be confused with pathology.
L3 and L4 ventral margin can be poorly defined, especially in older dogs.
C7 and L7 may be shorter than adjacent vertebral bodies.
Transverse processes of which cervical vertebra are normally much larger than the others?
C6 are naturally particularly large
Normal features of Intervertebral spaces:
T10- T11?
L7-S1?
T10- T11 commonly narrower
L7-S1 can be wider
Intervertebral foramina act as windows to the vertebral canal, best seen in
the lumbar region (“head of horse”), not seen clearly in cervical area (exception C2-C3).
Dorsal (lamina) and ventral (vertebral floor) borders of the vertebral foramen are seen as
a thin sclerotic line.
Describe the Spine in VD/DV view.
As little rotation as possible along vertebral column.
Spinous processes are seen as oblong shadows. If length can be seen - rotation!
Intervertebral disc spaces can naturally vary.
- Evaluate them on LAT view instead.
Describe interpretation of spines on x-ray.
Many findings can be incidental with no clinical value.
Many abnormalities are not visible radiographically.
What Can be seen:
- Vertebral alignment, in particular that of the vertebral canal floor, which should have no abrupt change in level or angulation.
- The length, shape and opacity of the vertebral bodies and the transverse and spinous processes.
- The presence of normal cortical and trabecular architecture (lysis/sclerosis).
- Intervertebral disc space width and opacity (position critical – many false positive findings).
- Articular process joints and paravertebral soft tissues.
Dorsal arch of C2 should
overlap C1 by a little bit. Not too tight, not too loose.
whats up in them images
In image, the C2 arch overlaps a bit too tightly. In the right image, a fracture of C1 is visible.
Review sacral anatomy.
Spinal fractures Possible causes: (3)
Existing bone disease (neoplasia, metabolic…)
- Look for lytic or proliferative changes, osteopenia.
Trauma
- Possible instability – limit any movement!
Fracture of axial dens – atlantoaxial instability, spinal damage
(axial dens = the protuberance of the axis)
Congenital anomalies examples. (10)
Number-of-vertebrae-anomalies (one too many or one too few) – mostly asymptomatic.
Butterfly anomaly - bulldogs and related breeds, pugs.
Hemivertebrae
Block vertebrae
Transitional vertebrae
Spina bifida
Scoliosis
Lordosis
Kyphosis
Atlantoaxial instability
identify anomaly
Butterfly anomaly which is very specific to bulldog breeds (most have at least one if not more).
Vertebra is abnormally shaped like a butterfly.
Abnormality of ossification centers.
Two triangular units.
VD/DV views can catch it
Mostly asymptomatic.
identify anomaly
Hemivertebra
Failure of formation of a part of the vertebral body. The vertebra is missing bone part ventrally or dorsally.
Seen in Lateral view, Wedge shape.
More common in brachys but found in others as well. Can cause pain.
identify anomaly
block vertebrae so fusion of two vertebra that should normally be separate vertebrae. (left image)
how to tell if its fusion or loss of intervertebral disc?
Check the margin, is there any time of delineation? (right image)
identify anomaly
transitional vertebrae
Abnormal vertebra that Shares characteristics with those from an adjacent vertebral segment (can be rudimentary).
When in Lumbosacral area - problematic.
Can be a lumbar vertebra having a rib when it shouldn’t. (right image)
breed predilection, GSD
Review anomalous vertebrae.
Spina bifida is the
Failure of fusion of the dorsal part of the lamina (including the spinous process).
Can cause neuro issues/signs depending on severity.
whats this
spina bifida
dorsal arch looks split or is missing
what this
left: scoliosis = spine curved to the side
top right: kyphosis = hunchback
right bottom: lordosis = arched back
Describe Atlantoaxial instability.
Mostly small breeds.
Axial dens is absent, hypoplastic or fractured, or the ligaments are absent or torn.
Distance between C1 and C2 wider than usual.
LAT (+ VD) views
- For Lateral view, head should be slightly flexed.
NB! BE CAREFUL! (not to cause paralysis)
identify issue
Atlantoaxial instability
blue circle and arrow = normal
red arrows point to abnormalities
how to fix Atlantoaxial instability?
Angular relationship between the lamina of C1 and C2 in left image and fixed in right image.
Describe spondylosis.
Large, middle sized breeds.
Bony “bridges” between vertebrae develop (osteophytes).
Degenerative disease, causes pain.
identify issue
spondylosis
What is discospondylitis and spondylitis?
discospondylitis = Infection/inflammation of spinal discs and the adjacent vertebral bones. (left images)
spondylitis = Infection/inflammation of vertebral bodies (right image)
identify issue
Discospondylitis
see the half moons of lytic changes, is characteristic for this.
not many treatment options but they also depend on the cause (bacteria, fungal etc.)
identify issue
metastatic changes in top image
lytic changes due to primary bone neoplasia in bottom image
Metabolic diseases to affect bones. (4)
Hyperparathyroidism
- Renal origin
- Nutrition origin
Hypervitaminosis A
- Cats and raw liver diet
Mucopolysaccharidosis (genetic defective enzymes)
Osteopetrosis (genetic disease)
Muccopolysachharidosis
The mucopolysaccharidoses are part of the lysosomal storage disease family.
Mucopolysaccharidoses are a group of metabolic disorders caused by the absence or malfunctioning of lysosomal enzymes needed to break down molecules called glycosaminoglycans.
Over time, these glycosaminoglycans collect in the cells, blood and connective tissues. The result is permanent, progressive cellular damage which affects appearance, physical abilities, organ and system functioning.
identify pathology
Nutritional Hyperparathyroidism
Decreased contrast between bone and soft tissue. Pathological fractures/ pseudofractures. Bendy bones.
Painful
identify pathology
hyperparathyroidism in a 8 month kitten fed with sausages
- image shows bendy back and sternum.
- spinous processes not even visible anymore. pelvis poorly visible.
- no secondary fractures yet.
Can be treated with dietary change (Ca:P!!) but the bones will never return to normal.
Describe hypervitaminosis A.
First changes seen in cervical part of spine. Excessive bone formation around cervical vertebral bodies.
Frequently caused by feeding a Raw liver diet to cats - too much vitamin A.
identify issue
Mucopolysaccharidosis in a 7 year old CAT. Growth plates are open and vertebrae are weirdly shaped.
Mucopolysaccharidoses are a rare group of genetic disorders (storage disease) that cause physical deformities and organ dysfunction.
The disease is difficult, at best, to treat. There is no cure for Mucopolysaccharidoses, but there are treatments available that have shown some success in younger animals.
Describe Degenerative disc disease types.
Hansen type I
- Chondrodystrophic breeds
- Degeneration of disc nucleus at relatively young age.
Hansen type II
- Other breeds (large dogs)
- Due to age related reasons
Narrowing of intervertebral space, calcification of discs.
NB Spinal cord injury NOT visible in radiographs!
Ankylosing Spondylitis =
is characterized by long-term inflammation of the joints of the spine, typically where the spine joins the pelvis.
