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NYCC Bone & Joint > (1,3) Thoracic & Lumbar Vertebral Anomalies > Flashcards

(1,3) Thoracic & Lumbar Vertebral Anomalies Flashcards

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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
What does the Hahn venous cleft represent?
Passage of basivertebral vein or Batson’s venous plexus
26
What is the diagnosis?
Schmorl nodes
27
What is the diagnosis?
Schmorl nodes
28
What is the diagnosis?
Hahn venous cleft
29
What is a limbus bone?
Herniated nuclear material separates a portion of the ring apophysis and heals non-union creating a small, triangular fragment (Variant of Schmorl nodes)
30
What are the 3 types of limbus bones?
Anterior (MC) Lateral Posterior
31
What is the clinical significance of posterior limbus bones?
Central stenosis
32
What is the diagnosis?
Limbus bone
33
What is the diagnosis?
Nuclear impression
34
What is the diagnosis?
Limbus bone
35
What is an Oppenheimer ossicle?
Un-united ossicles of the articular process tips
36
What are the 3 forms of Oppenheimer ossicles?
Round Oval Triangular
37
What sign is visible on an AP lumbar spine radiograph of nuclear impressions?
Cupids bow sign/deformity
38
What is the diagnosis?
Oppenheimer ossicle
39
What sign is this?
Cupids bow sign
40
What is the diagnosis?
Oppenheimer ossicle
41
What is congenital pedicle agenesis?
Failure of ossification within the neural arch
42
What is on your DDx list for a missing pedicle?
1. Agenesis (most likely) 2. Metastatic disease (most concerning)
43
What are the radiographic findings of pedicle agenesis?
Stress hypertrophy of contralateral pedicle, or sometimes pedicles above and below the segment
44
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?
congenital pedicle agenesis (unlikely to be mets in younger pt)
45
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?
compare with previous imaging if available (MRI not necessary for young pt.)
46
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?
Metastasis
47
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?
MRI (or bone scan) to R/o mets
48
What is the most likely diagnosis?
Congenital pedicle agenesis
49
70-year old female presents with a breast lump and back pain, and no history of malignancy. What is the likely diagnosis?
Metastasis
50
70-year old female presents with a breast lump and back pain, and no history of malignancy. What is the likely diagnosis?
Metastasis
51
What is the diagnosis, including spinal level?
SBO at S1
52
What is the diagnosis, including spinal level?
SBO at L5
53
What is the diagnosis?
SBO (T2-T3)
54
How common are L/S transitional vertebrae (LSTV)?
4-30% of population
55
What is the clinical significance of a LSTV?
concern for DJD or IVD herniation above
56
Your patient with a LSTV presents with low back pain. What is the diagnosis?
Bertolotti Syndrome
57
What radiographic views are best to see LSTV?
Ferguson (AP angulated LS spot)
58
What is the name of the classification system for LSTV?
Castellvi classification
59
What does “spatulation” mean regarding LSTV?
TP is >19mm in height
60
What does castellvi 1 classification describe?
Spatulation without articulation
61
What does castellvi 2 classification describe?
Spatulation with articulation
62
What does castellvi 3 classification describe?
Complete fusion
63
What does castellvi 4 classification describe?
Combined fusion with accessory joint
64
What does the A or B mean in Castellvi classification?
A = unilateral B = bilateral
65
What is a LSTV Type 1A?
Unilateral spatulation
66
What is a LSTV Type 1B?
Bilateral spatulation
67
What is a LSTV Type 2A?
Spatulation with unilateral articulation
68
What is a LSTV Type 2B?
Spatulation with bilateral articulation
69
What is a LSTV Type 3A?
Unilateral fusion
70
What is a LSTV Type 3B?
Bilateral fusion
71
How can you tell the difference between congenital fusion and LSTV on a radiograph?
LSTV has hypoplastic disc but no wasp waist deformity
72
Which type of LSTV is considered a true synovial joint?
LSTV type 2A
73
What is the clinical significance of a LSTV type 2A?
^incidence of disc herniation at disc above
74
Where would pain be located in a symptomatic patient with a LSTV type 2A?
accessory joint or contralateral facet
75
Patient presents with low back pain. What is the diagnosis?
Bertolotti syndrome (LSTV type 2A + pain)
76
What is the diagnosis?
LSTV type 2B
77
What is the diagnosis?
LSTV type 3A
78
What is the diagnosis?
LSTV type 1A
79
What is facet tropism?
Asymmetrical orientation of facets, where one is more coronal, and one is more sagittal
80
What modality is best to view facet tropism?
CT or MRI
81
What modality is used?
CT
82
What is the clinical significance of facet tropism?
Strongly debated (none)
83
What is clasp knife syndrome?
SBO at S1 + megaspinous at L5
84
What soft tissue is implicated in clasp knife syndrome?
Thecal sac is compressed in extension
85
What radiographic view should **never** be used to diagnose clasp knife syndrome?
Ferguson view
86
What is the diagnosis?
Clasp knife deformity (Syndrome if pain associated)
87
What is the diagnosis?
Agenesis of articular process

NYCC Bone & Joint (71 decks)

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