MSK - Spine Flashcards
What type of mets do Breast Ca cause?
Lytic or sclerotic or Mixed
What is Klippel-feil syndrome?
Segmental anaomaly
Arises during foetal development
Leads to cervical fusion of 2 or more vertebrae:
- usually C2-3
- next most common is C5-6
Associated features:
- -GU abnormalities*
- -Scoliosis*
- -Sprengel shoulder (scapula attached to cervical vertebra by fibrous or osseous connection known as Omovertebral bone)*
- -Deafness*
- -Cervical rib*
Others:
- Odontoid dysplasia
- Hemivertebrae (incomplete formation of one half of veretbra - results in scoliosis)
- Syringomelia
- Ear anomalies
- Congenital heart disease
How to differentiate Tuberculous discitis with Staph discitis?
Intramedullary spinal lesion in a young adult
What are main differential diagnoses?
- Ependymona (most common)
- Astrocytoma
Ependymomas demonstrate AVID enhancement whereas astrocytoma enhances less
What is an ependymoma?
Where are they located usually?
What are characteristics on MRI?
Cystic tumours
Occur in 4th ventricle and spinal cord (intramedullary)
Most common spinal cord tumour in adults and children
Most common CERVICAL SPINE
Features
MRI: low T1, high T2, avid contrast enhancement (inhomogenously)
Will cause symmetric expansion of cord
Can be associated with a syrinx the higher they are
How does a spinal haemangioblastoma appear?
What are features on MRI?
How to differentiate from ependymona?
3rd most common intramedullary spinal lesion
Can have mixed intramedullary/extramedullary location
RARELY occur in children
1/3 of patients have Von hippel lindau
Tumours are BENIGN and do NOT undergo malignant transformation
MRI: T1 iso/low, T2 iso/high
Tumour nodule enhances
Differentials:
Neoplastic (look for enhancing component) vs Vascular malformations (look for enlarged vessels)
Causes of atlanto axial subluxation
Name 4
What are causes of posterior vertebral scalloping?
SATAN mnemonic
Due to pressure effect on bone causing remodelling
Differing bone marrow signal on MRI
How does normal marrow appear?
How does post radiotherapy appear?
How does myeloma appear?
Intradural vs extradural lesions?
What are main extra dural lesions?
What are the classic apperances of a hemangioblastoma?
Cyst with an enhancing nodule (less common apperance in the spine though)
High T1
High T2
Can cause polycythaemia due to EPO production
What are dumbell lesions of the spinal cord?
Give examples
Lesions that extend from central canal to the paravertebral space through exit foramina
MNNGS
Meningioma
Neurofibroma
Neuroblastoma
Ganglioneuroma
Schwannoma
What are the apperances on MRI of spine infiltration by myelofibrosis?
Bone marrow replaced by fibrous tissue
Low T1
Low T2
Concurrent hepatosplenomegaly common due to need for extramedullary haematopoesis (production of red and white cells outside of bome marrow (medulla))
Haematopoetic stem cells migrate to liver and spleen where cells are then made
Name 3 causes of anterior vertebral scalloping?
AAA
Lymohadenopathy
TB
Delayed motor development
What is ivory vertebra?
What causes it?
Dense sclerosis of a vertebral body
- Pagets
- Sclerotic mets
- Lymphoma + Leukaemia + Mastocytosis
- Infection
- Hemangioma
What are differentials for widened interpedicular distance?
Diastematomyelia is where cord is split in two
- either two separate dural sacs (Type 2 - less severe)
- or split cord within 1 dural sac (Type 1)
TIMED mnemonic
What is appearance of vertebral body post radiotherapy?
Very HIGH T1
Iso T2
There is marrow replacement with FAT post radiotherapy
Dermatomes
