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(3) Musculoskeletal Imaging > S2_L1 Trauma & Degenerative Conditions of the LS Spine; SI Joint Pathology > Flashcards

S2_L1 Trauma & Degenerative Conditions of the LS Spine; SI Joint Pathology Flashcards

1
Q

Modified T/F
A. CT Scan is the ideal imaging modality for evaluating major trauma patients.
B. Its speed and versatility of imaging multiple body systems in one examination makes it preferred for life threatening situations.

A

TT

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2
Q

Modified T/F
A. The TL junction is the predominant site of vertebral fractures due to a relatively mobile thoracic spine and fixed lumbar spine.
B. The TL junction is from T11-L2, and is referred to as a “transition segment.”

A

FT

A: due to a relatively fixed thoracic spine and mobile lumbar spine.

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3
Q

Meyerding Classification of Spondylolisthesis

The vertebra has translated forward as much as 75%.

A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

A

C. Grade 3

Note: 51-75% slippage

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4
Q

Meyerding Classification of Spondylolisthesis

Approximately 48% of the vertebra has slipped

A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

A

B. Grade 2

Note: Grade 2 = >25-50% slippage

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5
Q

Meyerding Classification of Spondylolisthesis

The vertebra has completely slipped (100%) from the vertebra below it.

A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

A

D. Grade 4

Note: Spondyloptosis refers to ≥100 slippage

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6
Q

Meyerding Classification of Spondylolisthesis

The vertebra has slipped by 20%

A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

A

A. Grade 1

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7
Q

Modified T/F
A. Spondylolysis is the forward displacement of one vertebra over the stationary vertebra below.
B. Spondylolisthesis refers to a defect or fracture of the pars interarticularis.

A

FF

A: Spondylolisthesis
B: Spondylolysis

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8
Q

Modified T/F
A. Fracture spondylolisthesis leads to the step off of the spinous process below the level of the slip.
B. Degenerative spondylolisthesis results in a step off of the spinous process above the level of the slip.

A

FF

A: step off is above
B: step off is below

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9
Q

Modified T/F
A. A radiolucent line across the pars interarticularis, known as the Scottie dog with a collar, is a radiologic finding in spondylolysis.
B. A decapitated Scottie dog is a radiologic finding in spondylolisthesis.

A

TT

Note: The Scottie dog with a collar can be seen in the oblique view.

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10
Q

Modified T/F
A. SPECT can be used to distinguish stenosis vs medical disease, infections or tumors.
B. MRI is the best choice for characterizing spinal stenosis, providing an accurate canal diameter and the status of neural tissues in the canal.

A

TT

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11
Q

Modified T/F: Imaging spinal stenosis
A. CT myelogram injects the thecal sac with contrast media, showing constriction of the thecal sac and impeded flow of CSF, but it is invasive.
B. CT with contrast shows an enhanced visualization of margins of the epidural space.

A

TT

Note: CT myelogram is used for worst case scenarios.

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12
Q

Radiologic Findings in SI joint pathology

  1. Joint sclerosis and ligamentous ossification
  2. Water density mass posterior to defect, CSF within the sac
  3. Bamboo Spine

A. Ankylosing spondylitis
B. Spina bifida

A
  1. A
  2. B
  3. A
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13
Q

Radiologic Findings in SI joint pathology

  1. Squaring-off of anterior border of vertebral bodies
  2. Widened interpedicular distance on AP view due to failure of arches to develop

A. Ankylosing spondylitis
B. Spina bifida

A
  1. A
  2. B
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14
Q

Modified T/F
A. Sacroiliitis is the first presenting symptom of SI joint pathology.
B. In the early stage, it presents with a narrowed space secondary to progressive inflammatory erosions, but in later stages the space widens.

A

TF

B: Early stage - widened space secondary to progressive inflammatory erosions; Later stage - narrowed space

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15
Q

Modified T/F
A. The upper halves of the SI joint are synovial in nature.
B. The lower halves of the SI joint are syndesmotic in nature.

A

FF

A: Upper halves = syndesmotic
B: Lower halves = synovial

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16
Q

TRUE OR FALSE: Radiographic examination for IV disc herniation is unnecessary in the first 4-6 weeks at the onset of symptoms.

A

True

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17
Q

Spina Bifida

  1. Most benign manifestation of spina bifida
  2. No skin abnormality on the low back of the patient
  3. Defect in posterior arch allows protrusion of spinal cord and coverings outside the spinal canal

A. Spina Bifida Occulta
B. Spina Bifida Vera

A
  1. A
  2. A
  3. B
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18
Q

TRUE OR FALSE: Spina bifida vera goes beyond the skin of the patient, resulting in a skin abnormality.

A

True

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19
Q

Radiologic Findings of Ankylosing Spondylitis (Yes or No)

  1. Syndesmophytes bridge vertebral bodies
  2. Radiolucent line cannot be seen anymore
A
  1. Yes
  2. Yes
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20
Q

Radiologic Findings of Ankylosing Spondylitis (Yes or No)

  1. Fusion of SI joint
  2. Narrowing of lower half of the SI joint is the earliest finding.
A
  1. Yes
  2. No (Narrowing of the upper half)
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21
Q

It is the most common congenital anomaly of the spine.

A

Spina bifida

22
Q

SI Joint Pathology

  1. Chronic progressive inflammatory arthritis
  2. Neural tube defects
  3. Causes stiffness of the back
  4. Failure of posterior vertebral arches to fuse

A. Ankylosing spondylitis
B. Spina bifida

A
  1. A
  2. B
  3. A
  4. B
23
Q

TRUE OR FALSE: Ankylosing spondylitis is more common in women, especially postmenopausal women.

A

False, it is common in males

24
Q

Modified T/F
A. Sacroiliitis is the inflammation of the synovial portions of the SI joint, seen only on the upper segments.
B. Sacroiliitis can be caused by RA, infections, or early degenerative processes.

A

FT

A: sacroiliitis is seen only on the lower segments that are synovial in nature

25
Q

Radiologic Findings

  1. Decreased disk space height
  2. Sclerosis
  3. Osteophytosis at joint margins

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. A
  2. B
  3. B
26
Q

Radiologic Findings

  1. Schmorl’s nodes
  2. Osteophytes visible as radiodense irregularities at vertebral joint margins

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. A
  2. C
27
Q

Radiologic Findings

  1. Osteophytes at vertebral endplates
  2. Vacuum phenomenon
  3. Decreased zygapophyseal joint space

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. A
  2. A
  3. B
28
Q

Characteristics of degenerative conditions

  1. Osteophytosis
  2. Affects zygapophyseal (facet) joints
  3. Disk dehydration

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. B
  2. B
  3. A
29
Q

Characteristics of degenerative conditions

  1. Eburnation
  2. Formation of osteophytes at the vertebral endplates in response to degenerative disk disease

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. B
  2. C
30
Q

Characteristics of degenerative conditions

  1. Subchondral bone sclerosis
  2. Intravertebral herniation of nuclear material
  3. Fibrous replacement of annulus

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. B
  2. A
  3. A
31
Q

Characteristics of degenerative conditions

  1. Articular cartilage thinning
  2. Nuclear herniation

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. B
  2. A
32
Q

Radiologic Findings

  1. Annular protrusion
  2. Accumulation of nitrogen gas in fissures of disk

A. Degenerative Disk Disease
B. Degenerative Joint Disease
C. Spondylosis

A
  1. A
  2. A
33
Q

Enumerate the anatomical regions of stenosis

A
  1. Central spinal canal
  2. IV foramen
  3. Subarticular or lateral recess
34
Q

IV disc herniation

  1. posterior or posterolateral herniation from acute trauma (falls, heavy lifting)
  2. due to compression injuries or weakening of Sharpey’s fibers

A. Anterior disc herniation
B. Intravertebral
C. Intervertebral
D. Intra-spinal

A
  1. C
  2. A
35
Q

IV disc herniation

  1. due to rupture of annulus and posterior longitudinal ligament
  2. due to weakening of the vertebral end plate (osteoporosis)

A. Anterior disc herniation
B. Intravertebral
C. Intervertebral
D. Intra-spinal

A
  1. D
  2. B
36
Q

Modified T/F
A. IV disc herniation is the extension of disc material beyond adjacent vertebral margins with or without annulus tear.
B. A posterior disc herniation is more commonly seen than an anterior disc herniation.

A

TT

37
Q

TRUE OR FALSE: Intervertebral disk herniations are common with the lumbar spine.

A

True

38
Q

Modified T/F
A. MRI is the imaging study of choice for IV disc herniations if the patient presents with focal and/or progressive neurologic deficits.
B. Most disc herniations will appear normal on x-rays.

A

TT

Note: X-rays are of little significance for disc herniations.

39
Q

Modified T/F
A. Discography is a provocation test used for IV disc herniations to see the morphology of the disc with injection of a radiopaque dye.
B. The dye distends the nucleus pulposus, and if pain is present, the disc is the source of the pain.

A

TF

B: The dye distends the annulus, and if pain is present, the disc is the source of the pain.

40
Q

Lumbar disk pathology

  1. Involves <25% (<90º)
  2. Involves 50-100% of circumference
  3. Narrower neck

A. Bulging disc
B. Broad-based protrusion
C. Focal protrusion
D. Extrusion
E. Sequestered

A
  1. C
  2. A
  3. D
41
Q

Lumbar disk pathology

  1. Involves 25-50% (90-180º)
  2. Free fragments
  3. Not a herniation

A. Bulging disc
B. Broad-based protrusion
C. Focal protrusion
D. Extrusion
E. Sequestered

A
  1. B
  2. E
  3. A
42
Q

Modified T/F
A. X-rays help localize the lesion in fractures of the lumbar spine.
B. On the other hand, MRI is not indicated if CT scan is normal as isolated ligamentous injuries are rare in the lumbar spine.

A

TT

Note: MRI can be used to evaluate spinal cord edema, cord contusion, epidural hematoma, ligamentous disruptions or nerve root involvement.

43
Q

Enumerate the spinal levels commonly affected in spondylolysis.

A

L4-L5 and L5-S1

44
Q

Modified T/F
A. Lumbar spinal stenosis is the narrowing or constriction of the spinal canal because of soft tissue or bony enlargement.
B. It leads to compression of the lower segments of the spinal cord, thecal sac with CSF, and dural membranes.

A

TF

B: compression of the upper segments of the spinal cord

45
Q

Modified T/F
A. In imaging of spondylolysis, CT scan has high sensitivity and anatomic detail but the spinal level must be known first prior to scanning.
B. MRI can also be used to detect edema on T1 weighted imaging.

A

TF

B: detect edema on T2 weighted imaging

46
Q

S pinal canal AP diameter (normal or stenosed)
1. C5-C7: 13 mm
2. Thoracic spine: 9 mm
3. Lumbar spine: 25 mm
4. C3-C7: 18 mm

A
  1. Normal (NV: 12-14mm)
  2. Stenosed (<10-13mm = stenosed)
  3. Normal (NV: 15-27mm)
  4. Normal (NV: 17-18mm)
47
Q

Spinal canal AP diameter (normal or stenosed)
1. C5-C7: 8 mm
2. Thoracic spine: 14 mm
3. Lumbar spine: 12 mm
4. C3-C7: 9 mm
5. Thoracic spine: 12 mm

A
  1. Stenosed (<10 = stenosis)
  2. Normal (12-14mm)
  3. Stenosed (<10-12 mm = stenosis)
  4. Stenosed (<10 = stenosis)
  5. Normal
48
Q

Modified T/F
A. Spondylolysis can be congenital, traumatic, or caused by chronic strain leading to a stress fracture.
B. The most common cause is trauma.

A

TF

B: most common is chronic strain leading to stress fracture

49
Q

TRUE OR FALSE: SPECT has excellent accuracy in imaging of spondylolysis, but it is not cost-effective and not readily available.

A

True

50
Q

TRUE OR FALSE: Spondylolisthesis can be a result of spondylolysis, congenital or developmental aberrations, and pathological processes or degenerative changes.

A

True

51
Q

Modified T/F
A. Failure of conservative treatment warrants radiographic evaluation of IV disc herniation.
B. CT with contrast is used to image disc herniations if MRI is contraindicated or unavailable.

A

TT

52
Q

Radiographic findings of IV disc herniation (Yes or No)
1. Spondylosis
2. Vacuum disc
3. Joint space alterations
4. Schmorl’s nodes

A

Yes, all are radiographic findings

Note: Schmorl’s nodes are seen in arthritic changes in the spine

(3) Musculoskeletal Imaging (25 decks)

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