7c. Spine Pathologies

Question 1

what are the 3 things that bones should be examined for

Answer 1

examined for fractures collapse/height/avulsion
parallel facet joints
abnormal calcification

Question 2

what should be examined for disc spaces

Answer 2

examine for symmetry/normality of the intervertebral discs between each vertebra

Question 3

what are the spaces that should be checked for dens view of C spine

Answer 3

height of disk symmetrical on both sides

distance between medial sides of lat masses and peg are equal on both sides

check if lateral aspect of C1 and 2 aligned

Question 4

what are the lines to be checked for alignment of vertebral bodies and processes

Answer 4

anterior and posterior vertebral lines

Question 5

what may widening prevertebral soft tissue indicate

Answer 5

pus or blood build up in the neck leading to swelling of tissue

Question 6

what is the max prevert soft tissue space distance in C3

Answer 6

max 5mm

Question 7

what is the max prevert soft tissue space distance in C2

Answer 7

<7mm anterior to C2

Question 8

what is the max prevert soft tissue space distance in C7

Answer 8

<2cm anterior to C7

Question 9

what is retropharyngeal infection and what does it look like

Answer 9

collection of pus and space gets larger and pushes out anteriorly and can obstruct airway by retropharyngeal mass/infection

anterior to C2/3 there is an increase in prevertebral soft tissue space

Question 10

what is scoliosis

Answer 10

side to side curvature of the spine

Question 11

what is kyphosis

Answer 11

AP curvature of spine

Question 12

what are the 3 causes of scoliosis

Answer 12

idiopathic, associated with cerebral palsy and muscular dystrophy

Question 13

what are the 3 causes of kyphosis

Answer 13

idiopathic, fractures, osteoporosis

Question 14

how can kyphosis impact the spinal cord

Answer 14

spinal cord stretches around the deformity/kyphotic angle and can result in impingement

Question 15

what is spina bifida occulta

Answer 15

small defect of posterior elements of a vertebra

Question 16

what is spina bifida - myelomeningocele

Answer 16

spinal canal remains open along several vertebrae in the lower/middle back

both the membranes and the spinal cord or nerves exposed in sac

Question 17

what is spina bifida - meningocele

Answer 17

no cord protruding just fluid in sac

Fluid filled sac at back with no neural tissue often occur below level of where you have spinal cord like in sacrum

Question 18

what is a cause of spina bifida

Answer 18

Deficiency of folic acid

Question 19

what is multiple sclerosis

Answer 19

autoimmune disease response that destroys myelin sheath that insulates nerve fibres

Question 20

what does multiple sclerosis affect

Answer 20

brain and spinal cord

Question 21

where can lesions of multiple sclerosis develop

Answer 21

brain, optic nerves and spinal cord

Question 22

metastases has what appearance on xrays

Answer 22

increased bone signal

Question 23

what do sclerotic metastases do to the bone strength and what does this mean for #

Answer 23

retain strength in bone so unlikely fracture, increases bone density

Question 24

what do lytic metastases do to the bone strength

Answer 24

decrease density and destroy bone

Question 25

what can metastases do to the spinal cord

Answer 25

can encroach on spinal cord and cause spinal cord compression

Question 26

if the metastases are high signal and bright but the spinal canal is dark what MRI type is it

Answer 26

T1 as its contrast enhanced and metastases have higher water content

Question 27

will there be a difference between pre and post contrast for metastases in MRI T2

Answer 27

no

Question 28

what is multiple myeloma

Answer 28

white blood cell malignancy and deposits widely in bone

Question 29

what appearance does multiple myeloma have for bone on images

Answer 29

moth eaten appearance

Question 30

what does multiple myeloma do to the bone in the spine

Answer 30

Spine taken over by tumor and destroys bone and replaced bone so bone becomes weaker and collapse on itself, vert reduced in height and tumor replacement between bony fragments

Question 31

what other condition resembles multiple myeloma

Answer 31

osteoporosis

Question 32

what is ewing sarcoma

Answer 32

aggressive primary bone tumor, locally invasive and has soft tissue mass

Question 33

what do patients present with for ewings sarcoma

Answer 33

swelling and pain at site of tumor

Question 34

what is characteristic of ewing sarcoma on images

Answer 34

soft tissue mass expands into the spinal canal

Question 35

what are bone hemangiomas

Answer 35

benign malformed vascular lesions

Question 36

where do bone hemangiomas occur most frequently

Answer 36

occur most frequently in vertebral column, commonly in L spine

Question 37

what are bone hemangiomas seen as on images

Answer 37

bright round spot

Question 38

what are 3 characteristic features of OA in the vertebral column

Answer 38

bony spur/osteophyte vertebral/intervertebral height loss nerve root entrapment/compression

Question 39

what is typical of TB in the spine

Answer 39

collection of fluid ant to vert itself and collection post compressing spinal cord (ant collect is typical of TB)

Question 40

what is gibbous TB

Answer 40

Gibbous is acute angulation/kyphosis of sp cord due to TB

Question 41

what is osteoporosis in the spine

Answer 41

compression fracture risk and greatly reduced bone density

Question 42

why does osteoporosis in the spine increase fracture risk and what results

Answer 42

Once structure of vertebrae itself becomes frail it can collapse on itself, lose height ant but post mostly fine -> kyphosis results (wedge fractures)

Question 43

what does a osteoporotic vertebra create in the lateral veiw

Answer 43

wedge shape

Question 44

what is a slipped disk

Answer 44

intervertebral disk has defect and soft centre of disk protrudes into spinal canal and can compress nerve roots emerging from spinal cord or compress spine

Question 45

what is disc herniation

Answer 45

height of disc reduced so less space for spinal nerve content of disc squished posteriorly and impinges on nerve as it exits foramina

Question 46

what are the most common areas for disk herniation

Answer 46

L3-5 commonly C spine second most common area of spine

Question 47

what is spinal stenosis

Answer 47

reduce space for spinal cord

Question 48

what is the 3 most common cause of spinal stenosis

Answer 48

disc herniation thickening of ligamentum flavum OA

Question 49

what scan is needed if suspect a Cspine injury

Answer 49

CT scan

Question 50

what is a tear drop # caused by

Answer 50

hyperflexion injury head acutely flexed forwards causing compression of vert so ant part breaks off (hyperflex injury)

Question 51

what is a burst fracture

Answer 51

Fragments of bone going ant and post that can protrude into the spinal canal and can impinge on sp cord

Question 52

why is a C2 dens fracture so unstable

Answer 52

once dens #s, only ligament holds C1 and 2 together so very unstable

Question 53

what can be seen in a sagittal view for a C2 dens #

Answer 53

small collection of blood could be ant to dens

Question 54

why is C2 body # deadly

Answer 54

because it can cut straight through the spinal cord that could kill the patient

Question 55

what is a jefferson fracture

Answer 55

compression fracture of C1 bony ring

Question 56

what 3 things to be checked in a jefferson fracture

Answer 56

check height which is equal both sides, distance betw dens and med border of lat masses, Lateral masses movement

Question 57

what is spondylolithesis

Answer 57

both or one of pars in the vert Vert body slipped ant to lower levels and can cause compression of nerve roots