bone path midterm Flashcards
(136 cards)
1
Q
What is the most widely used skeletal imaging method used?
A
Plain film radiography.
2
Q
How much bone loss must be present to be seen on an X-ray or on an MRI? How large must lesion be?
A
X-ray- 30-50%. MRI- 1%. X-ray- at leaste 1-5 cm.
3
Q
What will be darker fat or water?
A
Fat.
4
Q
What is radiopaque and radiolucent?
A
Radiopaque- white. Radiolucent- dark.
5
Q
Name the 3 rules of I don?t know just name the 3 rules?
A
- Anomalies occur more commonly in transitional areas. 2. Anomalies may be isolated but are frequently associated with other skeletal/spinal anomalies. 3. Anomalies may have an increased frequency of organ/soft tissue anomalies.
6
Q
How can you tell if occipitalization has taken place?
A
use lateral view and check for space between posterior arch of C1-occiput.
7
Q
What things are seen with occipitalization?
A
up to 70% of the time C1-C2 will be unstable and there can be basilar impression.
8
Q
Name 4 occipital vertebrae and what views they can be seen on?
A
- Third condyle- lateral film. 2. Epitransverse process. 3. Paracondylar process. 4. Paramastoid process. 2-4 seen on APOM.
9
Q
What is a third condyle?
A
An anterior midline bony process located between the 2 occipital condyles and continuous with the anterior foramen magnum extends a variable distance caudally. Occasionally forms an articulation with the apex of the dens or anterior arch.
10
Q
What are paracondylar, paramastoid and epitransverse processes?
A
variations of congenital bone bars that extend between the occiput and transverse processes of the atlas. They may be unilateral or bilateral.
11
Q
What is a paramastoid process?
A
Bony protuberance from jugular process of occiput and projects inferiorly toward the atlas TP.
12
Q
What is the paracondylar process?
A
arises slightly more medial and anterior in the paracondylar area of the occiput and projects inferiorly.
13
Q
What is the epitransverse process?
A
Attached to atlas TP and directed superiorly toward the adjacent occiput.
14
Q
What is Basilar impression/invagination?
A
Dens encrochment into foramen.
15
Q
What are the 2 types of Basilar impression/invagination?
A
primary- congenital- occipitalization, C1 posterior arch agenesis, SBO.. Secondary- bone softening diseases like pagets, osteomalacia, fibrous dysplasia.
16
Q
What is arnold-chiari 1 malformation?
A
Downward displacement and elongation of the brainstem and cerebellar tonsils.
17
Q
What are the symptoms of Arnold-chiari malformation?
A
variable with headaches, neck pains, and other more serious stuff.
18
Q
Arnold-chiari malformation is associated with what?
A
Skeletal anomalies, occipitalization, basilar impression, wrong way scoliosis, blocked cervical vertebrae, cervical ribs.
19
Q
What other findings are commonly seen with arnold-chiari malformation?
A
Syringomyleia (syrinx), hydrocephalus.
20
Q
What is a normal variant of arnold-chiari malformation?
A
less than 3 mm downward displacement.
21
Q
Name 5 things to do when evaluating a flim?
A
- Identify the study. 2. Identify info markers. 3. Note collimation, sheilding, and artifacts. 4. Note techniqual quality. 5. Search pattern like ABC’S.
22
Q
What are the categories of lesions?
A
CATBITES= Congenital/dysplasia, Arthritis, Trauma, Blood/vasculature, Infection/inflammatory, Tumor/tumor like, Endocrine/metabolic, Soft tissue.
23
Q
How can you tell C7 apart from T1?
A
C7- TP’s point out laterally. T1- TP’s point up.
24
Q
What causes Pars defects?
A
Repetitive trauma causing fractures and they were not healed up usually happens in youth.
25
With plain film it is absolutly necessary to have how many views?
Atleaste 2 and they should be perpendicular to eachother.
26
Tomo means what?
A cutting.
27
What are the advantages to Tomography?
Evaluate complex structures like the skull and spine and complex deformities can be readily analyzed.
28
What are the disadvantages of tomography?
Increased radiation.
29
What is xeroradiography used for?
detecting foreign bodies in soft tissues like mammography.
30
What is platybasia?
Flat skull base.
31
What causes platybasia?
Congenital sphenoid and/or occipital maldevelopment.
32
Basilar impression can be complicated by what?
Sudden hearing loss, pyramidal signs, posterior column signs and wasting of the upper limbs.
33
What is spina bifida occulta AKA SBO?
failure of fusion of the 2 posterior arch ossification centers producing a midline default.
34
What is the clinical significance of SBO?
Y and R say none, but others say it can have a increased incidence of posterior disc herniation and associated isthmic sponlylisthesis.
35
How is a C1 anterior arch agenesis seen?
Absence of a D shaped anterior arch on lateral cervical film.
36
Name 2 bone destroying diseases?
tumor and infection.
37
What causes agenesis of posterior arch of C1?
lack of cartilage template or a cartilage template that did not ossify. May be partial or complete.
38
What is usually seen with agenesis of posterior arch of C1?
Hypertrophy of anterior arch and megaspinous of C2.
39
Can a missing posterior arch of C1 be due to a tumor?
Not usually since there is a lack of blood supply to C1 since there is no body.
40
What is a posterior ponticle?
Partial or complete ossification of the oblique portion of the atlanto-occipital membrane.
41
Where is the atlanto-occipital membrane located at?
It bridges the posterior lateral mass and the posterior arch and forms the peripheral border of the arcuate foramen.
42
What travels through the arcuate foramen?
Vertebral artery and veins, first cervical nerve and perivascular sympathetics.
43
Will a posterior ponticle be uni or bi lateral?
Most common unilateral.
44
What radiographic feature is seen in Down's syndrome?
20% are born without a transverse ligament and this leads to axial instability. This will be seen as increased ADI on flexion and lateral view.
45
What is ossiculum terminale and it is aka?
non-fusion of secondary growht center of the dens and it is aka persistens of Bergmann.
46
What is the clinical significance of ossiculum terminale aka persistens of Bergmann?
No clinical significance.
47
What is Os odontoideum?
2 halves of the odontoid unite and do not fuse to C2 body.
48
What causes Os odontoideum?
Probably due to old fracture with nonunion.
49
Will Os odontoideum be stable and why or why not?
Not stable the transverse ligament if intact, but dens is not attached to C2 body.
50
When can os odontoideum be diagnosed?
Not until after age 5 unless hypermobility of dens is demonstrated.
51
What is hypoplastic/agenetic odontoid?
The odontoid halves do not develop fully or at all.
52
What is the cause of hypoplastic/ agenetic odontoid?
Hypoplastic- partial formation of dens. Agnetic- complete agenesis of dens and is very rare.
53
What films should be ordered and why when a hypoplastic/ agenetic odontoid is seen?
Flexion/ extension to see if it is stable.
54
What might need to be done to a patient with hypoplastic/ agenetic odontoid?
Possible surgery.
55
What is block vertebra? AKA?
Non segmentation of two adjacent segments. AKA synostosis.
56
What are the classic findings of a block vertebra aka synostosis?
decreased AP diameter, rudimentary disc, apophyseal joint fusion, possible fusion or malformation of SP's and a Wasp waisted appearance.
57
What are the complications seen with block vertebra/synostosis?
Premature DJD at adjacent levels, laxity at adjacent levels due to increased stresses.
58
What is the most common level in the cervical and lumbar spine for block vertebra/ synostosis?
C2-3 than C5-6. L4-5.
59
What is klippel-feil syndrome?
Multiple block verebra with SBO, scoliosis, spregel's deformity, platybasia.
60
What is the classic triad of klippel-feil syndrome?
1. Short neck webbed neck (pterygium colli). 2. Lowered hairline. 3. Decreased cervical ROM.
61
What else is commonly seen with Klippel-feil syndrome?
genito-urinary (GU) anomalies. Use ultrasound to demostrate presence of 2 functioning kidneys. Can also use MRI, intravenous urogram.
62
What is Sprengles deformity?
Congenital undescended scapula.
63
What is seen with sprengles deformity besides an undescended scapula?
Omovertebral bone that connects scapula to spine.
64
What is the scapula like with sprengels deformity?
Hypoplatic (underdeveloped or incomplete), shortened vertically and is broad on radiographic examination and is rotated so that the glenoid process is directed inferiorly. It can be elevated 2-10 cm.
65
What is cervical spondylolisthesis?
A slipping of the cervical vertebra caused congenitally by bilateral agenesis of pedicles and dysplasia of articular processes.
66
Cervical spondylolisthesis is most common at what level? And most common amoung who?
C6. M>F.
67
What is commonly seen with cervical spondylolisthesis?
SBO at the same level.
68
What is the clinical significance of cervical spondylolisthesis?
Most are asymptomatic and lack neurological abnormalities. There can be problems like radicular pain and neck stiffness, headaches and torticollis but link to defect is unclear.
69
Where are the cervical ribs most commonly seen at?
C7>C6>C5.
70
What is the difference between a cervical rib and a hyperplastic (over-developed) TP?
Cervical rib- articulation with TP and Hyperplatic TP will have no articulation.
71
What is seen clinically with cervical ribs?
May get myelopathy, weakness and other symptoms.
72
What are C1 lateral mass notches?
Apparent defects in the medial aspects of the lateral masses, but these lucencies of the atlas represent attachment sites for the transverse ligament.
73
What is the Mach effect?
A lucency that looks like a fracture of the odontoid base but it is caused by overlapping of posterior arch of C1 or overlapping of; lips, tounge, and occiput.
74
What are paraodontoid notches?
Notches in the Notches that are on the sides of the dens seen in APOM and are normal variants not pathological.
75
What is stylohyoid ligament ossification?
Ossification of the stylohyoid ligament that may be isolated or associated with other diseases.
76
What is stylohyoid ligmanet ossification and dysphasia (loss of or deficiency in the power to use or understand language as a result of injury to or disease of the brain) called?
This is known as Eagle's syndrome.
77
What is facet notching?
Normal notching of superior articular process may mimic erosive process or fracture.
78
What can mimic a cervical vertical pillar fracture?
Rotation due to articular pillar overlap.
79
Transverse foramen of C2 appear as what and are seen more in which view?
They are round lucency and should not be confused with a destructive process and may be seen more in a true lateral position.
80
What is Hahn's venous clefts?
Vascular channels seen as horizontal lucencies through mid-vertebral body.
81
Where are han's venous clefts most common at?
Lower throacic spine.
82
Will blocked vertebra be more common in cervical region or lumbars?
Cervical.
83
What are butterfly vertebra?
Vertebra that have a sagital cleft that separtes the vertebral body into 2 symmetrical halves.
84
Butterfly vertebra are most commonly seen where?
Thoracic and lumbar vertebra.
85
What is the clinical significance of butterfly vertebra?
If isolated no significance, but if there are multiple then is is associated with other anomalies.
86
What is another finding seen with butterfly vertebra?
Continuous disc material from adjacent discs.
87
What causes hemivertebra?
Failure of ossification center of part of the vertebra. May be dorsal or ventral (leaste common).
88
What is usually also seen with hemivertebra?
Other anomalies like block vertebra, Klippel-feil, diastematomyelia.
89
What is the shape of a hemivertebra?
Wedge-shaped.
90
What are endplates like with hemivertebra?
adjacent endplate deformities.
91
When will hemivertebra cause scoliosis?
When isolated.
92
What is the term for multiple hemivertebra with block vertebra?
Scrambled spine.
93
What is a differential for a dorsal hemivertebra?
Compression fracture.
94
What are schmorl's nodes?
Herniation of nucleus pulposus through vertebral endplates.
95
What causes schmorl's nodes?
Due to developmentally weak endlpates, trauma, or pathological process like osteoporosis.
96
What is the clinical significance of schmorl's nodes?
usually asymptomatic, but may be painful.
97
What will schmorls nodes look like?
Focal indentations into vertebral body with sclerotic margins. May be central or peripheral.
98
What is the difference between nuclear impression and schmorl's nodes? What is a nuclear impression.
Nuclear impressions are a persistent notochord that looks like a schomorl's node and have smooth borders and are not as sclerotic.
99
What are 2 different names for nuclear impressions?
Double hump, cupid's bow.
100
What is an anterior limbus vertebra/bone?
Nucleus pulposus herniates through the endplate and is like a schmorls node.
101
Where will limbus vertebra/bone have nucleus pulposus herniate through the endplate at?
At ring apophysis a secondary growth area of vertebral body. Usually leaves a triangel shaped bone that is separate from the vertebral body in the superior anterior part.
102
What causes limbus vertebra/ bone and what is the clinical significance?
Most likely due to trauma in developing spine and is usually not associated with symptoms unless it is a posterior limbus bone and this may cause spinal canal stenosis.
103
What is spina bifida vera?
A true spina bifida. A larger defect in posterior elements and may allow fro meninges and or spinal cord protusion (meningocele/ myelomeningocele).
104
What % of spina bifida vera is genetic and what is a lab finding of spina bifida vera before birth?
60%. Seen with incerased alpha-fetoprotein in amniotic fluid.
105
What is a common outward finding of spina bifida vera?
Overlying hair patch, dimple, or lipoma.
106
What is the clinical significance of spina bifida vera?
Multiple neurologic and musculoskeletal compliactions are possible.
107
Depending on the severity spina bifid vera with meningocele or meningomyelocele may be associated with what?
Clubfeet, lower extremity paralysis, incontinence or incomplete development of lower extremities.
108
What is Diastematomyelia?
An intraspinal canal cartilage, osseous or fibrous sagittal bar dividing the spinal cord into 2 hemicords.
109
How common is diastematomyelia and where is it most commonly seen at?
Rare and is most commonly seen in the thoracolumbar junction.
110
You may seen an increase of what with diastematomyelia?
interpediculate distance at this level, osseous intracanal density as well as other spinal anomalies.
111
What is a better way to visualize diastematomyelia?
MRI.
112
What symptoms are seen with distematomyelia?
Tethered cord syndrome; pain, bladder incontinence, weakness in lower extremities.
113
What is seen with pedicle agenesis?
Absent pedicle on one side with hypertophy and sclerosis(tissue hardening or fibrotic) of contralateral pedicle due to altered stresses. Sometimes hypertophy and sclerosis of pedicles of adjacent vertebra. This is often seen as an isolated anomaly.
114
What is the most common cause of pedicle agenesis?
osteolytic metastasis which should not have changes to other pedicles since not as long standing as a pedicle agenesis.
115
What are other causes of sclerotic pedicles besides pedicle agenesis?
Benign or malignant tumors, unilateral spondylolysis, facet anomalies, post-surgical, infection.
116
What is the name of a undifferentiated L5 or S1 vertebrae?
Transitional L/S vertebrae.
117
What will transitional L/S vertebrae have?
Spatulated transverse process uni or bi lateral.
118
What makes a TP a spatulated TP?
>19 mm vertically.
119
What happens to L/S disc with transitional L/S vertebra?
They are hypoplastic.
120
What is often present with transitional L/S vertebra?
Degeneration.
121
What is facet tropism?
Asymmetry of articular facets at any one level.
122
What is the most commonl level fro facet tropism?
L5-S1.
123
Are facet joints curved structures?
Yes they are not purely sagittal or coronal.
124
How can you tell if you have a facet tropism?
On x-ray if you can seen facet joint on one side and not the other, but the definitive proof would be on advanced imaging.
125
What is the clasp-knife syndrome?
SBO of S1 with enlargment of L5 SP.
126
What is the clinical significance of clasp-knife syndrome?
may produce low back pain on lumbar extension due to pressure on the laminar stumps or on the membrane that covers the dura.
127
Articular process agenesis is rare but you need to rule what out?
Osteolytic metastasis.
128
What could be seen with articular process agenesis?
Contralateral side may be sclerotic.
129
What will be seen commonly with lumbar ribs?
Hypoplastic lumbar TP's with lumbar ribs.
130
Lumar ribs are often seen with what other anomaly?
Lumbosacral transitional segment.
131
Where are the secondary growth centers at for vetebra?
SAP, IAP, SP, TP's,
132
What is the name of a unfused inferior articular process in skeletally mature individual?
Oppenheimer's ossicle.
133
What causes illiolumbar ligament ossification?
Often idiopathic but may be due to conditions that lead to soft tissue calcification or degneration.
134
What causes a trapezoidal shaped L5 body?
Normal variant not due to tauma, but may indicate a higher probability of slippage is seen with L5 sponylolisthesis.
135
What is sacral dysplasia/ agenesis?
Congenital absence of the distal portion of the spinal column.
136
Sacral dysplasia / agenesis is aka?
Caudal regression syndrome.
