Congenital Anomalies 1

Question 1

What term is used for the underdevelopment of anatomy?

Answer 1

Hypoplasia

Question 2

What term is used for the overdevelopment of anatomy?

Answer 2

Hyperplasia

Question 3

What term is used for the absence of development of anatomy?

Answer 3

Aplasia

Question 4

What term is used for the increased size of anatomy due to pathology?

Answer 4

Hypertrophy

Question 5

What term is used for the increased size of anatomy from development?

Answer 5

Hyperplasia

Question 6

What type of ossification occurs from a cartilage model formed from mesenchyme? Examples?

Answer 6

Enchondral ossification (extremities, spine, base of skull)

Question 7

What type of ossification occurs when bone tissue replaces membranous fibrous tissue? Example?

Answer 7

Intramembranous ossification (skull)

Question 8

What are the primary ossification centers of a vertebra?

Answer 8

One for centrum, two for each neural arch (3 total)

Question 9

When are primary ossification centers present? Secondary?

Answer 9

Primary = before birth
Secondary = after birth

Question 10

What is the difference between an epiphysis and apophysis?

Answer 10

Epiphysis = forms articular cartilage and gives length to bone
Apophysis = attachment for ligaments and tendons

Question 11

Is a trochanter is an example of an apophysis or epiphysis?

Answer 11

Apophysis

Question 12

What is the condition of the failure of separation of the most cranial somites?

Answer 12

Occipitalization (assimilation of atlas)

Question 13

50% of those with occipitalization of atlas also have vertebral fusion at what level?

Answer 13

C2/C3

Question 14

Since the odontoid process is high with occipitalization, is basically impression common?

Answer 14

No

Question 15

What other films must be done when occipitalization is seen on the lateral X-ray?

Answer 15

Flexion/extension (assess ADI)

Question 16

What are the areas of compensation for agenesis of the posterior arch of C1?

Answer 16

1 enlarged spinous of C2

2 hypertrophy of anterior tubercle

Question 17

What is the condition where the posterior arch of C1 never developed due to a defect in the cartilage template?

Answer 17

Agenesis posterior arch

Question 18

What must be done next when agenesis posterior arch is seen?

Answer 18

Flexion/extension views to check transverse atlantal ligament and to see if C1 and C2 are fused

Question 19

Why does the anterior tubercle become larger with agenesis posterior arch?

Answer 19

Stress is shifted anteriorly from behind

Question 20

What is the condition of spina bifida at C1?

Answer 20

Non union of the posterior arch of C1

Question 21

Why can we still adjust on the posterior arch of C1 if there is a non union?

Answer 21

“hole” is mostly likely made out of cartilage and sturdy

Question 22

What normal finding would be absent on the lateral cervical film with a non union of the posterior arch of C1?

Answer 22

Spinolaminar line

Question 23

What area will compensate by increasing in size following a non union of the posterior arch of C1?

Answer 23

Anterior tubercle

Question 24

What is the most common reason for a terribly large ADI?

Answer 24

Rheumatoid arthritis

Question 25

What is the term for a small piece of bone that grows separately but near the anterior tubercle of C1 that is well corticated?

Answer 25

Accessory ossicle

Question 26

Chiari malformations tend to lead to anomalies specific to what organ system?

Answer 26

Renal

Question 27

What is a Chiari malformation?

Answer 27

Herniation of the cerebellar tonsils

Question 28

Herniation of the cerebellar tonsils less than how many millimeters is considered within normal limits?

Answer 28

3mm

Question 29

Chiari malformation is associated with what kind of spinal curvature?

Answer 29

"wrong way" scoliosis (different from the right thoracic norm)

Question 30

Which is more clinically significant of a serious pathology: right or left scoliotic curve?

Answer 30

Left curve

Question 31

What is the term for a cystic cavity in the spinal cord that tends to develop following an Chiari malformation?

Answer 31

Syrinx/syringomyelia

Question 32

If a left curvature is seen upon X-ray, what should be the next move?

Answer 32

``` Adults = MRI if neurological symptoms are present Children = always do MRI ```

Question 33

What would the treatment be for syringomyelia?

Answer 33

Laminectomy to relieve cord pressure

Question 34

What is the eponym for a posterior ponticle?

Answer 34

Kimmerly anomaly

Question 35

What ligament is ossified to form the ponticulus posticus?

Answer 35

Atlanta-occipital ligament between posterior aspect of lateral mass and posterior arch

Question 36

What structures are contained in the arcuate foramen?

Answer 36

Vertebral artery and first cervical nerve

Question 37

What is a bony extension originating from the transverse process of C1 to the skull base?

Answer 37

Epitransverse process

Question 38

What is a bony extension originating from the skull base to the transverse process area of C1?

Answer 38

Paracondylar process

Question 39

What is the significance of an epitransverse or paracondylar process?

Answer 39

1 possible lateral head tilt | 2 may affect adjusting technique

Question 40

What is os terminale?

Answer 40

Failure of the UNION of the secondary center of ossification found at the TIP of the dens

Question 41

What is os odontoideum?

Answer 41

Failure of FUSION of the odontoid with the body of C2

Question 42

When in age is os terminale usually seen?

Answer 42

After the age of 12

Question 43

How can you differentiate between os terminale and a fracture?

Answer 43

Smooth, white margins = os terminale

Question 44

Which is associated with hypermobility: os terminale or os odontoideum?

Answer 44

Os odontoideum

Question 45

Why is hypermobility associated with os odontoideum?

Answer 45

Dens isn't there to restrict the transverse atlantal ligament

Question 46

What other conditions are associated with os odontoideum?

Answer 46

1 Down's syndrome | 2 Klippel-Feil syndrome

Question 47

How can we assess for atlanto-axial stability especially in cases like an os odontoideum?

Answer 47

Flexion/extension views

Question 48

Most os odontoideum are a result of what prior condition?

Answer 48

Old un-united odontoid fracture

Question 49

Are most old un-united odontoid fractures an os odontoideum?

Answer 49

No

Question 50

What kinds of neurological symptoms can be present with an os odontoideum?

Answer 50

Cerebellar/gait issues, upper motor neuron findings like hyperreflexia

Question 51

What are the most common areas for block vertebrae?

Answer 51

C5/C6 C2/C3 L4/L5

Question 52

How can you tell a block vertebra from a fusion derived from infection?

Answer 52

Maintenance of vertebral body height with block vertebra

Question 53

What is the term for the smooth, concave anterior vertebral body margins seen with block vertebra?

Answer 53

Wasp waist vertebra

Question 54

How is the IVD affected by block vertebra?

Answer 54

Hypoplastic

Question 55

What structures become visible on a lateral X-ray with block vertebra that are usually only seen on cervical obliques?

Answer 55

IVFs

Question 56

What are the four diagnostic criteria for block vertebra?

Answer 56

1 wasp waist configuration 2 hypoplastic IVD 3 IVFs visible on lateral X-ray 4 posterior elements also fused

Question 57

How can block vertebra change mobility?

Answer 57

Hypo at area of blocking, therefore hyper above and below the area

Question 58

What is the term for congenital fusion? Fusion from pathology? Fusion from surgery?

Answer 58

``` Congenital = synostosis Pathology = ankylosis Surgery = arthrodesis ```

Question 59

What condition involves multiple block anomalies in the cervical spine?

Answer 59

Klippel-Feil syndrome

Question 60

Klippel-Feil syndrome is associated with anomalies of what organ system in 50% of cases?

Answer 60

Renal

Question 61

What is the unique appearance of the neck associated with Klippel-Feil syndrome?

Answer 61

Short, webbed neck (pterygium colli)

Question 62

How is the appearance of the hair different in those with Klippel-Feil syndrome?

Answer 62

Low hairline

Question 63

What other conditions or abnormalities are associated with Klippel-Feil syndrome?

Answer 63

1 renal anomalies 2 deafness 3 spinal cord issues like chiari 4 Sprengel's deformity

Question 64

What is Sprengel's deformity?

Answer 64

Failure of a scapula to descend (appears elevated)

Question 65

Horseshoe kidney is seen in patients with what cervical spine anomaly?

Answer 65

Klippel-Feil syndrome

Question 66

What structures appear massive in the cervical spine due to Klippel-Feil syndrome along with anterior body scalloping?

Answer 66

IVFs

Question 67

What gender is more likely to have Sprengel's deformity?

Answer 67

Females (usually unilateral)

Question 68

What is the piece of bone that can run from the superomedial border of the scapula to the spinous processes, transverses, or laminae of C4-C7?

Answer 68

Omovertebral bone

Question 69

Omovertebral bones are found in 35% of cases of what other underlying condition?

Answer 69

Sprengel's deformity

Question 70

A finding of an elongated transverse of C7 occurs when it extends beyond what structure?

Answer 70

Transverse of T1

Question 71

What forms when elongated transverses of C7 join?

Answer 71

Cervical rib

Question 72

Which gender is more likely to have cervical ribs?

Answer 72

Females

Question 73

What is the significance of cervical ribs (although normally asymptomatic)?

Answer 73

Thoracic outlet syndrome (especially in older patients)

Question 74

Cervical ribs can be palpated and confused with what other structure?

Answer 74

Enlarged lymph nodes

Question 75

Why do cervical ribs have symptomatology more in older patients?

Answer 75

Drooped posture of shoulders

Question 76

How do pedicles change in a segment exhibiting butterfly vertebra?

Answer 76

Become wider

Question 77

How do the vertebrae above and below a segment exhibiting butterfly vertebra change to compensate?

Answer 77

Round into the curved space

Question 78

What causes a butterfly vertebra?

Answer 78

Failure of fusion of lateral halves secondary to persistence of notochord tissue

Question 79

In what areas of the spine are butterfly vertebrae most common?

Answer 79

Thoracics and lumbars

Question 80

Can we adjust butterfly vertebrae?

Answer 80

YES (if no hypermobility persists)

Question 81

How do pedicles differ in the lumbar spine?

Answer 81

Become wider as you descend

Question 82

What are the only two conditions that can cause pedicle shadows of a segment above to be wider than the segment below?

Answer 82

1 burst fracture | 2 butterfly vertebra

Question 83

What type of segment forms when there is a lack of formation of one half of a vertebral body?

Answer 83

Hemivertebra

Question 84

What type of curvature can be caused by hemivertebra?

Answer 84

Structural scoliosis (usually 2 or more on the same side)

Question 85

Hemivertebrae are associated with what other congenital anomaly?

Answer 85

Block vertebra

Question 86

Which progress more: segmented or nonsegmented hemivertebra?

Answer 86

Segmented

Question 87

Why are extra ribs a potential complication from hemivertebrae?

Answer 87

Possible aberrant respiration

Question 88

In what region of the spine are Schmorl nodes more common?

Answer 88

Thoracics and lumbars

Question 89

What causes Schmorl nodes?

Answer 89

Nucleus pulposus herniates through vertebral end plates

Question 90

Giant Schmorl nodes are associated with what conditions?

Answer 90

1 degenerative disc disease 2 vacuum phenomenon 3 elongation of vertebral bodies

Question 91

What is the other term for juvenile discogenic disease involving multiple Schmorl nodes?

Answer 91

Scheuermann's disease

Question 92

What causes a limbus vertebra?

Answer 92

Herniation of the nucleus pulpous through secondary growth centers (appear as free fragment at margin of body)

Question 93

Where in the spine are limbus vertebrae most common?

Answer 93

Lumbars

Question 94

Why is it easy to differentiate a limbus vertebra in the lumbars from a vertebral body avulsion fracture?

Answer 94

Avulsion = less common (also history)

Question 95

Limbus vertebrae are associated with what condition?

Answer 95

Scheuermann's disease

Question 96

Cupid's bow contour is seen with what condition?

Answer 96

Nuclear impression (notochordal persistance)

Question 97

On what X-ray film can Cupid's bow contour be seen?

Answer 97

A-P

Question 98

What serious compilation can arise from significant spina bifida?

Answer 98

Meningocele (protrusion of meninges)

Question 99

What is the most common location for spina bifida occulta?

Answer 99

L5/S1

Question 100

Should spina bifida occult be considered in radiographic pre-employment screening?

Answer 100

NO