Flashcards in Lumbar Spine Deck (70):
What are the 4 lumbar spine views?
- anteroposterior (AP)
- Right and left oblique views
- Coned lateral view of lumbosacral articulation (L5–S1)
What do posterior oblique views image?
“downside” facet joints closest to image receptor
What do anterior oblique views image?
“upside” facet joints farther from image receptor
In the formation of the Scottie dog in the oblique lumbar images what does the nose represent?
In the formation of the Scottie dog in the oblique lumbar images what does the eye represent?
In the formation of the Scottie dog in the oblique lumbar images what does the ear represent?
superior articular process
In the formation of the Scottie dog in the oblique lumbar images what does the neck represent?
In the formation of the Scottie dog in the oblique lumbar images what does the foreleg represent?
inferior articular process
In the formation of the Scottie dog in the oblique lumbar images what does the body represent?
lamina and spinous process
In the formation of the Scottie dog in the oblique lumbar images what does the tail represent?
superior articular process of opposite side
In the formation of the Scottie dog in the oblique lumbar images what does the hind leg represent?
inferior articular process of opposite side
What is the imaging procedure of choice for evaluating trauma at the lumbar spine?
Computed tomography (CT)
Why are AP and lateral radiographs also obtained in trauma patients?
to help localize injuries
If the CT exam is normal is MRI indicated? Why or why not?
No, because isolated ligamentous injuries are rare in the lumbar spine
What areas of the lumbar spine are predominant sites of vertebral fractures? Why?
Thoracolumbar junction (T11-L2) because these vertebrae are transitional region between relatively fixed thoracic spine and mobile lumbar spine
What is Spondylolysis?
A defect of the pars interarticularis
What are 3 things that may lead to Spondylolysis?
- Stress fracture caused by chronic strain (most common)
What is Spondylolisthesis?
A forward displacement of one vertebra upon stationary vertebra beneath it
What is Spondylolisthesis aka?
What does the term retrolisthesis refer to?
Posterior displacement of one vertebra upon stationary vertebra above it
_-_% of people have spondylolisthesis
Who are typically affected by spondylolisthesis?
Children and adolescents, especially those involved in athletic activities
Which vertebral levels are most often involved in spondylolisthesis?
Lower lumbar levels (L4–L5 and L5–S1)
Spondylo______ can be consequence of spondylo_____.
What are 3 other things that spondylolisthesis can result from?
- Congenital or developmental aberrations
- Pathological processes
- Degenerative changes
What are the clinical presnetations of spondylolisthesis?
Patient c/o pain after athletic activities or physical labor
What usually reduces pain in patients with spondylolisthesis? Why?
Lumbar flexion, because it reduces the displacement
Palpation of the spinous processes in patients with spondylolisthesis can reveal what?
Either rotation or deep depression
Rotation of the spinous processes can be correlated with what?
An asymmetrical slip which is often the result of unilateral spondylolysis
Palpable depression over the spinous processes is indicative of what?
It is a classic sign of spondylolisthesis
What are the 2 types of spondylolistheses?
Degenerative or Fracture
Upon reviewing radiographic findings, how can you tell the difference between degenerative and fracture spondylolistheses?
- In degenerative spondylolisthesis the step off is below the level of the slip
- In fracture spondylolisthesis the step off is abovethe level of the slip
How is spondylolisthesis treated?
- Restriction of activities that load spine in extension
- Stretching lumbar joints into flexion
- Analgesics and bracing that reduces loads to lumbar spine
- Surgical fusion
What are 2 degenerative pathological conditions typically associated with the lumbar spine?
Spinal stenosis and intervertebral disk herniations
What are 4 other degenerative conditions of the lumbar spine?
- Degenerative joint disease (DJD)
- Degenerative disk disease (DDD)
- Spondylosis deformans
- Diffuse idiopathic skeletal hyperostosis (DISH)
What are the radiologic findings of DDD?
- decreased disk space height
- osteophytes at vertebral endplates
- Schmorl's nodes
- vacuum phenomenon
What are the radiologic findings of DJD?
- decreased zygapophyseal joint space
- osteophytes at joint margins
What are the radiologic findings of spondylosis?
- osteophytes visible as radiodense irregularities at vertebral joint margins
What are the radiologic findings of spondylosis deformans?
- claw-like spurs cupping toward intervertebral disk present at more than one level
What are the radiologic findings of DISH?
- flowing ossification of at least 4 contiguous vertebrae
- preservation of disk height and absence of DDD findings
- absence of sacroilitis or zygapopyseal joint DJD
What is spinal stenosis defined as?
A narrowing or constriction of the spinal canal secondary to adjacent soft tissue or bony enlargement
Spinal stenosis can be classified by what 2 things?
Either by etiology or by anatomic region involved
Etiologically, spinal stenosis can be divided into what 2 types
congenital or acquired
Anatomically, spinal stenosis divided into what 3 regions?
- Stenosis of central spinal canal
- Stenosis of intervertebral foramen (IVF)
- Stenosis of subarticular or lateral recesses (distance b/w thecal sac and IVF)
Spinal stenosis accounts for up to __% of asymptomatic population under age 40
Does spinal stenosis affect men or women more?
men > women
Spinal stenosis is most common in which spinal regions?
cervical and lumbar
Central canal narrowing is most prevalent at L_
Norma AP diameter of spinal canal adult men as follows:
Cervical spine C3–C5: __-__ mm
Cervical spine C5–C7: __-__ mm
Thoracic spine: __-__ mm
Lumbar spine: __-__ mm
17 to 18 mm
12 to 14 mm
12 to 14 mm
15 to 27 mm
Concurrent cervical and lumbar spinal stenosis can present with what 3 things?
- Gait disturbance
Symptoms of spinal stenosis are increased with lumbar ______ and decreased with lumbar ______.
Describe the simian stance
It is a position in which spinal stenosis patients attempt to relieve symptoms in which the trunk, hip, and knee are in flexion
(leaning on a shopping cart)
What is neurogenic claudication?
Congestion of blood vessels at a stenotic level that inhibits nerve conduction and results in poorly defined leg pain, numbness, and weakness
How can you tell the difference between neurogenic and vascular claudication?
- Neurogenic claudication is exacerbated by standing and spinal extension
- Vascular claudication is exacerbated by exercise and is improved with standing
How can you tell the difference between spinal stenosis and disk herniation?
- Pain from disk herniation is aggravated by sitting, flexion, lifting, and valsalva maneuvers and often relieved with walking
- Pain from spinal stenosis is not affected by any of those maneuvers and is aggravated with walking
How is mild to moderate spinal stenosis managed?
- Analgesic medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Epidural steroid injections
- PT for strengthening and flexibility exercises
What is the most frequent pathologies affecting the diskovertebral junction?
Intervertebral disk herniation
Intervertebral disk herniations are most common in what age group?
in 25 to 45 year-old age group
Do IVD herniations affect men or women more?
What are 3 other predisposing factors to IVD herniations?
- the obese
- those exposed to vehicular vibration
Were are IVDH most common?
in the lumbar spine
90% of all IVDH occur at what level?
- small percentage occur at L3-L4
__-__% of asymptomatic individuals have disk herniations
What are the radiographic hallmarks of DJD at SIJ?
- Decreased joint space
- Subchondral sclerosis
- Osteophyte formation at joint margins
Evaluation of DJD confined to ____ half of radiographic joint space. Why?
Because only the lower halves of joint space image represent synovial portion of joints.
The upper portions of joints are syndesmotic
What is ankylosing spondylitis?
a chronic, progressive inflammatory arthritis characterized by joint sclerosis and ligamentous ossification
Where does ankylosing spondylitis usually manifest first? Where does it extend to later?
First in stiffness of the SIJs and later extends to lumbar and thoracic spines
Does ankylosing spondylitis affect men or women more?
Men, 7 times more than women
When is onset of ankylosing spondylitis?
in the 20s