Module 4

Question 1

What are the 4 main lumbar spine views?

Answer 1

AP

Lateral

Oblique (try to avoid due to increased radiation)

L5-S1

Question 2

How are patients set up for an AP lumbar spine projection?

Answer 2

Supine with knees flexed (reduces lordosis and improves visualization of disc spaces)

Question 3

What conditions can be detected in an AP lumbar spine view?

Answer 3

Fractures

Dislocations

IVD space abnormalities

Spondylolisthesis (inverted napoleons hat sign)

Question 4

How are patients set up for a lateral lumbar spine projection?

Answer 4

Sidelying on affected side (hips and knees slightly flexed)

Question 5

What conditions can be seen with a lateral lumbar spine projection?

Answer 5

Fractures

Dislocations

IVD space abnormalities

IV foramina abnormalities

Schmorl nodes

Spondylolisthesis (spinous process or step off sign)

Question 6

How are patients set up for a L5-S1 lumbar spine projection?

Answer 6

Same as lateral lumbar view

Question 7

How are patients set up for an oblique lumbar spine projection?

Answer 7

Patient lying 45-60° oblique angle with affected side down

Question 8

What are conditions seen in an oblique lumbar spine view?

Answer 8

Articular process/facet abnormalities

Pars interarticularis abnormalities

Scottie dog configuration

Spondylolysis

Question 9

What is a Scottie dog?

Answer 9

Helps see spondylolthesis due to posterior translation

Fracture to pars interarticularis

Question 10

What happens at the columns with a compression fracture?

Answer 10

Anterior- Compression

Middle- none

Posterior- none or distraction

Question 11

What happens at the columns with a burst fracture?

Answer 11

Anterior- compression

Middle- compression

Posterior- none or distraction

Question 12

What happens at the columns with a seat-belt (chance) fracture?

Answer 12

Anterior- none or compression

Middle- distraction

Posterior- distraction

Question 13

What happens at the columns with a fracture- dislocation?

Answer 13

Anterior- compression or rotation shear

Middle- distraction or rotation shear

Posterior- distraction or rotation shear

Question 14

What is a key feature seen in a lateral view not seen in an AP view?

Answer 14

Intervertebral discs

Question 15

What is a key feature seen in an oblique view not seen in any other view?

Answer 15

Pars interarticularis and transverse process

Question 16

What is a wedge compression fracture?

Answer 16

Failure of anterior column under compression forces

Question 17

What is a compression burst fracture?

Answer 17

Failure of anterior and middle columns due to axial compression forces

Question 18

What is a chance fracture?

Answer 18

Flexion distraction injury (L1-L2)

Horizontal fracture with splitting of the spinous process, Lamina, Pedicles, and vertebral body

Question 19

When does a chance fracture usually occur?

Answer 19

Rear seat passengers with lap belts (seat belt fracture)

Question 20

What is spondylolysis?

Answer 20

Fracture of pars interarticularis without separation

Question 21

What is Spondylolisthesis?

Answer 21

Fracture of the pars interarticularis along with slippage of vertebral disc

Question 22

What are other pathologies common to look at with imaging?

Answer 22

Ankylosing spondylitis

Osteoporosis

Scoliosis

Question 23

How is DDD recognized on imaging?

Answer 23

The disc will go from white to a dark grey (eventually a collapse)

Question 24

What is the relationship between age and disc findings?

Answer 24

There are more disc findings with increased age (most are asymptomatic)

Question 25

What is the most standard view for the pelvis?

Answer 25

AP

Question 26

What are the differences in shapes of the pelvis between genders?

Answer 26

Males- triangular Females- round

Question 27

How is the patient positioned when doing imaging of the pelvis?

Answer 27

Supine with legs extended and IR 15-20°

Question 28

What is the inlet view used for on the pelvis?

Answer 28

Trauma view to see posterior displacement of hemipelvis (beam target 40° inferiorly)

Question 29

What is an important structure that an inlet view lets you visualize on the pelvis?

Answer 29

Acetabulum

Question 30

What is an outlet view used for?

Answer 30

Trauma and looks a superior displacement fractures (beam pointed 40° superiorly)

Question 31

How does imaging of the SIJ work?

Answer 31

Patient in supine with legs extended (beam pointed 30-35° superiorly)

Question 32

What is a more specific view used to target one SIJ at a time?

Answer 32

Patient in supine but rotated 25-30° (oblique view)

Question 33

What condition does ankylosing or sclerosis to the SIJ entail?

Answer 33

Early sign of ankylosing spondylitis

Question 34

How much of a pelvic symphysis diastases is normal post partum?

Answer 34

> 1 cm

Question 35

Diastases greater than what represents ligamentous damage at SIJ?

Answer 35

> 2.5 cm

Question 36

What is important to know about fractures to the pelvic ring?

Answer 36

Fractures usually occur in more than one area

Question 37

What are the things that help rule out a pelvic fracture without use of radiograph?

Answer 37

Age > 3 No impairments or consciousness No other major distracting injuries No complaints of pelvic pain No signs of fracture on inspection Painless compression of iliac or pubic symphysis Pain free hip rotation and flexion

Question 38

What are the predictors of a pelvic stress fracture?

Answer 38

History of overuse Relief with non weight bearing Insidious in nature Local pain or swelling Bone scan is diagnostic early

Question 39

What is the most common area for a pelvic stress fracture?

Answer 39

Inferior pubic ramus