Rad L3: Degenerative disorders of the spine Flashcards Preview

CHI303:clinical Science And Diagnosis > Rad L3: Degenerative disorders of the spine > Flashcards

Flashcards in Rad L3: Degenerative disorders of the spine Deck (28):
1

What is the most common site for Degenerative Disorders of the Spine?

And what % of adults are asymptomatic?

C5/C6

45%

2

Radiographic signs of IVD in Cervical Spine

  • osteophytes, sclerosis 
  • Most reliable sign of DDD = height loss 
  • Intercalary bone: calcification of annular fibers may be an early sign
  • Vacuum cleft may be present as early sign
  • Ant. osteophytes large, may = dysphagia 
  • post. osteophytes usually sml, can = stenosis
  • Possible instability, flex/ext studies

3

Radiographic signs of apophyseal joints in the Cervical Spine

  • Facet arthrosis
  • Usually lower C-spine
  • Loss joint space, sclerosis, osteophytes, anterolisthesis
  • AP projection see sclerosis and hypertrophy of pillars

4

Radiographic signs of uncovertebral joints in the Cervical Spine

  • uncovertebral arthrosis
  • Lower segments, C5/C6
  • Blunting and/or hypertrophy of uncinate, osteophytes 
  • IVF narrowing, lateral stenosis
  • Pseudofracture appearance lateral view

5

Radiographic signs of IVD in thoracic vertebrae

  • Spondylosis, DDD
  • Disc height normally decrease cephalad direction, T2/T4 narrowest 
  • Small right-sided osteophytes, sclerosis, disc narrowing 
  • Less pronounced than other regions 

6

Radiographic signs of costal joints in thoracic spine

  • Costotransverse/costovertebral arthrosis
  • Lower segments most common (T9, T10)
  • Bony hypertrophy, osteophytes, sclerosis, loss of joint space
  • may simulate a lung mass on lateral chest view
  • May simulate upper GI disease symptoms

7

Radiographic signs of apophyseal joints in the thoracic spine

  • uncommon
  • Seen best on AP, sclerosis
  • Pain referral distally or laterally

8

Radiographic signs of apophyseal joints in the lumbar spine

  • Facet arthrosis
  • Most common at L4/L5
  • Loss of space, sclerosis, osteophytes/hypertrophy
  • Degenerative anterolisthesis- may be only obvious finding
  • Best seen AP, oblique views
  • Flex/ext studies for stability

9

Radiographic signs of IVD in the lumbar spine

  • Most common L4/L5 ; L5/S1
  • Best seen on lateral view
  • DDD, IVOC or spondylosis deformans
  • Height loss, sclerosis, vacuum, alignment altered, osteophytes

10

Name and describe the two different types of osteophytes

Traction

  • Approx. 2mm length
  • Non-marginal, horizontal, tapered end

Claw

  • Broader base, non-marginal
  • Horizontal, climb vertical
  • Curvilinear, tapered end

11

What are the radiographic features seen in Spondylosis Deformans?

  • Degeneration at body/disc
  • Breakdown at outer annular attachment to body
  • MINIMAL LOSS OF DISC HEIGHT WITH LARGE OSTEOPHYTES
  • Osteophytes are CLAW type

milder cases = spondylosis

12

What are the radiographic features seen in Intervertebral Osteochondrosis (IVOC)?

  • Small osteophytes (traction)
  • LOSS OF DISC HEIGHT WITH SEVERE ENDPLATE SCLEROSIS
  • Schmorl’s node formation
  • Vacuum phenomenon commonly seen

milder cases = DDD

13

Describe the 3 types of modic changes

Type I

  • Low signal on T1WI
  • High signal on T2WI
  • Due to proliferation of fibro-granulation tissue

Type II

  • Continued, worsening disease leads to fatty changes in the endplates
  • High signal on T1WI
  • Intermediate to high signal on T2WI

Type III

  • Eventually leads to sclerotic changes
  • Low signal on both T1- and T2WI

14

Disc Bulge:

Definition

Radiographic Signs

Possible Aetiology

Definition: (not a herniation) 

  • Circumferential, broad based displacement (displacement >50% of circumference of the disc)
  • part of natural aging with DDD

Radiographic Signs

  • Typically symetric with maximal bulge midline 
  • See loss of disc signal (T2WI)

Possible Aetiology

  • natural degeneration (DDD)
  • Normal variant
  • Advanced DDD
  • Vertebral body remodeling (osteoporosis, trauma, adjacent structural deformity)
  • Illusion
    • caused by posterior central sub-ligamentous disc protrusion
    • volume averaging

15

What changes would you see on an MRI of a degenerative motion segment (disc displacement)?

  • Loss of signal on T2 = loss H2O
  • Loss first seen anterior 2/3rds
  • Loss of height with signal changes
  • Osteophyte formation w/long term disease

16

Disc Protrusion:

Definition

Outcome

Modic changes

Definition:

  • Focal (<25%) or broad-based (<50%) migration of nuclear material contained by outer annulus
  • Maximum width of herniation is no greater than base of herniation
  • Annulus is partially disrupted
  • May also contain fragmented apophyseal bone, cartilag

Possible outcome

  • Myelopathy may result from large protrusions
  • ant. protrusions have little clinical significance as no contained structures to impinge

Modic Changes

  • T1WI shows disc past vertebral margins, with hyperintense signal to CSF

17

Disc Extrusion:

Definition

Contained Extrusion

Non-contained Extrusion

Definition:

  • Maximum width of herniation is greater than base of herniation in any plane 
  • Disc material remains attached but may not be contained by annulus
  • Contained: outer annulus/PLL walls off disc
  • Non-contained: extends through annulus and possibly beyond the PLL (sub-ligamentous or trans-ligamentous)

 

18

Sequestration:

Definition

MRI features

 

Definition:

  • Free fragment of disc material 
  • Still hydrated, so can see high signal on T2WI
     
  • May travel inferior or superior
  • May eventually be resorbed by the body
  • Not associated with increased risk of adhesions
  • Clinically no difference between extrusion and sequestration

19

What are some clinical considerations of Disc Displacement?

  • Need clinical correlation - value of MRI diminishes without it
  • Abnormal disc seen in 20% of asymptomatic population
  • Cauda Equina Syndrome

    • Back/leg pain, U/B incontinent, numbness, impotency

    • SURGICAL EMERGENCY !!

20

(Epidemiology) what % of US population are affected by DISH?

12%

21

What are some clinical features of Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

  • Morning stiffness, bone/joint pain

  • 20% dysphagia due to bone growth (>1cm)

  • Increase kyphosis/decrease lordosis

  • ​​​​​​​​90% in C-spine, C5-C7 levels

  • 13-32% correlation w/diabetes mellitus

22

What are the 4 classic radiographic findings for DISH?

plus additional

  1. Ossification of ant. longitudinal ligament

  2. Flowing hyperostosis at four continuous vertebral levels

  3. Relative preservation of disc height

  4. preservation of facet joints
     

Additional:

  • Can see OPLL
  • T-spine right side predominately - from aortic pressure on left
  • 20% pts. costal joints are involved 
  • Absence of lower SI/apophyseal sclerosis, osseous fusion 
  • SI joint upper portion, can cause ankylosis “star sign”
  • Enthesopathy (wiskering) of the peripheral skeleton (look at ilium)

23

Clinical features of Ossification Posterior Longitudinal Ligament (OPLL)

  • Can occur with DISH or on its own
  • Higher incidence in Japanese males
  • Usually seen in cervical spine
  • Myelopathy can occur when ossification reaches greater than 60% canal size.

24

Radiographic findings of OPLL

  • Continuous/discontinuous osseous density at the back of 1 or more vert. segments
  • stenosis

25

Clinical Features of Neuropathic Arthropathy

  • Diabetes, syphilis, syringomyelia

  • 5% diabetics: ankle/feet

  • 20% syphilis: L-spine, knee, ankle

  • 25% syringomyelia: in upper extremity

  • “Bag of Bones”, painless, enlarged

  • Weeks/months/years of onset/duration

26

Radiographic findings for the Hypertrophic Pattern of Neuropathic Arthropathy

  • Distention
  • Debris
  • Dislocation
  • Density increased
  • Disorganization
  • Destruction

Normally weight bearing joints

27

Radiographic findings for the Atrophic Pattern of Neuropathic Arthropathy

  • Lack of hypertrophic features

  • Sharp amputation of articular ends (bone resorption)

  • Tapered appearance “licked candy stick” appearance

  • Non-weight bearing joints

Associated with cord syringomyelia

28