Radiologic Eval of Lumbosacral Spine Flashcards
(31 cards)
List radiologic views of the Lumbar spine that may be used during a routine exam
- AP
- Lateral
- R/L Oblique
- Coned lateral view L5-S1
- Lateral view standing flexion and extension
list radiologic views of the SIJ that may be used during a routine exam
- AP axial
- R/L Oblique view
- Lateral view: coccyx
what can be observed with a R/L Posterior Oblique projection at the Lumbar spine? (4)
- articulating process
- Z-joints
- Pars interarticularis
- Scotty dog
what can be seen with a coned lateral view of L5-S1? (3)
- can still observe 3 parallel lines of vertebral bodies (like with lateral view)
- disc spaces preserved
- lumbosacral angles
- Barge’s
- Ferguson’s
what can be observed with an AP axial view of the SIJ? (5)
- Articular surfaces are superimposed
- smooth osseous margins
- symmetry of SIJs
- L5/S1
- Coccyx
which view allows a better appreciation of the SIJ?
L/R Oblique view of SIJ
list general indications for CT of the spine (5 important ones)
- Acute trauma (adults)
- degenerative conditions
- post-op assessment
- infection
- image guided intervention procedures
- neoplasms
- inflammatory lesions
- congenital/developmental conditions
- Cord syrinxes/masses (with MRI contraindicated)
notes about CTs of lumbar spine
what is a CT of the spine great for viewing?
- CT great for viewing bone
- Basic protocol
- lower thoracic to SIJs (or less)
- Axial slices; reformatting to sagittal and coronal planes
- Other CTs
- CT myelogram
- CT with contrast (tumor, infection)
- Abdominal/Pelvic CT
list general indications for MRI of the spine (3 important ones)
- acute trauma with suspected cord encroachment
- DDD
-
neoplasm
- diagnosis and intervention f/u
- intrinsic spinal cord pathology
- pre and post-op assessment (soft tissues, vertebroplasty)
- meningeal abnormalities
- infection
- disc space infections
- epidural abscess
list incidental imaging findings in the lumbar spine region
- disc protrusion → high prevalence rates in asymptomatic populations (20-30%)
- spondylolysis → pars defect reported in asymptomatic vs symptomatic populations
- 7-10% in asymptomatic
- 9% in symptomatic
- spondylolisthesis → 3-4 mm anterior slippage advocated as a threshold for clinical instability
characteristics of a bulging disc
- these are not herniations
- involve 50-100% circumference
- described as either symmetric or asymmetric
what are the 2 types of herniations?
protrusions and extrusions
describe protrusions and extrusions
- Protrusion
- broad-based = 25-50% (total of 90-180 degrees)
- focal = <25% (less than 90 degrees)
- Extrusions
- narrower neck
- sequestered or free fragment
how are herniation locations described?
- by plane
- axial plane divided into zones
- sagittal plane divided into levels
list ACR appropriateness criteria to consider in the lumbar spien
- Suspected spine trauma
- Suspected spine trauma-child
- low back pain
- back pain - child
- chronic back pain: suspected sacroilitis/spondyloarthropathy
- stress (fatigue/insufficiency) fracture, including sacrum, excluding other vertebrae
what initial imaging study is most appropriate for a patient that is age greater than or equal to 16 years with blunt trauma meeting criteria for thoracic and lumbar imaging?
CT thoracic and lumbar spine
for a pt age greater than or equal to 16 years what next imaging study is most appropriate if acute thoracic/lumbar spine injury has been detected on radiographs or noncontrast CT with neurologic abnormalities?
MRI thoracic and lumbar spine
what initial imaging study is most appropriate for a child (younger than 16) with suspected thoracolumbar spine trauma?
Radiography thoracic and lumbar spine
what initial imaging study is most appropriate for a patient with acute low back pain with/without radiculopathy, no red flags and no prior management?
no imaging
what initial imaging study is most appropriate for a pt with subacute or chronic LBP with/without radiculopathy, no red flags, and no prior management?
no imaging
what initial imaging study would be most appropriate for a pt with subacute or chronic LBP with/without radiculopathy? Additionally, they are a surgical or intervention candidate with persistent or progressive symptoms during/following 6 weeks or optimal medical management.
MRI lumbar spine
What initial imaging study is most appropriate for a pt with LBP with suspected cauda equina syndrome?
MRI lumbar spine
What initial imaging study is most appropriate for a pt with LBP and a history of prior lumbar surgery with/without radiculopathy. They have new or progressing symptoms or clinical findings
Radiography lumbar spine
MRI lumbar spine
what initial imaging study is most appropriate for a pt with LBP with/without radiculopathy. Along with one or more of the following: low-velocity trauma, osteoporosis, elderly individual, or chronic steroid use.
radiography lumbar spine
MRI lumbar spine
CT lumbar spine
