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Clin Skills Exam 3 > Spine Radiology > Flashcards

Spine Radiology Flashcards

1
Q

what are the three spinal columns & classifications

A

anterior column
- ALL (anterior longitudinal ligament)
- anterior 2/3 of vertebrae & discs

Middle column
- posterior 1/3 of vetebrae and discs
- PLL (posteror longitudianl ligamnet)

Posteroir column
- everything posterior to the PLL
- Neural arch: pedicles, lamina, spinous processes
- facet joints
- ligamentum flavum and connecting ligaments

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2
Q

Cervical Spine Xray

A
  • visulaize C1, C2 and C3 through an open mouth xray : see dens (odontoid process)
  • see C4,5,6,7 on A-P or lateral
  • gentle lordosis of curve
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3
Q

Thoracic Spine Xray Ap/Lateral

keys to know

A

Thoracic spine: 12 vertebrae : a kyphotic alignment
- pedicles more porminent (connecting the body to transverse process
- transverse process connected to spinous process via the lamina
- spinous processes on the thoraic point downwards
- each thoracic vertebrae have their corresponding rib
- decending abdominal aorta runs in front of teh T spine

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4
Q

LUmbar Spine Xray
things to know

A
  • normally a lordotic alignment
  • L1-L5 (5 vertebrae) some may have a transitional vertebrae
  • Spinal cord ends around L1-L2
  • illiac arteries run in front of L spine
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5
Q

Scoliosis
- angle
- type of film

A

Scoliosis: curvature of the spine within the coronal plane; leading to abnormal rotaion of the spinal column
cobb angle: > 10 degrees is scoliosis
- Left v Righ direction: dextro (right) v levo (left)
- can be adolescent or adult (deformity)

when getting films: Xray needs to be a specific survery film: to capture from the base of skull to the pelvis/hip joints
- see head in relation to spine
- see hips in relation too

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6
Q

MRI scans of the spine
T2 v T1: what will be bright

A

T2 scan: fat anf fluid will be BRIGHT
T1: fluid is dark, fat is bright

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7
Q

CT Myelogram
- when is it used
- what does it help with
- how is it done

A

when
- used when MRI is contraincidated (have pacemaker, magenetic FB)
- good for those with prior spinal fusions (get less artifcat from the implanted hardware)

How
- LP into subarachnoid spcae and iodine contrast given: pt. leaned back tolet contrast flow while CT imaging is done

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8
Q

Jefferson Fracture

A
  • a fracture of Atlas C1 : a fracture through the anteroir and posteroir arches
  • due to: axial loading (head-first trauma)
  • can be accompanied by spinal cord injury or C spine injury
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9
Q

Odontoid (Dens) Fracture
Type 1, 2, 3

A
  • a fracutre of the dens on C2

Type 1: avulsion of the tip

Type 2: fracture at the base of the dens unstable pt

Type 3: fracture at the junction of the body and dens unstable pt

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10
Q

Hangman’s Fracture

A

traumatic spondylolisthesis of C2
- a fracutre of the C2 pars interarticularis bilaterally (so that the dens and vertebral body of C2 completely detaches from the posterior portion of C2 posteriorly)

ususally results in spinal cord injury and death

  • due to axial load injsty in a lateral extension (diving high speed MVA)
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11
Q

Teardrop Fracture - Extenstion

A

extenstion: avulsion fracture of teh anterioinferior corner of the vertebral body
- most anteroir and low point of the vertebrae is avulsion (chipped off)

  • disrupt ALL
  • relatively unstable, especially in extension
  • occurs in C spin and not commonly a SC injury
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12
Q

Teardrop Fracture - Flextion

A

a compression/shear isolating a triangular formation fo the anterior fragmenet
- ruputre ALL: result in a triangle in the anteriorinferior vertebral body
- unstable!!!
- assocaited with spinal cord injury and instability: because this pushed the back half of the vertebrae into the spinal cord

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13
Q

Neural Arch fracture

A
  • the boney arch of the back part of the verterbrae which surrounds the spinal cord: contains the lamina and the spinous process
  • due to hyperextension
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14
Q

Clay Shoveler’s Fracture

A
  • fracture of the spinous process of C7!!
  • stable
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15
Q

Simple Wedge Compression Fracture

A

more common in thoracolumbar > c spine
- if its a single compression, with no spinal cord compression, boney destruction or no other masses seen = a bengin compression fx.

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16
Q

Burst Compression Fracture

A

high energy axial laoding causes compression fracture
- disrupt the endplate and cortex of the vertebral body: can retropulsion into the spinal cord!!!

17
Q

Chance Fracture

A

sealtbelt fracture
- injury invloving all three columns of spinal cord : unstable
- so impacting the anterior, middle and posterior aspects

18
Q

Non-traumatic fx.
osteoporotic & pathologic compression fx.

A

osteoperotic
- boney breakdown over time: get downgers hump as the bones start to deform: falling forward in posture

Pathologic
- compression fx. due to malignancy
- see fracture and possible boney lesion/lytic lesion
- obtian MRI to further understand disease

19
Q

atlanto-occiptial dislocation

Atlanto-occiptial subluxation

A

Dislocation
- displacement of teh occipital condyles in comparison to the atlas (C1)
- requires surgical fixation and immobilization
- on x-ray/CT: see wide spcae between the occiptial bones and the atlas

Subluxation
- disorder of C1/C2 causing impair rotation of the neck (so partial disloaction)
- the anterior facet of C1 is fixed to C2
- higher occurance in connective tissue disorder/downs
- (see on x-ray once side has bigger space than the other)
- in the throacic spine: see malailgnment

20
Q

Unilateral Facet Joint Dislocation

v

Bilateral Facet joint dislocation

A

UNILATERAL
- the vertebrae above moves superior: disloacting the articulation with the facet surface of the vertebrae below
- flexion/distraction and rotation
- relatively stable: c collar them and get MRI

BILATERAL
- see BOTH facet joints “jump: out of place and appear stacked on the acet joint of below
- Unstable!!!! : c collar and MRI for cord injury
- without anything next to it, can cause anteroirlitesis and lamalignment (slid forward)

21
Q

Spondylolysis

A

pars defect: a probably at the articulation between the superior and inferior articular facets
90% of cases are at the L5 level
- see as a stress fracture which fracutres the connection between vertebrae

BIlateral = UNSTABLE

see as the scotty dog collar: the collar of the dog = fracture or defect of the pars

22
Q

spondylolisthesis

A

listhesis: to slip
- slippage of one verterbal body onto the other
- can be a result of a pars defect or degenerative changes in the lumbar spine
- anterolithesis: anterior
- retrolithesis: posterior
- laterolisthesis: to the side

23
Q

Degenerative Disc Disease

A
  • degenerative changes affect the hydration and the elasticity of the dics

MRI
- healthy disc: appear bright/grey (see the fluid) & anulus is dark
- discs with degenerative changes: dark/black and flattened

24
Q

Spinal Stenosis

A
  • causes myopathy and nerves congested in the spinal canal

stenosis = narrowing of the spinal canal

Herniated Nucleus Pulposus
- can impinge/compress spinal cord or exiting nerves
- see it protruding backwards into the canal

25
Q

Spinal Cord Compression
where is the spinal canal
what does it contain

A

Spinal Canal : locations of lesions
-1. extramedullary (outside the cord but within the sac)
- epidural: outside the thecal sac (extradural)
- intradural/intrathecal: inside the thecal sac –> subdural or subarachnoid
- peripheral never sheath
- 2. intermeduallry (within the cord itself)

26
Q

types of cord compression

A
  • traumatic cord compression
  • cord transection: all 3 columns are impacted
  • cauda equina syndrome: compression below L1/L2 termination of the spinal cord
27
Q

Nontraumatic cord compression

A
  • disc degeneration/spondylosis (sponteanous)
  • acute HNP
  • epidural abcess: MIR without and then with contrast will show this best: with ring enhancing lesions in the cord
  • tumor
  • epidural hematoma : acute bleed seen in bleeding disorder pts. trauma, tumor or post-op!

Clin Skills Exam 3 (13 decks)

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