Spine Variants and Pathology

Question 1

Where are filar cysts located?

Answer 1

Within midline terminale, inferior to the conus

Question 2

T or F? Filar cysts are a normal variant?

Answer 2

True

Question 3

Where are ventricular terminalis located?

Answer 3

Transition from tip of the conus to origin of filum terminale

Question 4

What are ventricular terminalis also known as?

Answer 4

5th ventricle or persistent terminal ventricle

Question 5

What is the ventricular terminalis?

Answer 5

Widening of the distal central canal

Question 6

What are the two normal variants of the spine?

Answer 6

1. Filar cyst
2. Ventricular terminalis

Question 7

By what week gestation is the neural tube formed?

Answer 7

8 weeks

Question 8

The neural tube is formed by the closure of the?

Answer 8

Neural plate

Question 9

Spinal dysraphism occurs when?

Answer 9

The neural plate fails to fuse completely

Question 10

What is another term for OSD and CSD?

Answer 10

OSD - spina bifida aperta

CSD - spina bifida occulta

Question 11

What is the difference between OSD and CSD?

Answer 11

OSP - Neural tissue communicates with the outside through a defect that does NOT include skin or tissue covering

CSD - Skin covered abnormality - usually seen as a dimple or tuft of hair in the lower back

Question 12

What is a meningocele?

Answer 12

Protrusion of meninges without neural tissue (covered by a thin layer of skin)

Question 13

What is a myelomeningocele?

Answer 13

Protrusion of meninges and neural tissue through a defect

Question 14

What is a myelocele?

Answer 14

Protrusion of neural tissue without skin or meninges - shows as “flush” with the skin

Question 15

How does spina bifida occulta present?

Answer 15

As a tuft of hair

Question 16

What abnormality is a flat plate of neural tissue flush with the skin surface?

Answer 16

Myelocele

Question 17

What 2 abnormalities are known as a herniation thru a defect in the dura mater?

Answer 17

1. Myelomeningocele
2. Myelocele

Question 18

Is a meningocele classified as an open or closed spinal dysraphism?

Answer 18

Closed

Question 19

Open and closed spina bifida are typically all associated with?

Answer 19

A tethered cord

Question 20

What is the definition of a tethered cord?

Answer 20

Low-lying cord with thickened filum terminale (< 2mm)

Question 21

What is almost ALWAYS associated with dysraphic spinal anomalies?

Answer 21

Tethered cord

Question 22

What are 3 complications of OPEN spinal dysraphism?

Answer 22

1. Decreased limb function and paralysis
2. Bladder and bowel dysfunction
3. Hydrocephalus

Question 23

SF of open spinal dysraphism?

Answer 23

1. Anechoic mass continuous with spinal cord
2. Loss of normal conus

Question 24

SF of a tethered cord?

Answer 24

1. Lack of movement of filum terminale and nerve roots
2. Spinal cord low (conus terminates at L3 or after)
3. Conus will be abnormally elongated and lack normal tapering
4. Thickened filum terminale (>2mm)

Question 25

What is another name for diastomyelia?

Answer 25

Split cord malformation

Question 26

What is known as a longitudinal split of the spinal cord into 2 hemicords?

Answer 26

Diastomyelia

Question 27

Where in the spine does split cord normally occur?

Answer 27

Thoracolumbar region

Question 28

In what plane of imaging is a split cord diagnosed?

Answer 28

Transverse orientation

Question 29

What anomalies are associated with diastomyelia?

Answer 29

1. Tethered cord 2. Scoliosis 3. Clubfoot 4. Vertebral anomalies 5. Dilation of central canal (hydromelia)

Question 30

What is known as a thin epithelial-lined tract that courses from the skin towards the spinal canal representing a focal disruption on the fusion of the spinal canal?

Answer 30

Dorsal dermal sinus (DDS)

Question 31

Where is DDS most common?

Answer 31

Lumbosacral region

Question 32

How do DDS clinically appear?

Answer 32

As deep midline dimples or pits

Question 33

What are patients at risk for developing with DDS?

Answer 33

Meningitis

Question 34

SF of DDS?

Answer 34

Midline tract from spinal cord to skin (most likely in the area of a skin marker)

Question 35

An abnormal focus of echogenicity within the canal of a DDS is visualized. What may be the most likely diagnosis?

Answer 35

Dermoid

Question 36

What is the most common reason an infant is referred for a spinal ultrasound?

Answer 36

Sacral dimple

Question 37

Sacral dimples may appear as one of two things, what are they?

Answer 37

1. Blind ending 2. As a pilonidal sinus - tract that leads to the coccyx

Question 38

Does a pilonidal sinus communicate with the spinal canal?

Answer 38

NO - do not confuse for DDS

Question 39

What are the three types of spinal lipomas?

Answer 39

1. Lipomyocele/lipomyelomeningocele 2. Intradural lipoma 3. Lipoma of the filum terminale

Question 40

What is the most common spinal lipoma?

Answer 40

Lipomyocele/lipomyelomeningocele

Question 41

What is the difference between a lipomyocele and lipomyelomeningocele?

Answer 41

Lipomyocele - Stays within spinal canal Lipomyelomeningocele - Enlarged subarachnoid space and a fatty mass extending through posterior defect

Question 42

Why are intradural lipomas and lipomas of the filum terminale different from lipomyocele/lipomyelomeningocele?

Answer 42

The first two DO NOT contain an associated subcutaneous mass and may or may not have a tethered cord

Question 43

What is known as an abnormal dilatation of the terminal ventricle that communicates with the central spinal cord but does not communicate with the subarachnoid space?

Answer 43

Terminal myelocystocele

Question 44

SF of terminal myelocystocele?

Answer 44

1. Large, skin-covered, fluid filled mass in lumbar region 2. Widened central canal of spinal cord with DIRECT communication with the cyst 3. Hydromelia

Question 45

What are the 3 vertebral anomalies?

Answer 45

1. Block vertebrae - incomplete separation of vertebral bodies 2. Hemi-vertebrae - lack of formation of one vertebral body 3. Butterfly vertebrae - failure of fusion of the lateral halves of the vertebrae

Question 46

What is the most common type of germ cell tumour occurring in the neonatal period?

Answer 46

Sacrococcygeal teratoma