Spondylolysis, listhesis, and stenosis Flashcards Preview

Orthopedic Imaging > Spondylolysis, listhesis, and stenosis > Flashcards

Flashcards in Spondylolysis, listhesis, and stenosis Deck (54):
1

what is the term used for any displacement of the vertebral body

spondylolisthesis

2

spondylolisthesis is described and graded in relationship to the vertebral body __ to it

inferior

3

anterior translation
posterior translation
lateral translation

anteriolisthesis
retrolisthesis
laterolisthesis

4

complete loss of articular relationship between two vertebral segments is always ___

and is referred to as

anterior

spondyloptosis

5

what is the most common presenting sign or symptoms associated spondylolisthesis

pain
radiculopathy
neurogenic claudication (cramping or weakness)

6

spondylolisthesis is more common in __

women

7

spondylolisthesis is classified on what system

wiltse classification

8

what are the different types of wiltse classifications for spondylolisthesis

type 1 - dysplastic
type 2 - isthmic
type 3 - degenerative
type 4 - traumatic
type 5 - pathologic

9

what causes type 1 dysplastic spondylolisthesis

due to congenital anamoly of the upper sacrum or L5 neural arch leading to displacement

10

what causes type 2 isthmic spondylolisthesis

due to spondylolysis

11

what are the 3 subtypes of type 2 isthmic spondylolisthesis

Type a - stress fracture (due to fatigue) of pars interarticularis

Type b - elongated but intact pars interarticularis

Type c - acute fracture of pars interarticularis (rare)

12

what causes type 3 degenerative spondylolisthesis

due to long standing degenerative disease of facet and discovertebreal joints with no separation of pars interarticularis

13

what wiltse classification is also called pseudospondylolisthesis

type 3 degenerative

14

what causes type 4 traumatic spondylolisthesis

due to fracture of neural arch in any place EXCEPT pars interarticularis

15

what causes type 5 pathological spondylolisthesis

due to generalized bone disease (pagets or mets)

16

what is the easiest modality for spondylolisthesis

plain film xray

17

what is used to evaluate the cause of the spondylolisthesis

advanced imaging

18

spondylolisthesis is graded on what system

meyerdings grading system

19

what are the different grades of meyerdings grading system

grade 1 - <25%
grade 2 - 25-50
grade 3 - 50-75
grade 4 - 75-100
grade 5 - >100 - spondyloptosis

20

inverted napoleons hat sign is seen in what

grade 5 spondylolisthesis

21

isthmic spondylolistehsis is due to what

spondylolysis due to repetitive stress through the posterior arch

22

where is spondylolysis most common

second

MC - L5
2nd - L4

23

spondylolysis occurs between the ages of __ snd __ for active spondylolysis

10-20 years old

24

spondylolysis most commonly occurs in e

males 3:1

especially adolescent male athletes that train 15 hours per week

25

higher rates of spondylolysis is seen in what populations

inuit
american indians
caucasian males

26

what actions cause spondylolysis

repetitive rotation, flexion, extension, and hyperextension

27

what genetics increase your risk of spondylolysis

marfans
OI
osteopetrosis
downs syndrome
congenital disease

28

spondylolysis symptoms

low back pain
(usually during growth spurt)

possible radiculopathy, gait disturbance, back spasm

can progress to spondylolisthesis - more common in females

29

the pars interarticularis can be evaluated with __ and __ views

how do you see the scotty dog

AP and lateral

oblique views

30

how do I know if the back pain is due to spondylolysis

prior gold standard imaging - SPECT scan (injection of radiopharmaceutical)

new gold standard - MR

MR just as accurate and less radiation

31

if a patient has spondylolysis, the progression to spondylolisthesis occurs in who

what gender

skeletally immature

more common in females

risk to progress - 3-28%

32

if the sacral base is more ___ in orientation, the chances of spondylolysis progressing to spondylolisthesis are diminished

if ___ oriented, the chances increase

horizontal - decrease

vertical - increase

33

spinal stenosis is also called what

spondylosis

34

what is the definition of stenosis

spinal canal and neural foraminal narrowing

35

what is stenosis due to

secondary to multifactorial degenerative changes

process is progressive and dynamic

36

spinal stenosis most commonly occurs in what age group

> 50 years old

37

spinal stenosis most commonly occurs in what gender? and where in the spine

lumbar spine - m = f
cervical spine - m > f

38

what is 4x more common in women

degenerative spondylolisthesis

39

what are the 4 Fs of degenerative spondylolisthesis

female
four - L4
forty
fat

40

what are the signs and symptoms of spinal stenosis in the cervical and lumbar spine

cervical - no pathognomic signs or symptoms, maybe spastic paraesis, myelopathic hand (radic or heavy hand), gait disturbance, loss of position and vibration, chronic neck pain

lumbar spine - chronic low back pain, bilateral lower extremity pain, paresthesia, weakness, FLEXION RELIEVES SYMPTOMS 80% of the time, exacerbated by prolonged standning and walking, degree of spinal stenosis doesnt always correlate with symptoms

41

what imaging findings do you see on a patient with spinal stenosis

disc space narrowing

significant spondylosis

spondylophytes

hypertrophy of facet joints and uncinate processes

possible bony neural foraminal encroachment - c spine

congenitally short pedicles may be associated with the symptoms and stenosis

42

MR and CT findings for a sagittal central canal measurement

what is seen in axial plane

stenosis CS - <13 mm
stenosis LS - <10-12mm

visualization of cord and nerve root compression --> cord myelomalacia or contusion

trefoil pattern of central canal

43

what are the soft tissue changes seen in MR and CT with a patient having stenosis

disc herniations or bulges

ligamentous thickening or hypertrophy of LF and PLL

synovial cyst

spinal cord tumor

44

trefoil pattern means what

what is it seen in

latin - 3 leaved plant

thecal sac pattern seen in stenosis

45

posterior aspect of trefoil pattern is due to what

facet arthrosis
ligamentum flavum hypertrophy

46

what is a ganglion cyst called located in the facet joint

what causes this

synovial fact cyst

degeneration of facet joint

47

where does synovial facet cyst occur

posterolateral to thecal sac

48

where do majority of synovial facet cysts occur

lumbar spine (90%)

MC - L4-L5 (70-80%)

49

synovial facet cysts cause what

extra dural mass extending from facet into spinal canal, lateral recess, neural foramen, or extraforaminal spance

50

facet cysts occur in what age and gender

>60 years old

females

51

what are the symptoms of facet cysts

chronic low back pain

others - acute pain, radic, claudication, cauda equina syndrome, myelopathy

52

what is the gold standard for facet cyst

MR

53

what does a facet cyst look like on MRI

bright on T2
dark on T1

dark fibrous capsule on all pulse sequences

with contrast the wall of the cyst enhances

54

what is natural history and treatment of facet cysts

may spontaneously regress

tx - conservative care, surgery with cyst excision, steroid injection