Spondylolysis, listhesis, and stenosis

Question 1

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

Answer 1

spondylolisthesis

Question 2

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

Answer 2

inferior

Question 3

anterior translation
posterior translation
lateral translation

Answer 3

anteriolisthesis
retrolisthesis
laterolisthesis

Question 4

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

and is referred to as

Answer 4

anterior

spondyloptosis

Question 5

what is the most common presenting sign or symptoms associated spondylolisthesis

Answer 5

pain
radiculopathy
neurogenic claudication (cramping or weakness)

Question 6

spondylolisthesis is more common in __

Answer 6

women

Question 7

spondylolisthesis is classified on what system

Answer 7

wiltse classification

Question 8

what are the different types of wiltse classifications for spondylolisthesis

Answer 8

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

Question 9

what causes type 1 dysplastic spondylolisthesis

Answer 9

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

Question 10

what causes type 2 isthmic spondylolisthesis

Answer 10

due to spondylolysis

Question 11

what are the 3 subtypes of type 2 isthmic spondylolisthesis

Answer 11

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)

Question 12

what causes type 3 degenerative spondylolisthesis

Answer 12

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

Question 13

what wiltse classification is also called pseudospondylolisthesis

Answer 13

type 3 degenerative

Question 14

what causes type 4 traumatic spondylolisthesis

Answer 14

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

Question 15

what causes type 5 pathological spondylolisthesis

Answer 15

due to generalized bone disease (pagets or mets)

Question 16

what is the easiest modality for spondylolisthesis

Answer 16

plain film xray

Question 17

what is used to evaluate the cause of the spondylolisthesis

Answer 17

advanced imaging

Question 18

spondylolisthesis is graded on what system

Answer 18

meyerdings grading system

Question 19

what are the different grades of meyerdings grading system

Answer 19

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

Question 20

inverted napoleons hat sign is seen in what

Answer 20

grade 5 spondylolisthesis

Question 21

isthmic spondylolistehsis is due to what

Answer 21

spondylolysis due to repetitive stress through the posterior arch

Question 22

where is spondylolysis most common

second

Answer 22

MC - L5

2nd - L4

Question 23

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

Answer 23

10-20 years old

Question 24

spondylolysis most commonly occurs in e

Answer 24

males 3:1

especially adolescent male athletes that train 15 hours per week

Question 25

higher rates of spondylolysis is seen in what populations

Answer 25

inuit american indians caucasian males

Question 26

what actions cause spondylolysis

Answer 26

repetitive rotation, flexion, extension, and hyperextension

Question 27

what genetics increase your risk of spondylolysis

Answer 27

``` marfans OI osteopetrosis downs syndrome congenital disease ```

Question 28

spondylolysis symptoms

Answer 28

low back pain (usually during growth spurt) possible radiculopathy, gait disturbance, back spasm can progress to spondylolisthesis - more common in females

Question 29

the pars interarticularis can be evaluated with __ and __ views how do you see the scotty dog

Answer 29

AP and lateral oblique views

Question 30

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

Answer 30

prior gold standard imaging - SPECT scan (injection of radiopharmaceutical) new gold standard - MR MR just as accurate and less radiation

Question 31

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

Answer 31

skeletally immature more common in females risk to progress - 3-28%

Question 32

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

Answer 32

horizontal - decrease vertical - increase

Question 33

spinal stenosis is also called what

Answer 33

spondylosis

Question 34

what is the definition of stenosis

Answer 34

spinal canal and neural foraminal narrowing

Question 35

what is stenosis due to

Answer 35

secondary to multifactorial degenerative changes process is progressive and dynamic

Question 36

spinal stenosis most commonly occurs in what age group

Answer 36

> 50 years old

Question 37

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

Answer 37

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

Question 38

what is 4x more common in women

Answer 38

degenerative spondylolisthesis

Question 39

what are the 4 Fs of degenerative spondylolisthesis

Answer 39

female four - L4 forty fat

Question 40

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

Answer 40

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

Question 41

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

Answer 41

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

Question 42

MR and CT findings for a sagittal central canal measurement what is seen in axial plane

Answer 42

stenosis CS - <13 mm stenosis LS - <10-12mm visualization of cord and nerve root compression --> cord myelomalacia or contusion trefoil pattern of central canal

Question 43

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

Answer 43

disc herniations or bulges ligamentous thickening or hypertrophy of LF and PLL synovial cyst spinal cord tumor

Question 44

trefoil pattern means what what is it seen in

Answer 44

latin - 3 leaved plant thecal sac pattern seen in stenosis

Question 45

posterior aspect of trefoil pattern is due to what

Answer 45

facet arthrosis | ligamentum flavum hypertrophy

Question 46

what is a ganglion cyst called located in the facet joint what causes this

Answer 46

synovial fact cyst degeneration of facet joint

Question 47

where does synovial facet cyst occur

Answer 47

posterolateral to thecal sac

Question 48

where do majority of synovial facet cysts occur

Answer 48

lumbar spine (90%) MC - L4-L5 (70-80%)

Question 49

synovial facet cysts cause what

Answer 49

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

Question 50

facet cysts occur in what age and gender

Answer 50

>60 years old females

Question 51

what are the symptoms of facet cysts

Answer 51

chronic low back pain others - acute pain, radic, claudication, cauda equina syndrome, myelopathy

Question 52

what is the gold standard for facet cyst

Answer 52

MR

Question 53

what does a facet cyst look like on MRI

Answer 53

bright on T2 dark on T1 dark fibrous capsule on all pulse sequences with contrast the wall of the cyst enhances

Question 54

what is natural history and treatment of facet cysts

Answer 54

may spontaneously regress tx - conservative care, surgery with cyst excision, steroid injection