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Flashcards in Test 2: CT of the Spine Deck (84)
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1

Indications for CT of the spine

-MRI contraindicated
-before and after spinal surgery (bony anatomy, alignment of hardware)
-visualize fractures, including pars defects
-characterize osseous lesions: neoplasm/metastases, hemangioma, bone cyst, osteoid osteoma

2

Spine CT: contrast or non contrast?

NON

3

Best imaging modality to view spinal cord?

MRI

4

If a patient is contraindicated to get an MRI, but needs imaging of an IV disc, what type of imaging will be used?

CT, soft tissue window

5

What imaging findings might come with a pars defect? What imaging modality is a pars defect best seen, and why?

anterolisthesis, elongated, flute shaped spinal canal, horizontal lucency at pars interarticularis in sagittal and axial CT views
-CT best: too much overlap on XR

6

Burst fracture: characteristics on CT

-break in cortical continuity (areas of lucency)
-narrowed spinal canal
-loss of height of vertebral body
-vertebral body misshapen
-may see fragments displaced posteriorly into spinal canal

7

Vertebral augmentation: define the concept and list 2 procedures

-procedures used for palliation of pain related to vertebral compression fractures
-2 types: percutaneous vertebroplasty (PV) and balloon-assisted kyphoplasty

8

management of compression fractures

-initially: conservative management is the gold standard
-medical management with or without methods of immobilization
-medication

9

complications of medication for treatment of pain in compression fractures:

NSAIDS: gastrointestinal hemorrhage, ulcers
Narcotics: addiction, constipation, nausea, somnolence

10

osteoporotic fractures: talk about pain, medication, and what happens over time

most patients have a spontaneous resolution of pain within 4-6 weeks of onset, even without medication

11

extra credit: causes of vertebral compression fractures

1. osteoporosis (most common)
2. direct trauma
3. neoplasm/metastatic disease

12

indications for vertebral augmentation

-conservative treatment failed
-pain refractory to oral medications for 6-12 weeks
-contraindications to medication
-hospitalization with IV narcotics administered

13

Define percutaneous vertebroplasty

Injection of low viscosity PMMA cement into vertebral body using a unipedicule or bipedicule needle

14

Success rate for pain relief? who benefits most?

89-93% success rate; women and people <75 years old benefit most

15

Percutaneous Vertebroplasty: Clinical History/Physical exam criteria for indication/contraindication of PV procedure:

1. focal pain at spinal process level corresponding to level of fracture
2. 6-12 weeks after onset of pain: time frame for treatment (first 6-12 conservative)
Patients treated EARLIER if:
-they required hospitalization and IV narcotics for pain
-they have a history of a successful prior PV
DISQUALIFICATION for PV:
-radicular pain involving LEs or LBP radiating to hips (pt may need a different intervention)

16

PV: complications; acute and delayed

ACUTE: 1-3.9%
-cement leak: symptomatic or asymptomatic
-cement pulmonary embolism: symptomatic or asymptomatic
-bleeding
-infection
-neurological deficit
DELAYED:
-risk for new fractures at other levels: cement decreases compliance
-clustering of fxs as a natural history of OP?

17

Balloon kyphopasty: explain the procedure

insertion of a unipedicle or bipedicle needle, inflation of intravertebral balloon to create a void in which high-viscosity bone cement is injected
-more recently developed (than PV?)

18

Between Balloon kyphoplasty and PV:
-which has better outcomes?
-which has fewer complications?
-which has better height restoration?
-which is better for burst fxs?
-which is more expensive?

-no difference in outcomes
-no difference in complications
-"some believe" kyphoplasty offers better height restoration
-kyphoplasty may be better for burst fxs; can offer more controlled angular and fracture correction
-kyphoplasty more costly

19

is cement bright or dark on CT?

bright

20

osseous metastasis: appearance on XR, CT

heterogenous, patchy appearance within bone

21

Indications for CT myelogram:

-pt has a need for visualization of soft tissue within spinal canal:
-pt cannot get an MRI
-pt has hardware that obscures spinal canal on CT or MR

22

CT myeologram: technique

-injection of contrast by lumbar puncture (into thecal sac) under fluoroscopic XR guidance
-subsequent imaging of spine

23

CT myelogram: contraindications

-elevated INR or bleeding disorders

24

MRI indications: 6 main categories

1. degenerative disease
2. osseous/extraosseous infection
3. neoplasm
4. demyelinating/inflammatory disease
5. trauma
6. postop spine imaging

25

MRI: absolute and relative contraindications

ABSOLUTE:
-pacemaker
-ferromagnetic aneurysm clip
-cochlear implant
-IVC filter
-orbital metallic foreign body
RELATIVE
-metal fragments, depending on location
-1st trimester pregnancy (risk v. benefits)
-transcutaneous nerve stimulators
-claustrophobia

26

Contrast enhanced MRI: indications

-postop spine recurrent back pain evaluation: to view granulation tissue from recurrent or new disc herniation
-metastatic bone disease (bone and spinal cord)
-primary SC lesions (tumor, demyelination)
-spinal infection (discitis, osteomyelitis, epidural abscess)

27

Noncontrast MRI: indications

-degenerative disease
-low back pain
-preoperative planning
-radiculopathy

28

Contraindication for MRI contrast

Pt with EGFR <30
-measure of kidney function
-risk of nephrogenic system fibrosis (NSF)

29

Non Contrast MRI for Cervical Spine: what sequences are used for the cervical spine, and which views for each sequence?

Cervical spine:
-T1 and T2: sagittal and axial views
-STIR: sagittal view
-Gradient Echo: axial view

30

Non Contrast MRI for Thoracic and Lumbar Spine: sequences used and views

Thoracic/Lumbar Spine:
-T1 & T2: sagittal and axial
-STIR: sagittal