Flashcards in Thoracic spine II Deck (56)
Classic radiologic hallmarks of osteoporosis:
Increased radiolucency of vertebrae:
ﬁrst evidenced at cancellous vertebral bodies
empty box appearance of vertebral body
Thinning of cortical margins:
ﬁrst noted at vertebral body margins, especially at endplates, where cortical outline normally relatively thick
Cortical margins of vertebral arches also become thinned
Alterations in trabecular patterns:
Trabecular changes within vertebral bodies often leave distinct vertical striations
Wedge deformity in osteoporosis:
Structurally weakened vertebral bodies often collapse under ﬂexion or axial compressive forces
What happens in severe osteoporosis?
vertebral compression fractures may be due to relatively minor or normal everyday forces
Preponderance toward fracture directly related to severity
What do chronic microfractures produces?
biconcave appearance of vertebral body
Conﬁguration results from structural weakness and expansile pressures of disk
What does a single traumatic event result in?
flat appearing vertebra
Endplate deformities in osteoporosis:
Smooth indentations seen in endplates centrally, in region of NP
Sclerosis along endplates most common where?
thoracic and lumbar spines
Schmorl's nodes in osteoporosis?
Focal intrusion of nuclear material into vertebral body through structurally weakened endplates results in these radiolucent “nodes”
How is bone mineral density measured?
Early treatment for osteoporosis:
improvement of posture via strengthening and ﬂexibility exercises and improvement of general conditioning via weight-bearing activities and ambulation
Treatment for later stages osteoporosis:
rehabilitation important in providing adaptive modiﬁcations to preserve functional independence in ADL’s and ambulation
What is scoliosis?
lateral deviation of spine from mid-sagittal plane combined with rotational deformities of vertebrae and ribs
Pathological changes due to compressive forces on concave side of curvature include
Narrowed disk spaces
Wedge-shaped vertebral bodies
Shorter/thinner pedicles and laminae
Narrowed IVF and spinal canal spaces
Pathological changes on convex side of curvature include
Widened rib spaces
Posteriorly positioned rib cage (resulting in deforming “rib hump”)
Curves over 5 degrees appear in:
5% of population
Curves over 10 degrees appear in:
2-4% of population
Curves over 25 degrees occur in:
How many children will develop scoliotic curves large enough to warrant treatment?
3-5 out of 1000
What percentage of scoliosis cases are idiopathic?
What are the three types of idiopathic scoliosis:
appears before age 3 and may include neurological involvement
Many cases resolve spontaneously, although some progress to severe deformity
appears b/w ages 3-10, more often in girls, and presents high risk for progression
appears b/w age 10 and skeletal maturity at 7:1 female:male ratio
What are the distinct patterns of curvature in scoliosis:
1. right thoracic curve
2. right thoracolumbar curve
3. left lumbar curve
4. left lumbar, right thoracic curve
Right thoracic curve:
Most frequently seen curve is right convex thoracic curve
Major curve extends from T4–T6 to T11–L1
Secondary/minor curves seen above and below major curve as compensatory curves that aid in balancing spine and keeping eyes oriented to horizontal
Right thoracolumbar curve:
Major curve longer, extending from T4–T6 to L2–L4
It can appear to either side, but right is most common