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Bone Pathology > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is spina bifida occulta (SPO)?

A

Failure of fusion of the two posterior arch ossification centers producing a midline defect

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2
Q

Occult means?

A

Hidden, small hidden

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3
Q

What can not be seen on xray with spina bifida occulta?

A

Can not see the spinal laminar junction

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4
Q

What are some associated conditions w/ SPO

A

Posterior disc herniation, and association w/ isthmic spondylolisthesis

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5
Q

What is anterior arch agenesis?

A

Absence of D-shaped anterior arch on lateral cervical film (rare)

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6
Q

For stability b/t C1/C2 w/ anterior arch agenesis we need what?

A

An intact dens, anterior arch, lateral masses and transverse processes, don’t really need a posterior arch

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7
Q

How do we test for hypermobility w/ anterior arch agenesis?

A

Perform flex/ext study to screen hypermobility

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8
Q

What is posterior arch agenesis?

A

Lack of cartilage template (partial or complete) for absence of a posterior arch

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9
Q

What happens to the anterior arch and C2 w/ posterior arch agenesis?

A

Hypertrophy and sclerosis of anterior arch and megaspinous of C2

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10
Q

What is a posterior ponticle?

A

Partial or complete ossification of the oblique portion of the atlanto-occipital membrane

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11
Q

What does the posterior ponticle/arcuate foramen contain?

A

Vertebral artery and 1st cervical nerve

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12
Q

How common is a posterior ponticle?

A

15% of the pop.

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13
Q

Is a posterior ponticle more common uni or bilaterally?

A

Unilaterally

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14
Q

What are some other names for posterior ponticle?

A

Arcuate foramen, Kimmerly anomaly, ponticulus posticus

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15
Q

What might the posterior ponticle do to the nerves?

A

May compress and traction

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16
Q

Down’s syndrome?

A

Trisomy 21, 1 in 600 births

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17
Q

What can Down’s syndrome lead to?

A

Atlanto-axial instability due to lax transverse ligament

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18
Q

What % of Down’s syndrome patients are born w/out transverse ligaments?

A

20%

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19
Q

What are Down’s syndrome patients prone to?

A

Cervical spondylosis and myelopathy

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20
Q

What increased space is seen in Down’s syndrome patients?

A

Increased atlanto-dental interspace (ADI) flexion lateral view

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21
Q

What is Ossiculum Terminale/Persistens of Bergman?

A

Non-fusion of secondary growth center of dens, separate ossicles in patients over 12 y/o

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22
Q

What is Os Odontoideum?

A

Two halves of the odontoid unite do not fuse to C2, probably due to old fracture w/ non-union

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23
Q

Is the transverse ligament usually intact or not intact w/ Os ondontoideum?

A

Intact

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24
Q

What is the exception for dx before 5 y/o w/ Os Odontoideum?

A

Hypermobility of the dens is demonstrated

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25
Q

What type of translation is seen w/ Os Odontoideum?

A

Sagittal translation, see if masses of C1 slide over C2

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26
Q

What is hypoplastic/ageneic odontoid?

A

The odontoid halves do not develop fully or at all (extremely rare), possible surgery

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27
Q

What is a block vertebra/synostosis?

A

Non-segmentation of two adjacent segments

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28
Q

What is the appearance of block vertebra/synostosis?

A

Wasp wasted appearance of AP diameter where two levels were joined together

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29
Q

What are some complications of block vertebra?

A

Premature DJD at adjacent levels, laxity at adjacent levels d/t increased stresses

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30
Q

Where in the neck is block vertebra/synostosis the most common at?

A

C2/C3 and C5/C6

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31
Q

Where in the lumbar is block vertebra/synostosis the most common?

A

L4/L5

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32
Q

Radiographs showing block vertebra/synostosis what becomes no longer visible?

A

Discs and roughened endplates

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33
Q

What is Klippel-Feil Syndrome?

A

Multiple block vertebra, SBO, scoliosis, Sprengel’s deformity, platybasia

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34
Q

What is the classic triad associated w/ KFS?

A

Shortness (d/t loss of disc spaces)
Webbed neck (pterygium coli)
Lowered hairline
Decreased Cx ROM

35
Q

What soft tissue anomalies are associated w/ KFS?

A

GU anomalis (horseshoe kidney or 2 ureters off one kidney) intravenous urogram or pylogram

36
Q

What is Sprengel Deformity?

A

Congenitally undescended scapula

37
Q

Where is Sprengel’s Deformity normally at?

A

Inferior angle at T7

38
Q

What is an omovertebral bone?

A

In Sprengel’s deformity it is a chunk of bone that fixes the scapula to the spine present only sometimes

39
Q

Is KFS and Sprengel’s deformity isolated from each other or associated w/ each other?

A

Both

40
Q

What is cervical spondylolisthesis?

A

Congenital form caused by bilateral agenesis of pedicles and dysplasia (malformation) of articular processes

41
Q

At what level is cervical spondylolisthesis most common?

A

C6 (C6 slipped forward compared to C7)

42
Q

Is cervical spondylolistheses more common in males or females?

A

M>F

43
Q

What is commonly associated at the same level as cervical spondylolisthesis?

A

SBO

44
Q

Is cervical spondylolisthesis symptomatic or asymptomatic?

A

Both

45
Q

What does a lateral view of cervical spondylolisthesis show?

A

Lucencies b/t pedicle and SP

46
Q

Where are cervical ribs most common at?

A

C5-7

47
Q

What do the cervical ribs articulate w/?

A

The TPs. Articulations w/ TP differentiates from hyperplastic TP

48
Q

If a patient as a cervical rib at C5 what else will the patient present w/?

A

Cervical ribs the rest of the way down

49
Q

What are apparent defects in the medial aspects of lateral masses in the cervical spine?

A

C1 lateral mass notches

50
Q

What is a C1 lateral mass notch?

A

Apparent defects in the medial aspects of lateral masses in the cervical spine

51
Q

What do the lucencies of the atlas in C1 lateral mass notches represent?

A

Attachment sites of the transverse ligament

52
Q

What are the central maxillary incisors?

A

May look like vertical fracture through the dens but is actually a space b/t teeth

53
Q

What may look like a vertical fracture through the dens?

A

Central maxillary incisors

54
Q

What is the match effect?

A

Overlapping structure of posterior arch of C1 we see lucency at bottom of C1, shadow formed by diverging xrays, may be lips, tongue and occiput

55
Q

What are the paraodontoid notches?

A

Notches next to the dens

56
Q

What do the paraodontoid notches represent?

A

Part of the growth centers/synchondrosis (didn’t fill w/ bone)

57
Q

What is Eagles Syndrome?

A

It is a stylohyoid ossification

58
Q

What view shows Eagles syndrome the best?

A

APOM, but can still be seen on lateral view

59
Q

What is associated w/ Eagles syndrome?

A

Dysphagia and anterior neck pain

60
Q

What can PLL ossification cause?

A

Spinal stenosis

61
Q

What is facet notching?

A

Mimics erosion or fracture, no trauma yet trauma can cause it

62
Q

Articular pillars overlapping due to what may mimic vertebral pillar fracture?

A

Rotation

63
Q

What is a pseudofracture and arthrosis?

A

Lucency seen through the body but actually unco-vertebral joint arthrosis, (look like they have become slightly horizontal)

64
Q

What is a pyriform sinus?

A

Lucency medial to v-body on AP film, may look like a destructive lesion, but just air space overlying the bone

65
Q

What is the transverse foramen of C2

A

Looks like holes in the bone but are very symmetric looking, not a destructive lesion

66
Q

What are Hahn’s venous clefts?

A

Vascular channels seen as horizontal lucencies thorugh the mid-vertebral body

67
Q

Where are Hahn’s venous cleft most common at?

A

Lower thoracic spine

68
Q

Are Hahn’s venous clefts normal or abnormal findings?

A

normal

69
Q

What is a lumbar block vertebra?

A

Non segmentation in thoracic and lumbar

70
Q

Are block vertebra more common in the cervicals or lumbar spine?

A

Cervicals

71
Q

Where are lumbar block vertebra m/c found?

A

L4/L5

72
Q

What do we assume if there is multiple block vertebra?

A

KFS

73
Q

What is a butterfly vertebra?

A

Central hourglass shaped lucency in the body on AP radiographs. Continuous disc material vertebra from adjacent discs

74
Q

How do butterfly vertebra and SBO differ?

A

In butterfly vertebra the body is separated compared to SBO where posterior elements are separated

75
Q

What happens to the vertebral body in butterfly vertebra?

A

Becomes wider

76
Q

Are butterfly vertebra stable or unstable?

A

Usually stable

77
Q

What type of fracture does a butterfly vertebra look like?

A

Burst fracture

78
Q

What is a hemivertebra?

A

Failure of ossification center, becomes a wedge shaped vertebra and adjacent endplate deformities

79
Q

Where are hemivertebra m/c?

A

Laterally m/c and dorsal/ventral l/c

80
Q

What are hemivertebra usually associated w/?

A

Block vertebra, KFS, diastematomyelia (spinal cord split into two halves)

81
Q

If a hemivertebra is isolated what does it often cause?

A

Scoliosis

82
Q

What does the term scrambled spine refer to?

A

When hemivertebra is w/ block vertebra

83
Q

How do we know hemivertebra are congenital?

A

B/c of the absence of osteophytes

Bone Pathology (2 decks)

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