Spondylolisthesis and Imaging Techniques

Questions and Answers

Anterior slippage of L5 as a result of a congenital anomaly or malformation of the posterior arch would be classified as _________ according to the Wiltse classification.

Dysplastic

Which radiographic line of mensuration is used to determine the presence of a spondylolisthesis or anterolisthesis?

Ullmann's line

Utilizing Myerding's method, an anterior displacement of L5 on S1 measuring 27% would be classified as a grade _________ spondylolisthesis.

Grade 2

Using the Wiltse classification, what type of spondylolisthesis is present in a patient with anterolisthesis of L5 due to a fractured lamina?

Traumatic Signup and view all the answers

A degenerative spondylolisthesis is most commonly observed at what level?

L4 Signup and view all the answers

The most common type of spondylolisthesis seen in patients less than 50 years of age is _____________________.

Isthmic Signup and view all the answers

The term spondylolisthesis traditionally refers to vertebral slippage in which direction?

Anterior Signup and view all the answers

A radiolucent line seen through the region of the pars interarticularis is known as ______________________.

Spondylolysis Signup and view all the answers

What is the most common level for an isthmic spondylolisthesis?

L5 Signup and view all the answers

Based on the description, what type of spondylolisthesis is present in the patient with anterolisthesis of L4 of 18%?

Degenerative Signup and view all the answers

The presence of a unilateral spondylolysis with stress hypertrophy of the opposite pedicle is characteristic and is also known as _____________ syndrome.

Wilkinson's Signup and view all the answers

Complete slippage of L5 on S1, greater than 100%, is termed _____________.

Spondyloptosis Signup and view all the answers

A vertebral body with a persistent midline-sagittal cleft in an adult appears radiographically as a _____________.

Butterfly vertebra Signup and view all the answers

The pressure from the superior gluteal arteries can create a groove at the lateral aspect of the inferior sacroiliac joint. This groove is called ____________.

paraglenoid sulcus Signup and view all the answers

Herniation of disc material into the vertebral body resulting in a short-based endplate depression surrounded by a thin sclerotic rim is known as what?

Schmorl's node Signup and view all the answers

The condition in which the S1 segment develops partial or complete lumbar type morphology is referred to as ____________.

lumbarization Signup and view all the answers

The absence of a spinolaminar line at any given level in the cervical spine is suggestive of what condition?

Spina bifida occulta Signup and view all the answers

Widening of the transverse processes of L5 greater than 19 mm vertically with no articulation with the sacrum is referred to as ______________.

spatualization Signup and view all the answers

Small round calcific densities within the pelvic basin representing calcified thrombi in the walls of the pelvic veins are called _____________.

Phleboliths Signup and view all the answers

Which imaging modality is usually the first and most extensively used for the evaluation of arthritic conditions?

Conventional radiography Signup and view all the answers

What is the other name for subchondral cysts, which are frequently seen in degenerative arthritis?

Geodes Signup and view all the answers

For the ABCS search pattern used to describe radiographic findings, which description is a good example for 'C'?

There is thinning of the C5/6 intervertebral disc space Signup and view all the answers

Calcification within the annular fibers of the intervertebral disc is known as a/an

intercalary bone Signup and view all the answers

Subchondral sclerosis is also known as ____________.

Eburnation Signup and view all the answers

Degeneration and osteoarthrosis are examples of which type of arthritic condition?

Non-inflammatory Signup and view all the answers

Non-union of the secondary growth center of an inferior articulating process within the lumbar spine is known as

oppenheimer's ossicle Signup and view all the answers

What is herniation of the cerebellar tonsils below the foramen magnum termed?

Arnold-Chiari Malformation Signup and view all the answers

A lumbar transitional segment with expansion of the transverse processes resulting in an accessory articulation with the sacral ala is classified as a Castellvi type ____

Type II Signup and view all the answers

Most common cause of work disability among US adults?

Articular Disease Signup and view all the answers

A disc herniation which remains covered by the posterior longitudinal ligament is categorized as?

contained Signup and view all the answers

On MRI, increased T1 signal and decreased T2 signal at vertebral endplates is consistent with?

Type 2 Modic Change Signup and view all the answers

The findings on the radiograph ARE NOT an absolute contraindication to chiropractic manipulation.

True Signup and view all the answers

Extension of disc material beyond the vertebral confines with the largest measurement being that of the depth of the displaced material is best termed a?

disc extrusion Signup and view all the answers

Which of the following causes of spinal stenosis is more common in women?

degenerative spondylolisthesis Signup and view all the answers

What other condition may be seen in patients with diffuse idiopathic skeletal hyperostosis?

Diabetes mellitus Type 2 Signup and view all the answers

What is the most common location for a synovial cyst?

L4-L5 Signup and view all the answers

Select the correct statement below regarding osteophytes.

The white arrows are pointing to osteophytes. Signup and view all the answers

A nuclear vacuum phenomenon is a reliable sign of early degenerative disc disease.

True Signup and view all the answers

What is the most common cause of neuropathic arthropathy of the upper extremity?

Syringomyelia Signup and view all the answers

Forestier's disease is another name for which condition?

Diffuse idiopathic skeletal hyperostosis Signup and view all the answers

What diagnosis would explain the pseudo-fracture appearance seen in a patient with chronic neck pain?

uncovertebral arthrosis Signup and view all the answers

What is the term for a free fragment of a herniated disc?

sequestration Signup and view all the answers

What type of signal intensity is expected in the nucleus pulposus of a desiccated intervertebral disc on MRI?

low T2 Signup and view all the answers

Which joint complex of the spine is a fibrocartilaginous joint?

intervertebral disc space Signup and view all the answers

Which radiographic view is best to evaluate for ossification of the posterior longitudinal ligament?

Lateral cervical neutral Signup and view all the answers

The finding of para-endplate bony sclerosis is consistent with?

Type 3 Modic Change Signup and view all the answers

Which type of Modic change is visible on conventional radiographs?

Type 3 Modic Change Signup and view all the answers

A 78-year-old female presents with low back pain. What motion is likely to be most painful for this patient based on radiographic findings?

extension Signup and view all the answers

A 58-year-old female presents with chronic, moderate neck pain. What is the diagnosis based on her cervical spine radiographs?

degenerative disc disease Signup and view all the answers

The findings of para-endplate bone marrow edema and inflammation on MRI are consistent with?

Type 1 Modic Changes Signup and view all the answers

Which of the following statements is TRUE regarding DISH?

It is characterized by calcification of the anterior longitudinal ligament. Signup and view all the answers

Which category of arthritis is most often encountered in chiropractic practice?

Non-inflammatory Signup and view all the answers

Rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis are all examples of which category of arthritis?

Inflammatory Signup and view all the answers

Gout, calcium pyrophosphate, and hydroxapatite are all examples of which category of arthritis?

Metabolic/depositional Signup and view all the answers

Which condition is described as having one facet joint oriented in the sagittal plane while the other side is oriented in the coronal plane?

Facet tropism Signup and view all the answers

A triangular ossicle that occurs as a result from herniation of nuclear disc material through the cartilaginous junction zone of the ring apophysis during childhood is known as?

Limbus bone Signup and view all the answers

What radiographic entity is seen dorsal to the cervical spinous processes?

Nuchal bone Signup and view all the answers

Which radiographic view is most beneficial for seeing a paracondylar process?

AP open mouth Signup and view all the answers

According to the Castellvi classification, a transitional segment that has a pseudoarticulation between an enlarged transverse process and the sacral would be classified as which type?

II Signup and view all the answers

Which radiographic finding is associated with thoracic outlet syndrome?

Cervical ribs Signup and view all the answers

A transverse, short radiolucent line seen in the midportion of a lower thoracic vertebra is called?

Hahn's venous cleft Signup and view all the answers

If a radiographic series demonstrates six distinct lumbar vertebrae on the film, which anomaly is present?

Lumbarization Signup and view all the answers

Which anomaly/normal variant causes absence of the spinolaminar line?

Spina bifida occulta Signup and view all the answers

A split cord by either an osseous bar or a fibrous septum is known as?

Diastematomyelia Signup and view all the answers

What is the term for downward displacement or elongation of the brainstem and cerebellar tonsils through the foramen magnum?

Arnold-Chiari malformation Signup and view all the answers

Small round radiopaque densities within the pelvic basin representing calcified thrombi in the walls of the pelvic veins are called?

phleboliths Signup and view all the answers

Which radiographic sign is most suggestive of a congenital block vertebra?

Wasp waist Signup and view all the answers

The most cephalic intervertebral disc of the spinal column is found at which level?

C2/C3 Signup and view all the answers

Which condition is associated with secondary basilar impression?

Paget disease Signup and view all the answers

The clinical triad of a short webbed neck, low posterior hairline, and reduced cervical motion is classic for which condition?

Klippel-Feil Signup and view all the answers

Anterior displacement of a vertebral body in relation to its subjacent segment is known as?

spondylolisthesis Signup and view all the answers

The line drawn between the basion and the opisthion is called?

McRae Signup and view all the answers

Which radiographic line of mensuration is demonstrated?

Interpediculate distance Signup and view all the answers

When using the canal-to-body ratio in the cervical spine, which of the following would be considered an indicator of spinal stenosis?

0.723 Signup and view all the answers

The curvilinear line drawn at the posterior aspect of the vertebral bodies is called ______________ line.

George Signup and view all the answers

Spinal stenosis in the cervical spine, at the C6 level, is suggested when the sagittal canal dimension measures less than ______ mm.

12 Signup and view all the answers

Which of the following is the correct way to draw the ______?

atlantodental interspace Signup and view all the answers

The sagittal spinal canal dimension measurement of the lumbar spine, using Eisenstein's method, has a minimum measurement of ______ mm.

15 Signup and view all the answers

Which radiographic line of mensuration is demonstrated?

Chamberlain's line Signup and view all the answers

Which line is considered the most accepted method for measuring a scoliotic spinal deviation?

Cobb Signup and view all the answers

The presacral space should NOT exceed more than ____ cm in adults.

2 Signup and view all the answers

The maximum measurement for the sella turcica is?

16mm x 12mm Signup and view all the answers

The cervical prevertebral (retropharyngeal) soft tissue at the level of C2 should measure no greater than _________ mm.

7 Signup and view all the answers

Which radiographic line is considered the most accurate and reproducible measurement of basilar impression?

McGregor's line Signup and view all the answers

Cerebral palsy, syringomyelia, and poliomyelitis would be examples of which kind of scoliosis?

Structural, neuromuscular Signup and view all the answers

A 15-year-old female complains of back pain. On physical exam, a noticeable 'rib humping' is seen during the Adam's sign, so radiographs were obtained to investigate a possible scoliosis.

Dextroscoliosis Signup and view all the answers

A thoracic scoliosis would have an apex at which of the following levels?

T8 Signup and view all the answers

Spinal curves are classified in three ways: 'cause', location, and direction of the curvature. Which of the following would be considered a 'cause' classification?

Structural scoliosis Signup and view all the answers

A spinal curvature measuring 14 degrees with the apex vertebra at L1 is classified as which type of scoliosis?

Thoracolumbar Signup and view all the answers

The most deviated vertebra from the vertical axis of the patient, or the most rotated vertebra in a curve is defined as __________ vertebra.

apical Signup and view all the answers

In general, scoliosis is defined as spinal curvature in which plane?

Coronal Signup and view all the answers

A spinal curvature with the convexity directed to the left side of the body is defined as a?

levoscoliosis Signup and view all the answers

A 15-year-old female complains of back pain. On physical exam, she has a noticeable 'rib hump', so X-rays were obtained to investigate a possible scoliosis. Her radiograph measures a curvature of 43.1 degrees.

Refer for a surgical consult Signup and view all the answers

What is the proper term for a fracture of abnormal bone that results from normal loading forces?

Insufficiency fracture Signup and view all the answers

What is an occult fracture and what should be the clinical course?

Fracture not visible on X-ray; treat the patient as if it were broken and follow-up with X-rays in 1-2 weeks. Signup and view all the answers

Which imaging modality is best for demonstrating a bone bruise?

Magnetic resonance imaging (MRI) Signup and view all the answers

In which stage of fracture healing is clinical union achieved?

Consolidation Signup and view all the answers

Which of the following is an acceptable definition of a comminuted fracture?

Two or more fracture fragments or lines Signup and view all the answers

A fracture that does not break the skin is best termed?

Closed Signup and view all the answers

Which of the following fractures generates more than two fragments?

Comminuted fracture Signup and view all the answers

Study Notes

Dysplastic Spondylolisthesis: Anterior slippage of L5 due to congenital anomaly.
Traumatic Spondylolisthesis: Occurs from injury, evident in car accident patients showing lamina or facet fractures.
Grade 2 Spondylolisthesis: Identified with a 27% anterior displacement of L5 on S1 using Myerding's method.
Most Common Levels: Degenerative spondylolisthesis is most often found at L4; isthmic type is most commonly at L5.
Spondyloptosis: Condition involving complete slippage of L5 on S1 greater than 100%.
Spondylolysis: Characterized by a radiolucent line at the pars interarticularis, often leading to unilateral spondylolysis syndrome (Wilkinson's).

Imaging Techniques and Findings

Ullmann's Line: A critical radiographic line for assessing spondylolisthesis or anterolisthesis.
Conventional Radiography: Primary imaging modality used for assessing arthritic conditions.
Myerding's Method: Utilized for classification of spondylolisthesis based on percentage of slippage.
Intercalary Bone: Refers to calcification within annular fibers of an intervertebral disc.
MRI Signals: Type 2 Modic Change shows increased T1 and decreased T2 signals at vertebral endplates.
George Line: A curvilinear line drawn posteriorly around vertebral bodies seen in imaging for various assessments.

Degenerative and Metabolic Changes

Degenerative Disc Disease: Observed through intervertebral disc height loss, endplate sclerosis, and osteophyte formation.
Phleboliths: Calcified thrombi in pelvic veins, seen as small, round radiopaque densities.
Eburnation: Another term for subchondral sclerosis, commonly found in arthritis.

Scoliosis and Its Types

Dextroscoliosis: Rightward spinal curve often diagnosed in young patients with rib humping signs.
Facial Tropism: A condition where one spinal facet joint is oriented differently than the opposite joint.
Structural Neuromuscular Scoliosis: Conditions such as cerebral palsy or poliomyelitis lead to this curvature.

Fractures and Healing

Occult Fracture: A fracture that is not visible on initial x-rays and may require follow-up imaging.
Insufficiency Fracture: A fracture occurring in abnormal bone due to normal loading forces.
Bone Bruise: Best demonstrated using Magnetic Resonance Imaging (MRI).

Developmental Anomalies

Limbus Bone: A triangular ossicle resulting from herniation of disc material.
Diastematomyelia: Describes a split spinal cord due to osseous or fibrous septum.

Miscellaneous

Arnold-Chiari Malformation: Refers to the downward displacement of brain structures through the foramen magnum.
Cobb Angle: The most accepted method for measuring spinal curvature in scoliosis cases.
Cervical Ribs: Radiographic findings relevant in diagnosing thoracic outlet syndrome.

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Description

Explore the various types of spondylolisthesis, including dysplastic and traumatic cases, as well as their imaging techniques. This quiz will test your knowledge on key concepts, definitions, and imaging methods used in diagnosing spondylolisthesis. Perfect for students and professionals in medical fields.