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Questions and Answers
Which spinal curvature is characteristic of the thoracic spine?
Which spinal curvature is characteristic of the thoracic spine?
- Scoliotic
- Neutral
- Kyphotic (correct)
- Lordotic
What is the primary indication for obtaining oblique views of the lumbar spine?
What is the primary indication for obtaining oblique views of the lumbar spine?
- To measure spinal alignment
- To visualize the intervertebral discs
- To evaluate the facet joints (correct)
- To assess vertebral body height
In radiographic interpretation of the lumbar spine, visualizing the T12-L1 disc space is crucial for ensuring adequate coverage. What anatomical landmark confirms the inferior extent of a lumbar spine x-ray?
In radiographic interpretation of the lumbar spine, visualizing the T12-L1 disc space is crucial for ensuring adequate coverage. What anatomical landmark confirms the inferior extent of a lumbar spine x-ray?
- Femoral head
- Lower sacrum (correct)
- Coccyx
- Iliac crest
Which imaging modality is generally considered superior for identifying soft tissue injuries of the spine, such as ligamentous damage or disc herniation?
Which imaging modality is generally considered superior for identifying soft tissue injuries of the spine, such as ligamentous damage or disc herniation?
An epidural steroid injection (ESI) is a common spinal procedure. What do the initials 'ESI' stand for?
An epidural steroid injection (ESI) is a common spinal procedure. What do the initials 'ESI' stand for?
A patient presents with acute lower back pain following a fall. Which initial radiographic view is MOST useful for a preliminary assessment of the lumbar spine?
A patient presents with acute lower back pain following a fall. Which initial radiographic view is MOST useful for a preliminary assessment of the lumbar spine?
What anatomical feature of a lumbar vertebra is represented by the 'eye' of the 'Scottie dog' on an oblique radiographic view?
What anatomical feature of a lumbar vertebra is represented by the 'eye' of the 'Scottie dog' on an oblique radiographic view?
Which of the following is a typical indication for a CT scan of the thoracic or lumbar spine WITHOUT contrast?
Which of the following is a typical indication for a CT scan of the thoracic or lumbar spine WITHOUT contrast?
What is the abbreviation 'DDD' commonly used to describe in the context of spinal pathology?
What is the abbreviation 'DDD' commonly used to describe in the context of spinal pathology?
In assessing alignment on a lateral lumbar spine radiograph, which line is typically drawn along the posterior aspect of the vertebral bodies?
In assessing alignment on a lateral lumbar spine radiograph, which line is typically drawn along the posterior aspect of the vertebral bodies?
What is the clinical significance of the 'neck' of the 'Scottie dog' in oblique lumbar spine radiographs?
What is the clinical significance of the 'neck' of the 'Scottie dog' in oblique lumbar spine radiographs?
For which of the following indications is MRI of the thoracic or lumbar spine WITH contrast generally preferred?
For which of the following indications is MRI of the thoracic or lumbar spine WITH contrast generally preferred?
What is the anatomical term for the opening through which the spinal cord passes in each vertebra?
What is the anatomical term for the opening through which the spinal cord passes in each vertebra?
Which of the following views is MOST effective for assessing spondylolisthesis?
Which of the following views is MOST effective for assessing spondylolisthesis?
What does 'HNP' stand for in spinal terminology?
What does 'HNP' stand for in spinal terminology?
In reading a thoracic spine AP radiograph, which of the following is a landmark for the approximate level of T3?
In reading a thoracic spine AP radiograph, which of the following is a landmark for the approximate level of T3?
Which spinal ligament is located anterior to the vertebral bodies?
Which spinal ligament is located anterior to the vertebral bodies?
A 'swimmer's view' x-ray is often utilized in thoracic spine imaging. What is the primary purpose of this specialized view?
A 'swimmer's view' x-ray is often utilized in thoracic spine imaging. What is the primary purpose of this specialized view?
Which component of the vertebra projects posteriorly and is palpable along the midline of the back?
Which component of the vertebra projects posteriorly and is palpable along the midline of the back?
What is the term for a surgical procedure that involves the removal of the lamina of a vertebra to relieve pressure on the spinal cord or nerve roots?
What is the term for a surgical procedure that involves the removal of the lamina of a vertebra to relieve pressure on the spinal cord or nerve roots?
In the context of spinal instability, which radiographic views are typically obtained to assess for abnormal movement between vertebrae?
In the context of spinal instability, which radiographic views are typically obtained to assess for abnormal movement between vertebrae?
What is the approximate vertebral level of the tracheal bifurcation, a key landmark in thoracic radiography?
What is the approximate vertebral level of the tracheal bifurcation, a key landmark in thoracic radiography?
Which of the following is NOT typically evaluated when assessing 'Bones' in the 'ABCS' approach to reading spine radiographs?
Which of the following is NOT typically evaluated when assessing 'Bones' in the 'ABCS' approach to reading spine radiographs?
What is the lordotic curvature?
What is the lordotic curvature?
What is the abbreviation for Lumbar Microdiscectomy with Fusion?
What is the abbreviation for Lumbar Microdiscectomy with Fusion?
Which part of the vertebra forms the posterior portion of the vertebral foramen?
Which part of the vertebra forms the posterior portion of the vertebral foramen?
In assessing vertebral body height on a lateral spine radiograph, where should measurements be compared to detect compression fractures?
In assessing vertebral body height on a lateral spine radiograph, where should measurements be compared to detect compression fractures?
Which imaging modality is considered inferior to CT for the identification and characterization of cortical fractures of the vertebral bodies?
Which imaging modality is considered inferior to CT for the identification and characterization of cortical fractures of the vertebral bodies?
What is the primary indication for obtaining flexion and extension views of the lumbar spine?
What is the primary indication for obtaining flexion and extension views of the lumbar spine?
Which term describes the cartilaginous structure between vertebral bodies?
Which term describes the cartilaginous structure between vertebral bodies?
What is the 'body' of the 'Scottie dog' analogy in oblique lumbar spine radiographs?
What is the 'body' of the 'Scottie dog' analogy in oblique lumbar spine radiographs?
For optimal visualization of the thoracic spine on a lateral radiograph, what additional view might be necessary if the upper thoracic vertebrae are obscured?
For optimal visualization of the thoracic spine on a lateral radiograph, what additional view might be necessary if the upper thoracic vertebrae are obscured?
Which of the following is an indication for obtaining a thoracic and lumbar spine X-ray?
Which of the following is an indication for obtaining a thoracic and lumbar spine X-ray?
What is the term for the condition where there is a defect or fracture in the pars interarticularis, often described as a 'collar' on the Scottie dog?
What is the term for the condition where there is a defect or fracture in the pars interarticularis, often described as a 'collar' on the Scottie dog?
In the 'ABCS' approach to radiographic interpretation of the spine, what does 'C' typically stand for?
In the 'ABCS' approach to radiographic interpretation of the spine, what does 'C' typically stand for?
Which of the following is considered a 'soft tissue' structure evaluated in spinal radiography?
Which of the following is considered a 'soft tissue' structure evaluated in spinal radiography?
What is the required vertebral level visualization for a thoracic spine x-ray to ensure adequate anatomical coverage?
What is the required vertebral level visualization for a thoracic spine x-ray to ensure adequate anatomical coverage?
Which view is specifically used to assess for 'Scottie dog' abnormalities in lumbar spine imaging?
Which view is specifically used to assess for 'Scottie dog' abnormalities in lumbar spine imaging?
What is the significance of evaluating 'Alignment' in the systematic reading of thoracolumbar spine x-rays?
What is the significance of evaluating 'Alignment' in the systematic reading of thoracolumbar spine x-rays?
In a lateral lumbar spine radiograph demonstrating 'loss of height' of a vertebral body, what is the MOST likely interpretation?
In a lateral lumbar spine radiograph demonstrating 'loss of height' of a vertebral body, what is the MOST likely interpretation?
What is the primary advantage of MRI over CT in evaluating spinal conditions?
What is the primary advantage of MRI over CT in evaluating spinal conditions?
What is the most common mechanism of injury associated with a Chance fracture?
What is the most common mechanism of injury associated with a Chance fracture?
Which imaging modality is BEST for the initial evaluation of bony elements in an unstable Chance fracture?
Which imaging modality is BEST for the initial evaluation of bony elements in an unstable Chance fracture?
At which vertebral levels are Chance fractures MOST commonly seen?
At which vertebral levels are Chance fractures MOST commonly seen?
A patient involved in a high-speed MVA complains of severe back pain. Imaging reveals a fracture with collapse of the entire vertebral body. Which type of fracture is MOST likely?
A patient involved in a high-speed MVA complains of severe back pain. Imaging reveals a fracture with collapse of the entire vertebral body. Which type of fracture is MOST likely?
What radiographic finding is MOST indicative of a burst fracture on a frontal view?
What radiographic finding is MOST indicative of a burst fracture on a frontal view?
A patient presents with a compression injury to a vertebral body, but the posterior wall remains intact, and the spinal canal is not involved. Which of the following fractures is MOST likely?
A patient presents with a compression injury to a vertebral body, but the posterior wall remains intact, and the spinal canal is not involved. Which of the following fractures is MOST likely?
What is the TYPICAL mechanism of injury for a wedge fracture?
What is the TYPICAL mechanism of injury for a wedge fracture?
A patient presents with localized back pain after a motor vehicle accident. Radiographs reveal a fracture involving the spinous process of C7. This is referred to as:
A patient presents with localized back pain after a motor vehicle accident. Radiographs reveal a fracture involving the spinous process of C7. This is referred to as:
Following a fall, a patient complains of pain localized to the mid-thoracic region. Imaging reveals multiple fractures of the spinous processes. What type of injury should be suspected?
Following a fall, a patient complains of pain localized to the mid-thoracic region. Imaging reveals multiple fractures of the spinous processes. What type of injury should be suspected?
What is the MOST common location for lumbar disc herniations?
What is the MOST common location for lumbar disc herniations?
A patient presents with low back pain radiating down the leg, exacerbated by prolonged sitting. Which of the following conditions is MOST likely?
A patient presents with low back pain radiating down the leg, exacerbated by prolonged sitting. Which of the following conditions is MOST likely?
When is contrast typically indicated for MRI of the lumbar spine in the evaluation of herniated disc?
When is contrast typically indicated for MRI of the lumbar spine in the evaluation of herniated disc?
A patient with an L4-L5 disc herniation is MOST likely to exhibit weakness in which of the following movements?
A patient with an L4-L5 disc herniation is MOST likely to exhibit weakness in which of the following movements?
A patient presents with suspected nerve root compression. Which electrodiagnostic test measures the electrical activity of muscles at rest and during contraction?
A patient presents with suspected nerve root compression. Which electrodiagnostic test measures the electrical activity of muscles at rest and during contraction?
Which diagnostic study involves injecting contrast dye into a spinal disc to determine the location of a damaged disc?
Which diagnostic study involves injecting contrast dye into a spinal disc to determine the location of a damaged disc?
A patient presents with saddle anesthesia, bowel and bladder incontinence, and bilateral leg weakness. Which of the following conditions is MOST indicated?
A patient presents with saddle anesthesia, bowel and bladder incontinence, and bilateral leg weakness. Which of the following conditions is MOST indicated?
Which of the following is MOST important in the management of Cauda Equina Syndrome?
Which of the following is MOST important in the management of Cauda Equina Syndrome?
Which diagnostic imaging modality is MOST appropriate for initial diagnosis of Cauda Equina Syndrome?
Which diagnostic imaging modality is MOST appropriate for initial diagnosis of Cauda Equina Syndrome?
A patient undergoes an NCV test. Which description BEST describes NCV?
A patient undergoes an NCV test. Which description BEST describes NCV?
What is the MOST likely cause of a decreased speed observed during a Nerve Conduction Velocity (NCV) test?
What is the MOST likely cause of a decreased speed observed during a Nerve Conduction Velocity (NCV) test?
Which of the following mechanisms is LEAST likely to result in a spinous process fracture?
Which of the following mechanisms is LEAST likely to result in a spinous process fracture?
In the context of lumbar disc herniation, which nerve root is MOST likely affected by a central herniation at the L5-S1 level?
In the context of lumbar disc herniation, which nerve root is MOST likely affected by a central herniation at the L5-S1 level?
A patient presents with severe back pain following a motor vehicle accident. Imaging reveals a burst fracture with retropulsion of fracture fragments into the spinal canal. Which of the following additional injuries should the clinician be MOST concerned about?
A patient presents with severe back pain following a motor vehicle accident. Imaging reveals a burst fracture with retropulsion of fracture fragments into the spinal canal. Which of the following additional injuries should the clinician be MOST concerned about?
During lumbar discography, a patient reports that the pain reproduced by the injection into the L4-L5 disc is MORE severe and distinct compared to other levels tested. What is the MOST likely interpretation of this finding?
During lumbar discography, a patient reports that the pain reproduced by the injection into the L4-L5 disc is MORE severe and distinct compared to other levels tested. What is the MOST likely interpretation of this finding?
A patient is diagnosed with Cauda Equina Syndrome. If left untreated, which of the following complications is MOST likely to occur?
A patient is diagnosed with Cauda Equina Syndrome. If left untreated, which of the following complications is MOST likely to occur?
Flashcards
Kyphosis
Kyphosis
Concave anteriorly. The normal curve of the thoracic spine .
Lordosis
Lordosis
Concave posteriorly. The normal curve of the lumbar spine.
ESI (Spine)
ESI (Spine)
Epidural Steroid Injection - a minimally invasive procedure used to treat pain caused by inflamed spinal nerves.
LL (Spine)
LL (Spine)
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LMD (Spine)
LMD (Spine)
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LMDF (Spine)
LMDF (Spine)
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ACDF (Spine)
ACDF (Spine)
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PCLF (Spine)
PCLF (Spine)
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HNP (Spine)
HNP (Spine)
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DDD (Spine)
DDD (Spine)
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Annulus Fibrosis
Annulus Fibrosis
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Nucleus Pulposus
Nucleus Pulposus
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Thoracic Spine
Thoracic Spine
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Lumbar Spine
Lumbar Spine
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Indications for Spine X-ray
Indications for Spine X-ray
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Indications for Spine CT
Indications for Spine CT
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Indications for Spine MRI
Indications for Spine MRI
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Scotty Dog
Scotty Dog
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Spondylolysis
Spondylolysis
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Chance Fracture
Chance Fracture
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Burst Fracture
Burst Fracture
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Wedge Fracture
Wedge Fracture
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Spinous Process Fracture
Spinous Process Fracture
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Herniated Disc
Herniated Disc
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EMG
EMG
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NCV
NCV
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Cauda Equina Syndrome
Cauda Equina Syndrome
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Study Notes
Thoracolumbar Spine
- Views and qualities are required for axial skeleton x-ray and indications for further testing.
- Fractures, dislocations, and subluxations of the thoracic and lumbar spine, including chance, burst and wedge fractures can be identified.
- Pathology is associated with the axial skeleton, including ankylosing spondylitis, herniated disc disease, kyphosis, scoliosis, spinal stenosis, spondylolisthesis, and spondylolysis
Chance Fracture
- AKA
lap seat belt fracture
- Result of MVA where lap belt immobilizes the pelvis, while the rest of the upper body thrusts forward (hyperflexion)
- Associated with intraabdominal injuries
- Presents with severe back pain, worse with movement
- Diagnose using T and L spine x-ray AP & lateral views
- Best seen on a lateral view of the spine
- Results in horizontal severing of a vertebra
- Usually T12, L1, or L2
- Unstable fracture
- CT evaluates bony elements and MRI assesses soft tissue
- Will present as an anterior wedge fracture of the vertebral body with a horizontal fracture through posterior elements or distraction of facet joints and spinous processes
Burst Fracture
- High energy compressive axial loading spinal trauma (severe accidents, MVA or fall from a height)
- Diagnose via T & L spine x-ray AP & lateral.
- Considered an unstable fracture.
- Results in the collapse of an entire vertebral body.
- On lateral view the height of the anterior and posterior wall of vertebral body are short.
- On frontal view the interpedicular distance is increased.
- Fragments extend into the spinal canal, and are common, resulting in possible neurologic damage
Wedge Fracture
- Hyperflexion compression injury (high impact trauma: falling from height and landing on buttocks OR predisposing osteoporosis)
- No neurological damage is present
- Diagnose with T & L spine x-ray AP and lateral view.
- Results in Collapse of anterior vertebral body.
- On lateral view: Decreased height of anterior wall of vertebral body; Posterior wall of body remains intact and spinal canal is not involved.
Spinous Process Fracture
- Direct trauma (fall or MVA), repetitive stress (sports or heavy lifting), muscle spasms, osteoporosis
- Sharp and localized to the area of the fracture
- Diagnose using T or L spine x-ray AP & lateral
- Fracture presents as a black line in spinous process
- Referred to as Clay-Shoveler's when it is located C6-T3
- May be a contiguous fracture
Lumbar Spine: Herniated Disc
- Heavy lifting, fall, accident, poor posture, repetitive motion, aging are common causes
- Pain worsens after sitting or standing, at night, or when bending or when sneezing, coughing, or laughing
- Compresses nerve root, causing radicular pain (lumbar radiculopathy)
- Radiation of pain to the buttock, thigh, leg, and foot
- Decreased or absent reflexes, weakness and paresthesias (decreased sensation in dermatomal distribution), and + SLR
- Diagnose with L-spine MRI without contrast.
- Contrast is used when previous spine surgery or injury, suspected infection, tumor, or atypical presentation
- Most common at L5-S1 disc followed by L4-5.
- Central herniation will affect the nerve exiting below and lateral herniation will affect the nerve exiting at that level
- In the cervical and thoracic region, this doesn't usually apply because the spinal cord is compact and the nerve being affected doesn't typically change
- A C5-6 disc herniation central or lateral affects the C6 nerve root
- Example of L5-S1 disc herniation centrally affects S1 and laterally affects L5 because of the anatomy of the lumbar spinal nerves in the cauda equina
Tests
- Tests that can be helpful in identifying the specific nerve pathology: EMG, NCV, lumbar discography
EMG: Electromyogram
- Measures the electrical activity of muscles at rest & contraction
- Aids with dx of nerve compression or injury (carpal tunnel syndrome), nerve root injury (sciatica), other problems
- Electrodes placed into skin overlying muscle to detect electrical activity of muscle
- Electrical activity in the muscle is shown as wavy and spiky lines on video monitor
- Surface EMG (SEMG) does not involve piercing skin & is not painful
NCV: Nerve Conduction Velocity
- Shock-emitting electrode placed over nerve, recording electrode over muscles controlled by that nerve
- Measures time to contract in response to electric pulses
- Speed = conduction velocity
- Decreased speed indicates nerve damage - trauma, neuropathy, viral nerve infection or nerve entrapment diseases
Lumbar Discography
- Needle is inserted at various disc levels to determine location of damaged disc
- Contrast dye is injected into disc nucleus
- Dye replicates painful nerve compression, confirming source of pain
Cauda Equina Syndrome
- Causes same as for disc herniation
- Cauda equina and cord compression develop in hours
- Result of inadequate or delayed treatment of HNP
- Triad:
- Saddle anesthesia
- Back and bilateral leg pain
- Urinary/Fecal incontinence or retention
- Diagnose with MRI. Cauda equina nerves are compressed
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