Thoracic and Lumbar Spine

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Questions and Answers

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?

  • 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?

  • 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?

<p>MRI (B)</p> Signup and view all the answers

An epidural steroid injection (ESI) is a common spinal procedure. What do the initials 'ESI' stand for?

<p>Epidural Steroid Injection (A)</p> Signup and view all the answers

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?

<p>AP and Lateral views (C)</p> Signup and view all the answers

What anatomical feature of a lumbar vertebra is represented by the 'eye' of the 'Scottie dog' on an oblique radiographic view?

<p>Pedicle (B)</p> Signup and view all the answers

Which of the following is a typical indication for a CT scan of the thoracic or lumbar spine WITHOUT contrast?

<p>Assessment of bony fractures post-trauma (B)</p> Signup and view all the answers

What is the abbreviation 'DDD' commonly used to describe in the context of spinal pathology?

<p>Degenerative Disc Disease (C)</p> Signup and view all the answers

In assessing alignment on a lateral lumbar spine radiograph, which line is typically drawn along the posterior aspect of the vertebral bodies?

<p>Posterior Longitudinal Ligament (PLL) (A)</p> Signup and view all the answers

What is the clinical significance of the 'neck' of the 'Scottie dog' in oblique lumbar spine radiographs?

<p>It represents the pars interarticularis and is evaluated for spondylolysis. (B)</p> Signup and view all the answers

For which of the following indications is MRI of the thoracic or lumbar spine WITH contrast generally preferred?

<p>Suspected epidural abscess (B)</p> Signup and view all the answers

What is the anatomical term for the opening through which the spinal cord passes in each vertebra?

<p>Vertebral foramen (C)</p> Signup and view all the answers

Which of the following views is MOST effective for assessing spondylolisthesis?

<p>Lateral view (C)</p> Signup and view all the answers

What does 'HNP' stand for in spinal terminology?

<p>Herniated Nucleus Pulposus (C)</p> Signup and view all the answers

In reading a thoracic spine AP radiograph, which of the following is a landmark for the approximate level of T3?

<p>Clavicle (B)</p> Signup and view all the answers

Which spinal ligament is located anterior to the vertebral bodies?

<p>Anterior Longitudinal Ligament (ALL) (A)</p> Signup and view all the answers

A 'swimmer's view' x-ray is often utilized in thoracic spine imaging. What is the primary purpose of this specialized view?

<p>To visualize the cervicothoracic junction (B)</p> Signup and view all the answers

Which component of the vertebra projects posteriorly and is palpable along the midline of the back?

<p>Spinous process (D)</p> Signup and view all the answers

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?

<p>Laminectomy (A)</p> Signup and view all the answers

In the context of spinal instability, which radiographic views are typically obtained to assess for abnormal movement between vertebrae?

<p>Flexion and extension lateral views (C)</p> Signup and view all the answers

What is the approximate vertebral level of the tracheal bifurcation, a key landmark in thoracic radiography?

<p>T4-T5 (B)</p> Signup and view all the answers

Which of the following is NOT typically evaluated when assessing 'Bones' in the 'ABCS' approach to reading spine radiographs?

<p>Intervertebral disc space (D)</p> Signup and view all the answers

What is the lordotic curvature?

<p>Convex anteriorly (A)</p> Signup and view all the answers

What is the abbreviation for Lumbar Microdiscectomy with Fusion?

<p>LMDF (B)</p> Signup and view all the answers

Which part of the vertebra forms the posterior portion of the vertebral foramen?

<p>Laminae (D)</p> Signup and view all the answers

In assessing vertebral body height on a lateral spine radiograph, where should measurements be compared to detect compression fractures?

<p>To adjacent vertebral bodies (C)</p> Signup and view all the answers

Which imaging modality is considered inferior to CT for the identification and characterization of cortical fractures of the vertebral bodies?

<p>MRI (C)</p> Signup and view all the answers

What is the primary indication for obtaining flexion and extension views of the lumbar spine?

<p>To evaluate for spinal instability (A)</p> Signup and view all the answers

Which term describes the cartilaginous structure between vertebral bodies?

<p>Intervertebral disc (A)</p> Signup and view all the answers

What is the 'body' of the 'Scottie dog' analogy in oblique lumbar spine radiographs?

<p>Lamina (B)</p> Signup and view all the answers

For optimal visualization of the thoracic spine on a lateral radiograph, what additional view might be necessary if the upper thoracic vertebrae are obscured?

<p>Swimmer's view (C)</p> Signup and view all the answers

Which of the following is an indication for obtaining a thoracic and lumbar spine X-ray?

<p>Post-operative back pain (B)</p> Signup and view all the answers

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?

<p>Spondylolysis (A)</p> Signup and view all the answers

In the 'ABCS' approach to radiographic interpretation of the spine, what does 'C' typically stand for?

<p>Cartilage (A)</p> Signup and view all the answers

Which of the following is considered a 'soft tissue' structure evaluated in spinal radiography?

<p>Intervertebral disc (A)</p> Signup and view all the answers

What is the required vertebral level visualization for a thoracic spine x-ray to ensure adequate anatomical coverage?

<p>C7-L1 (A)</p> Signup and view all the answers

Which view is specifically used to assess for 'Scottie dog' abnormalities in lumbar spine imaging?

<p>Oblique view (C)</p> Signup and view all the answers

What is the significance of evaluating 'Alignment' in the systematic reading of thoracolumbar spine x-rays?

<p>To identify any abnormal curvature or displacement of vertebrae (C)</p> Signup and view all the answers

In a lateral lumbar spine radiograph demonstrating 'loss of height' of a vertebral body, what is the MOST likely interpretation?

<p>Compression fracture (D)</p> Signup and view all the answers

What is the primary advantage of MRI over CT in evaluating spinal conditions?

<p>Superior soft tissue contrast (C)</p> Signup and view all the answers

What is the most common mechanism of injury associated with a Chance fracture?

<p>Hyperflexion with lap belt immobilization (B)</p> Signup and view all the answers

Which imaging modality is BEST for the initial evaluation of bony elements in an unstable Chance fracture?

<p>X-ray (D)</p> Signup and view all the answers

At which vertebral levels are Chance fractures MOST commonly seen?

<p>T12-L2 (B)</p> Signup and view all the answers

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?

<p>Burst fracture (D)</p> Signup and view all the answers

What radiographic finding is MOST indicative of a burst fracture on a frontal view?

<p>Increased interpedicular distance (C)</p> Signup and view all the answers

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?

<p>Wedge fracture (B)</p> Signup and view all the answers

What is the TYPICAL mechanism of injury for a wedge fracture?

<p>Hyperflexion compression injury (D)</p> Signup and view all the answers

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:

<p>Clay-Shoveler's fracture (B)</p> Signup and view all the answers

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?

<p>Clay-Shoveler's fracture (D)</p> Signup and view all the answers

What is the MOST common location for lumbar disc herniations?

<p>L5-S1 (C)</p> Signup and view all the answers

A patient presents with low back pain radiating down the leg, exacerbated by prolonged sitting. Which of the following conditions is MOST likely?

<p>Lumbar disc herniation (B)</p> Signup and view all the answers

When is contrast typically indicated for MRI of the lumbar spine in the evaluation of herniated disc?

<p>When there is a history of prior spine surgery (B)</p> Signup and view all the answers

A patient with an L4-L5 disc herniation is MOST likely to exhibit weakness in which of the following movements?

<p>Knee extension (A)</p> Signup and view all the answers

A patient presents with suspected nerve root compression. Which electrodiagnostic test measures the electrical activity of muscles at rest and during contraction?

<p>Electromyography (EMG) (D)</p> Signup and view all the answers

Which diagnostic study involves injecting contrast dye into a spinal disc to determine the location of a damaged disc?

<p>Lumbar Discography (B)</p> Signup and view all the answers

A patient presents with saddle anesthesia, bowel and bladder incontinence, and bilateral leg weakness. Which of the following conditions is MOST indicated?

<p>Cauda Equina Syndrome (C)</p> Signup and view all the answers

Which of the following is MOST important in the management of Cauda Equina Syndrome?

<p>Immediate surgical decompression (A)</p> Signup and view all the answers

Which diagnostic imaging modality is MOST appropriate for initial diagnosis of Cauda Equina Syndrome?

<p>MRI (B)</p> Signup and view all the answers

A patient undergoes an NCV test. Which description BEST describes NCV?

<p>Records time for muscle to contract after electrical stimulation (C)</p> Signup and view all the answers

What is the MOST likely cause of a decreased speed observed during a Nerve Conduction Velocity (NCV) test?

<p>Nerve damage (B)</p> Signup and view all the answers

Which of the following mechanisms is LEAST likely to result in a spinous process fracture?

<p>Distraction force (A)</p> Signup and view all the answers

In the context of lumbar disc herniation, which nerve root is MOST likely affected by a central herniation at the L5-S1 level?

<p>S1 nerve root (C)</p> Signup and view all the answers

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?

<p>Spinal cord compression (C)</p> Signup and view all the answers

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?

<p>The L4-L5 disc is the primary source of the patient's pain. (A)</p> Signup and view all the answers

A patient is diagnosed with Cauda Equina Syndrome. If left untreated, which of the following complications is MOST likely to occur?

<p>Permanent paralysis and loss of bowel/bladder control (D)</p> Signup and view all the answers

Flashcards

Kyphosis

Concave anteriorly. The normal curve of the thoracic spine .

Lordosis

Concave posteriorly. The normal curve of the lumbar spine.

ESI (Spine)

Epidural Steroid Injection - a minimally invasive procedure used to treat pain caused by inflamed spinal nerves.

LL (Spine)

Lumbar Laminectomy - surgical procedure that removes a portion of a vertebral bone called the lamina.

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LMD (Spine)

Lumbar Microdiscectomy - surgical procedure performed to remove herniated disc material that is pressing on a nerve root or the spinal cord.

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LMDF (Spine)

Lumbar Microdiscectomy with Fusion

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ACDF (Spine)

Anterior Cervical Discectomy with Fusion - surgery to remove a damaged disc to relieve spinal cord or nerve root pressure + fusion.

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PCLF (Spine)

Posterior Laminoforaminotomy - surgical procedure performed to relieve pressure on the spinal nerves in the lower back.

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HNP (Spine)

Herniated Nucleus Pulposus - the soft, gel-like central portion of an intervertebral disc.

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DDD (Spine)

Degenerative Disc Disease - natural changes in the discs of the spine that occur as people get older.

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Annulus Fibrosis

Fibrous outer layer of the intervertebral disc.

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Nucleus Pulposus

Gelatinous inner layer of the intervertebral disc

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Thoracic Spine

Thoracic spine = 12 vertebrae, T1-T12.

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Lumbar Spine

Lumbar spine = 5 vertebrae, L1-L5.

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Indications for Spine X-ray

Vertebral X-ray, AP and Lateral views are helpful in these situations.

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Indications for Spine CT

Vertebral CT w/o contrast is best in these situations.

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Indications for Spine MRI

Vertebral MRI is best in these situations.

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Scotty Dog

Oblique view of the lumbar spine

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Spondylolysis

Fracture through the pars interarticularis.

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Chance Fracture

Often from MVA; lap belt immobilizes pelvis, upper body thrusts forward.

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Burst Fracture

Usually from high energy compressive axial loading spinal trauma; unstable fracture.

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Wedge Fracture

Hyperflexion compression injury; no neurological damage.

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Spinous Process Fracture

Direct trauma (fall or MVA, Repetitive stress, sports).

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Herniated Disc

Heavy lifting, poor posture, repetitive motion, aging.

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EMG

EMG measures electrical activity of muscles, aids in dx of nerve injury.

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NCV

Electric Pulses to Nerve

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Cauda Equina Syndrome

Causes same as disc herniation; severe neurologic dysfunction.

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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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