A4 - Axial Skeleton Anomalies Lab

Fusion of atlas and occiput

Describe findings

Occipitalization of atlas

State diagnosis

Adjust C3 and below if normal

Can you adjust this patient?

Obtain flexion/extension view

Any recommendations?

1˚: Lack of posterior arch

2˚: megaspinous (C2), enlarged anterior tubercle (C1)

Describe findings

Agenesis of posterior arch C1

State diagnosis

C3 and below if normal

Can you adjust this patient?

- Neurosurgeon if atlantodental interspace > 3 mm

- Obtain flexion/extension view

Any recommendations?

- Calcification of inferior oblique fibers of atlanto-occipital ligament

- Arcuate foramen C1

Describe findings

Posterior ponticle

State diagnosis

Yes

Can you adjust this patient?

Adjust

Any recommendations?

- Dens not fused to body

- Small dens

- Superior cortical

Describe findings

Os odontoideum

State diagnosis

Not until they see a neurosurgeon

Can you adjust this patient?

Neurosurgeon

Any recommendations?

Non-union of posterior arch

Describe findings

Spina bifida occulta at C1

State diagnosis

Yes

Can you adjust this patient?

Don't say they have spina bifida occulta, will scare them

Any recommendations?

Cervical ribs at C7 bilaterally

Describe findings

Cervical ribs at C7 bilaterally

State diagnosis

Yes

Can you adjust this patient?

Look for thoracic outlet syndrome

Any recommendations?

Smooth, cortical separation

Describe findings

Un-united 2˚ ossification center of transverse processes

State diagnosis

Yes

Can you adjust this patient?

None

Any recommendations?

- Wasp waist

- Small disc

- Fusion

Describe findings

Block vertebrae

State diagnosis

Yes, above and below fusion

Can you adjust this patient?

None

Any recommendations?

Multiple block vertebrae

Describe findings

Klippel-Feil Syndrome

State diagnosis

- Decreased ROM, short neck, low hairline

- Elevated scapula

What are some other clinical findings that can be seen in a patient with this diagnosis?

Low-force techniques

Can you adjust this patient?

Send to primary

Any recommendations?

Elevated scapula

Describe findings

Sprengel's Deformity

State diagnosis

Omovertebral bone

What is the name of the bone connecting the scapula with the vertebrae?

Ossification within nuchal ligament

Describe findings

Nuchal bone

State diagnosis

Yes

Can you adjust this patient?

Failure of ossification centers to meet in middle of vertebral body

Describe findings

Butterfly vertebrae

State diagnosis

Yes

Can you adjust this patient?

Neurologic assessment

Any recommendations?

Wedge-shaped vertebral body fused with segment above

Describe findings

Hemivertebra

State diagnosis

Yes

Can you adjust this patient?

- Not much, inform primary

- If younger patient, refer to pediatric orthopedist

Any recommendations?

Congenital

Type of scoliosis?

Indentation of vertebral endplate

Describe findings

Nuclear impression

State diagnosis

Yes

Can you adjust this patient?

None

Any recommendations?

Cupid's bow

In an AP radiograph, what sign can you expect to see with this diagnosis?

- Abrupt indentations in endplate

- Triangular cleavage of endplate

Describe findings

- Schmorl's Nodes

- Limbus bone

State diagnoses

Yes

Can you adjust this patient?

None

Any recommendations?

- Hyperkyphosis

- Hyperlordosis

- Schmorl's Nodes

- Wedging of bodies

- Small intervertebral discs

Describe findings (14 y.o. male)

Scheuermann's Disease

State diagnosis (14 y.o. male)

No, refer out

Can you adjust this patient? (14 y.o. male)

Refer to pediatric orthopedist

Any recommendations? (14 y.o. male)

Calcification of annulus fibrosis

Describe findings

Intercalary bone

State diagnosis

Yes

Can you adjust this patient?

None

Any recommendations?

- More vertical

- Limbus fits in like puzzle piece

How can you differentiate this diagnosis from Schmorl's Nodes/Limbus bone?

- Missing left L2 pedicle

- Sclerotic right L2 pedicle

Describe findings

Pedicle agenesis

State diagnosis

Yes, has been there their whole life

Can you adjust this patient?

- Contralateral pedicle would be the same density

- Aggressive lesion is not sclerotic

How could you differentiate this anomaly from an aggressive lesion?

- Non-union of posterior arch of S1

- Enlargement/hypertrophy of L5 spinous process

Describe findings

Clasp-knife

State diagnosis

Yes

Can you adjust this patient?

None

Any recommendations?

S1 superior articular processes oriented in different planes

Describe findings

Facet tropism

State diagnosis

Yes

Can you adjust this patient?

None

Any recommendations?

Fat right transverse process

Describe findings

Type Ia transitional segment

State diagnosis

Yes

Can you adjust this patient?

None

Any recommendations?

Castellvi's classification

What classification system is used for this diagnosis?

- Increased vertical orientation of the acetabulum

- Small epiphysis of the involved femoral head

- Lateral (and at times superior) displacement of the femoral head

Describe findings

Developmental hip dysplasia

State diagnosis

No, easy to dislocate hip

Can you adjust this patient?

Refer to pediatric orthopedist

Any recommendations?

Putti's Triad

What triad is used to describe this pathology?

- Joint degeneration

- Hip replacements

Any long-term considerations?

Un-united ossification center at center of acetabulum

Describe findings

Os acetabuli

State diagnosis

Yes

Can you adjust this patient?

None

Any recommendations?

CAM deformity

What is the name for this bump?

- Os acetabuli

- CAM

- PINCER

What are the types of femoroacetabular impingement?

Risser's sign

What is the name for the iliac apophysis?