Interp 2 Lumbar Spine (EXAM 1)

what makes intervertebral osteochondrosis?

decreased height and vacuum cleft

what are the causes of neuropathic arthropathy?

syringomyelia, tabes dorsalis, and diabetes mellitus

what is the most common neuropathic arthorpathy?

diabetes mellitus

what is the radiographic vertebrae finding of neuropathic arthropathy?

jigsaw vertebrae, tumble block spine

what are the 6 D’s of hypertrophic pattern of neuropathic arthropathy?

distention, dislocation, disorganization, destruction, debris, density increased

what is ankylosing spondylitis?

chronic inflammatory condition primarily affecting axial skeleton in males

what are the features of articular ankylosis?

articular ankylosis, ligament ossification, enthesopathy

what will 50% of patients with AS develop?

large peripheral joint development

what will 30% of patients with AS develop?

small peripheral joint involvement

what is the most sites of peripheral joint involvement with AS?

hip and shoulder

what are the radiograph findings of AS?

bilateral and symmetrical

osteoporosis

60% of AS cases start where?

the thoracolumbar spine

where does the 40% of AS cases not starting in the throacolumbar spine start?

SIJ

what is the hallmark of AS sacroiliac joint disease?

bilateral symmetric involvement

where are the changes from AS in the SIJ more severe?

iliac side due to less cartilage

what is stage one of AS in SIJ?

pseudo widening

what causes pseudo widening in AS SIJ?

resorption of the subchondral bone

what is two of AS in the SIJ?

erosion and sclerosis

what sign or appearance is a result of erosions of the SIJ?

rosary bead sign

what percent of AS SIJ cases go to stage two and resolve?

40%

what is stage 3 of AS in the SIJ?

ankylosis

what happens during ankylosis of the SIJ?

there is a hint of the SIJ after, “ghost joint”

what percent cases of AS develop complete ankylosis?

50%

what is the sign of upper SIJ ankylosis?

star sign

what happens to the corner of the vertebral bod when AS is in the spine?

erosion of the corner of vertebral body

what is erosion of the corner of vertebral body called?

romanus lesion

what are the findings of AS in the spine?

romanus lesion

squaring of vertebrae anteriorly

shiny corner sine

ossification of outer annular fibers

what is the spine finding of AS?

bamboo spine due to marginal syndesmophytes

what other seronegative spondyloarthropathies cause SIJ involvement?

psoriatic, enteropathic arthritis, AS, reactive arthritis

what is osteitis condensans ilii?

isolated sacroiliac arthopathy

what is true of orthopedic test with osteitis condensans ilii?

positive SIJ test with pain, adjust will hurt than quickly resolve

what are the radiographic findings of osteitis condensans ilii?

triangular sclerosis of the ilium

unilateral or bilateral

usually no abnormality of joint itself

sclerosis can regress

what is true of trauma to the spine?

Injury to the thoracolumbar or lumbar region is more likely then mid to upper thoracic spine due to mobility

what translation in the sagittal plane classifies instability of the L/S?

4.5 mm

what degree of sagittal rotation classifies as instability at L1-L4?

more than 15 degrees

what degree of sagittal rotation classifies as instability at L4/L5?

more than 20 degrees

what degree of sagittal rotation classifies as instability at L5/S1?

more than 25 degreees

on neutral radiographs what classifies as instability?

Sagittal translation greater than 4.5mm or 15% of the endplate width

Sagittal rotation (disc angles) greater than 22 degrees compared to surrounding levels

is a spondylolysis always associated with a spondylollisthesis?

no

where do 90% of spondylolysis occur?

L5

what is the common age for spondylolysis occur?

10-15

what is the most common etiology of spondylolysis?

stress fracture

what athletes are at higher risk for spondylolysis?

divers, gymnast, weightlifters and pole vaulter

what is a transverse process fracture secondary to?

avulsion force or direct trauma

what are the most common levels for a transverse process fracture?

L2 and L3

transverse fractures are usually oriented in which direction?

vertical

what needs to be ruled out in regards to a transverse process fracture?

urinary tract damage

what are the 3 types of seatbelt fractures?

chance fracture, Smith’s fracture and horizontal fracture

what is a chance fracture?

horizontal fracture through the spinous process, laminae, pedicles, transverse processes and posterior vertebral body extending into the end plate

what is the radiographic sign of a chance fracture on an x-ray?

empty vertebrae sign

what is the MOI of a chance fracture?

hyperflexion/distraction injury

what area of the lumbar spine is most commonly affected by a chance fracture?

upper lumbar

what else seeds to be evaluated with a chance fracture?

associated visceral damage

what is a Smith’s fracture?

similar to chance, but interspinous ligament is torn instead of SP fracture

what is a horizontal fracture?

fracture all the way through the body without endplate involvement

what are other tpes of fractures or dislocations in the lumbar spine?

vertebral body compression fracture

burst fracture

fracture-dislocation

apophyseal ring fracture

abused child syndrome

what is a limbus vertebra?

triangle shaped corner of vertebral body not attached to main vertebral body

what do limbus vertebra semonstrate?

smooth corticated margine

what are limbus vertebra mistaken for?

teardrop fracture and intercalary bone

what is true of lumbar suppurative infection?

there is about a 21 day latent period before radiographic changes are visible

what does suppurative lumbar infection cause?

rapid destruction of vertebral margin and rapid destruction of the disc with spread to the other endplate

what is the most common cause of lumbar spine non-suppurative infection?

tuberculosis

what is true of lumbar spine non-suppurative infection?

slower process than suppurative and hence can destroy more of vertebral body by the time it is caught

how does lumbar spin non-suppurative infection spread?

sub-ligamentous causing skip lesions and anterior vertebral body scalloping

what may lumbar spine non-suppurative infection demonstrate?

psoas calcification

what can cause unilateral sacroilitis?

suppurative infection of the SIJ

what may be the result of a SIJ suppurative infection?

joint ankylosis

what is the most common benign tumor of the spine?

hemangioma

what are the radiographic signs of hemangioma?

lucent vertebrae with accentuated vertical trabeculae, corduroy cloth appearance

rarely expansil

likes vertebral body

what is the ddx for a hemangioma?

pagets or osteoporosis

what is a chordoma?

malignant neoplasm that develops from a remnant of the notocord

where is the most common location for a chorodma?

sacrocoygeal area, clivus and the spine (C2)

what age range do cordomas occur?

40-70

what are the radiographic findings of a chordoma?

midline lesions

osteolytic lesion with soft tissue mass

calcification may be present

what age is paget’s disease common in?

55 or older

how many stages does Paget’s disease have?

4

what is true of the pain with Paget’s disease?

dull, boring, constant pain not exacerbated by activity

what are the stage 3 paget’s disease findings?

bone enlargement, thick cortices, trabecular accentuation

what do the radiographic features of stage 2 paget’s give the apperacne of?

picture frame vertebrae

the diffuse increase in bone density with stage 3 Paget’s diseas gives what apperance?

Ivory vertebrae

what are the ddx for ivory vertebrae?

blastic metastasis

Paget’s

hodgkin’s lymphoma

what are the complications of paget’s?

spinal canal and forminal stenosis from bony overgrowth

early osteoarthritis

malignant degeneration into osteosarcoma

paget’s diseas can leed to what type of malignany?

osteosarcoma

what are the primary malignant neoplasms of bone?

osteosarcoma (conventional)

chondrosarcoma

Ewing sarcoma and primitive neuroectodermal tumor

myeloproliferative disorders

plasma cell myeloma

plasamacytoma

Hodgkin disease

leukemia

what are primary benign neoplasms?

Enostosis 

Osteochondroma 

Osteoid osteoma 

Aneurysmal bone cyst 

Giant Cell tumor 

osteoblastoma

what are tumor like lesions?

neurofibromatosis type 1 and langerhans cell histiocytosis

what is vertebra plana?

vertebral body is significantly flattened, with minimal height remaining anteriorly and posteriorly. 

what are the radiographic findings of sickle cell?

bony changes

granular skull

hair on end skull

H vertebrae

osteoporosis

what conditions lead to posterior vertebral body scalloping?

Achondroplasia 

Acromegaly 

Hurlers/Morquio’s 

Spinal tumors (meningioma, ependymoma) 

Hydrocephalus 

Neurofibromatosis

what conditions may cause anterior vertebral body scalloping?

Aortic Aneurysms 

Lymphadenopathy 

Normal variant 

Tuberculosis

what is seen here?

spondylosis

what is seen here?

multiple intervertebral osteochondrosis

what is seen here?

degenerative disc

what is seen here?

facet arthrosis

what is seen here?

neuropathic arthropathy at L2/L3

what is seen here?

AS with stage 2 SI joint involvement

what is seen here?

AS with stage 3 SIJ involvment

what is seen here?

AS

what is seen here?

AS

what is seen here?

AS