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88 Cards in this Set
- Front
- Back
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What are the standard cervical spine views?
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APLC
APOM lateral L - anterior oblique R - anterior oblique |
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APLC - view is best for?
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visualize the cervical spine from C3-C7
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APOM view is best for?
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visualize C1-C2 levels
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Lateral cervical view is best for?
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sagittal anatomy
(must be able to see C7 - T1 and should see stella |
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LAO cervical is best for?
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left IVF's and most posterior arch structures
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RAO cervical view is best for?
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right IVF's and most posterior arch structures
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Additional Cervical views are?
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lateral flexion
lateral extension FUCH's Pillar |
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What is included in the DAVIS series and what in the primary use of this series?
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series includes
ALC/ APOM/ Lateral/ LAO/ RAO/ Lateral flexion and Lateral extension Used to primarily evaluate the inter segmental instability associated with trauma, arthritis, anomalies etc |
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what is the main purpose of a FUCH's view?
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evaluation of the atlas and dens if patient can't open mouth
(NB: similar to submentovertex view of skull - for base of skull |
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what is the main purpose of a PILLAR (Boyleston) view?
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to evaluate the ARTICULAR PILLARS
- especially for compressive fractures - usually done bilaterally |
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What are the ATLAS primary ossification centers and when do they ossify?
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There are 3 centers
1. one for each lateral mass (at birth) 2. one for anterior arch (birth or 1st yr) 3. posterior arch (as continuation of lateral mass centers) |
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What are the ATLAS secondary ossification centers?
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there are none
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What are the AXIS primary ossification centers and when do they ossify?
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There are 5 AXIS primary ossification centers.
1 for Body 1 for each half of neural arch 2 for dens dens analogous to C1 body and separated from C2 body by cartilaginous plate. Dens + C2 ossification at or before adolescence. |
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What are the AXIS secondary ossification centers and when do they ossify?
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There are 6 AXIS secondary ossification centers.
1 at tip of DENS 1 at inferior end plate of C2 - (the rim apophysis) 1 at tip of each TP 2 at tip of SP tip of dens unites at late adolescence all others unite late teens |
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What are the C3-C7 primary ossification centers and when do they ossify?
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similar to rest of spine......EXCEPTION
1. uncinate process form extension of the bodies 2. costal processes become anterior tubercles of TP's |
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What are the C3-C7 secondary ossification centers?
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similar to the rest of the spine....EXCEPTION SP's which have two centers - NB: Bifid.
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normal variants in the cervical region include......
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Spina Bifida occulta
Posterior Ponticle Ossiculum Terminale Ununited apophyses Hyperplastic Transverse Processes Calcification of Stylohyoid ligaments Nuchal Bones |
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Developmental anomalies in the cervical region include.............
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Congenital blocked vertebrae
Occipitalization Odontoid Anomalies Agenesis/ Hypogenesis Cervical Ribs |
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a normal structures in the cervical region that may simulated a pathology?
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thyroid cartilage
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normal variants - cervical spine?
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Spina Bifida Occulta
Posterior ponticle Ossiculum Terminale Ununited Apophyses Hyperplastic Transverse Processes Calcification of styloid ligaments Nuchal Bones |
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Developmental abnormalities - cervical?
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Congenital Block Vertebrae
Occipitalization Odontiod Anomalies Agenesis/ Hypogenisis Cervical Ribs |
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normal structure in cervical that simulates pathology?
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Thyroid Cartilage - calcification
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Spina Bifida Occulta?
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– Failure of union of lamina to SP,
or cleft SP – More likely to be seen with other anomalies when seen in the cervical spine – Likes C1 (cleft posterior arch), followed by the lower cervical area – Look for absence of the spinolaminar line on the lateral view to confirm and DDX from bifid S.P. |
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Posterior Ponticle?
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Ossification of the posterior
atlanto-occipital ligament forming an arch-like structure superior to the C1 posterior arch – Usually bilateral – The foramen formed is called the “arcuate foramen,” and the vertebral artery passes through it – Rarely, it has been thought to produce vertebral basilar insufficiency symptoms |
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Ossiculum Terminale
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– Failure of union of the
secondary ossification center at the tip of the odontoid – No clinical significance – Don’t mistake for fracture |
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Additional Ununited Apophyses
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– Failure of secondary growth center to unite with parent
bone. Borders are smooth and sclerotic. Most likely to occur at the C7 S.P. |
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Hyperplastic Transverse
Processes – At C7 |
– At C7: The T.P.’s
extend laterally beyond those at T1 – no clinical significance – must DDX from cervical ribs |
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Hyperplastic Transverse
Processes– C4-6 |
– C4-6: The anterior
tubercles of two adjacent T.P.’s may enlarge and grow toward each other forming accessory articulations – usually see associated hypoplastic disc – can simulate a fracture |
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Hyperplastic Transverse Processes– At C1
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– At C1: T.P.’s may enlarge and fuse to the occiput
– limits R.O.M. |
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Stylohyoid Ligament
Calcification |
– From styloid processes
to hyoid bone – Usually asymptomatic, but can occasionally be symptomatic if pseudojoint is present |
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What is Eagle’s syndrome?
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Stylohyoid ligament calcification where a pseudojoint is present- may be symptomatic.
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Nuchal Bones
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– Calcific material or
bone posterior to the S.P.’s within the nuchal ligament – No significance per se – May be associated with D.I.S.H. |
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Developmental Anomalies - cervical
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congenital block vertebrae
Occipitalization Odontoid Anomalies Agenesis/ Hypogenesis Cervical ribs |
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Block Vertebrae
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– Results from failure of segmentation, not fusion, and
may affect the body, arch, or both – 4 classic radiographic findings of a congenital block Rudimentary disc (with calcification occasionally) “WASP-WAIST” deformity: anterior concavity at the mid-point of block due to failure of formation of rim apophyses Posterior element involvement: DDX’s from surgical Height of the block: equal to the height of 2 normal segments plus disc |
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Klippel-Feil syndrome
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(congenital
block with lateral hemivertebrae) |
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Occipitalization
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– Failure of segmentation of
the occiput and C1 – C1 often assimilated into occiput and not be visible – Can be an isolated anomaly or associated with several dysplastic conditions – May result in basilar impression |
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Odontoid Agenesis (rare) & Hypogenesis
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– Complete or partial failure of formation
can be associated with significant upper cervical instability in the absence of clinical signs and symptoms |
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Os Odontoideum
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– Etiology debated: developmental failure of dens to
unite to body; odontoid hypoplasia with overgrowth of apical growth center; old, ununited dens fracture can be associated with significant upper cervical instability in the absence of clinical signs and symptoms |
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A normal thoracic series involves which views?
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A-P
Lateral PA chest |
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Additional thoracic views include
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swimmer's
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A-P view
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AP: T1 though T12
FILTRATION a must - compensatory filtration is essential for adequate visualization of the upper thoracic region |
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lateral view
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Upper thoracic region difficult to
visualize |
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PA chest
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To visualize the chest soft tissues,
if AP tightly collimated |
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PARASPINAL LINES
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Represent the pleural edges
Should be relatively smooth & parallel with spine A DEVIATION often indicates pathology: mass from tumor, infection, disc bulge, hematoma, edema, etc. |
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Use of swimmers view?
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Swimmer’s: Used to evaluate the
normally obscured upper thoracic spine |
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Normal variants in the thoracic region include?
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Hahn Fissure (vascular groove)
Spina Bifida Occulta Ununited Apophyses Transitional Thoracolumbar Segment |
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Developmental anomalies in the thoracic region include?
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Hemivertebrae
Congenital Block Vertebrae Agenesis/ Hypogenesis |
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Hahn’s Fissures (vascular grooves) are?
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– Two parallel sclerotic lines separated by a lucency in the middle of the vertebral body seen on the lateral projection
– Seen normally in young children or infants, but may persist into adulthood – They house communicating vasculature |
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Spina Bifida Occulta - thoracic
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– Less common here than in lumbar spine
– Usually at T1-2 or T11-12 –More likely to be associated with other anomalies than when seen at L5/S1 |
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What is the purpose for taking a Swimmer’s view?
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To visualize the upper thoracic spine in a lateral orientation when obscured by the shoulders
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Ununited Apophyses - thoracic
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– Same as any other area of the body ; must DDX from fracture
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What is the following condition?
– 12th ribs may be rudimentary or absent – Lumbar ribs may occur at L1 – Usually clinically insignificant, but may see 11 or 13 ribs in DOWN’S syndrome patients |
A Transitional Thoracolumbar Segment.
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Is a Transitional Thoracolumbar Segment a normal varient or developmental anomaly?
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a normal varient
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the following occurs in which developmental anomaly?
- Secondary to failure of formation of part of the vertebral body – Surrounding vertebrae may demonstrate some deformity in an attempt to accommodate – Can result in severe structural scoliosis |
Hemivertebrae
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Hemivertebrae where the anterior center fails to form?
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dorsal hemi
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Hemivertebrae where the posterior ossification center fails to form?
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ventral hemi
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Hemivertebrae where the chondrification center fails to form?
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lateral hemi
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hemiveterbral pathology can result in what?
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structural scoliosis
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STANDARD LUMBAR VIEWS?
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Anterior-Posterior (or P-A) - may collimate to
spine or leave open Lateral - may collimate to spine or leave open; must see from L1 to S1 Right Anterior Oblique - see left sided structures best Left Anterior Oblique - see right sided structures best P-A Angulated Spot: evaluates the S.I.’s, sacrum, L5/S1 disc, and L5 pars |
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ADDITIONAL VIEWS - lumbosacral?
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Lateral Lumbosacral Spot:
Bending Studies: |
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Bending Studies are used to evaluate?
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lateral bending or
flexion/extension views to evaluate end-range motion, likelihood of scoliosis progression, determine disc herniation level, or gross instability. Increases radiation dose - only do when clinically indicated |
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which view is used to to see the L5/S1 disc when not well visualized on lateral view?
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Lateral Lumbosacral Spot
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SACROCOCCYGEAL VIEWS?
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1. A-P: Must properly prepare patient with cleansing enema or cathartic to see osseous
structures best 2. Lateral |
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Which view must be properly prepared patient with cleansing enema or cathartic to see osseous
structures best |
SACROCOCCYGEAL VIEW - A-P
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NORMAL VARIANTS lumbosacral?
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Spina Bifida Occulta
Facet Tropism Nuclear Endplate Impressions Ununited Apophyses Calcification of Iliolumbar ligaments vertebral body size and shape |
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Which normal variant in the lumbosacral region is associated with the following?
– Failure of the lamina to fuse – Most common at L5 & S1 – Limited clinical significance – May be associated with other anomalies |
Spina Bifida Occulta
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Which normal variant in the lumbosacral region is associated with the following?
– Usually presents as asymmetrically oriented facets, but both can be turned as well – Commonly at L5/S1 – Questionable clinical significance – Overcalled diagnosis |
Facet Tropism
– “Tropism” means turning |
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Which normal variant in the lumbosacral region is associated with the following?
– Long, smooth indentation of the endplate (usually inferior) due to persistence of notochord remnants – Most common in lumbar, then cervical – Looks like a “Cupid’s Bow” on AP – Don’t mistake for Schmorl’s nodes or compression fractures |
Nuclear Endplate Impressions
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An Ununited Apophyses is?
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– Any Secondary growth center may
fail to unite – DDX from fracture |
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Calcification of the Iliolumbar Ligaments involves
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– Occasional occurrence, its physiologic
– Extends from L5 t.p. to iliac crest – May be unilateral or bilateral, complete or partial – DDX from L5 t.p. hypertrophy in a transitional segment |
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NORMAL VARIANTS - Vertebral Body Size & Shape?
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– May be slightly under or over sized
– May be slightly wedge-shaped, especially atL1 (anteriorly) and L5 (posteriorly) Must be greater than 3mm difference in height from front to back before fracture should be considered |
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DEVELOPMENTAL
ANOMALIES - Transitional Segments are? |
– Occur at an area of transition
–Most notable at lumbosacral junction .........evidenced by an attempt to form L6 from S1 or an additional sacral segment from L5 |
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– Terms such as “Lumbarization”,
“Pseudolumbarization”, and/or “Sacralization” are NOT appropriate for transitional Segments----------------- Why? |
– Because there could be a transitional segment at the T-L junction (or elsewhere) making 13 rib bearing segments and leaving only 4 “lumbar”
segments -- clearly NOT sacralization! |
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Transitional Segments– Appearance at L5/S1?
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-Large spatulated T.P.’s (unilateral or
bilateral) |
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Transitional Segments-Functionally lumbar when?
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large T.P.’s are
NOT attached to sacrum |
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Transitional Segments-Functionally Sacral when?
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spatulated T.P.
fused to the sacrum |
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Transitional Segments-Accessory Articulation when?
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spatulated T.P forms a joint with the sacrum
NB: –May present with a rudimentary disc –May alter biomechanics (causing DJD or disc pathology) or entrap nerve roots |
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DEVELOPMENTAL
ANOMALIES - lumbosacral? |
transitional lumbosacral segments
knife clasp deformity agenisis/ hypogenisis Block vertebrae Hemivertebrae Butterfly vertebrae |
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Normal structures that simulate pathology - lumbosacral?
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Rotation
Lateral Flexion |
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Knife Clasp deformity
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– Spina bifida occulta of S1 (posterior arch fails to unite)
– S1 tubercle attaches to L5 S.P. making L5 SP longer –May produce symptoms in extreme extension - poss impingement on spinal canal contents |
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which lumbosacral developmental anomaly often is the result of failure or partial formation and – Could lead to instability or additional stress?
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agenesis/ hypogenesis
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Block Vertebrae often can be identified by?
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–Wasp waist
– Rudimentary disc – Posterior arches may be fused NB: – Less common in the lumbar spine |
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the following developmental anomaly is?
– a variation of hemivertebrae – lateral bodies form but don’t unite – due to persistence of notochord – nucleus extends through the body |
Butterfly vertebrae
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Which normal structure may simulate the following pathology?
– On the lateral view, may see oblique white lines oriented more vertical than sacral base –Mistaken for an increased sacral base angle – Represent anterior aspect of sacral alas |
Sacral Alas
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how can L5/S1 IVF’s simulate pathology?
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– Look stenotic due to
oblique orientation – Need axial imaging to determine patency |
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CAN SP orientation alone be used to
determine vertebral rotation? |
No
other evidence is required (pedicle rotation) as Spinous Processes often show variation in size, shape, and orientation |
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POSITIONAL VARIATIONS
SIMULATING PATHOLOGY - Rotation |
Pseudo-Retrolisthesis: due to rotation and/or anatomical distortion/variation
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POSITIONAL VARIATIONS
SIMULATING PATHOLOGY - Lateral Flexion |
Lateral Flexion
– False loss of disc height – Must measure between the 2 highest or lowest endplates. |
