Interventional Spine Radiology

Front 1

What does a standard complete c-spine set of radiographs entail?

Back 1

AP, lateral, bilateral oblique, open mouth

Front 2

What view do you get for C6/7, especially in trauma?

Back 2

Swimmer's lateral, with one arm elevated and the other depressed

Front 3

What are the complete lumbar view?

Back 3

AP, lateral, bilateral oblique

Front 4

What two types of MRI are most sensitive to visualizing edema?

Back 4

fat-suppressed T2-weighted fast spin echo and short tau inversion recovery

Front 5

Name the three things that T1 weighted MRI is most useful in evaluating

Back 5

vertebral body marrow, epidural fat, foraminal fat

Front 6

What modification do you want with T2 imaging to evaluate the vertebrae for things like edema associated with trauma, infection, and inflammation

Back 6

Fat suppression, as both fat and water are relatively bright on T2 (though water brighter)

Front 7

What is STIR especially valuable for?

Back 7

trauma, both of the bones but also in the soft tissues, such as ligaments. Usually only done in sagittal view

Front 8

What is the main advantage of spine CT over MRI

Back 8

bone stenosis of the neuroforamina in the cervical spine is easier to see.

Front 9

What is the Hounsfield unit for water? For air?

Back 9

0 for water, 1000 for air.

Front 10

What is the window number and window width for Hounsfield units?

Back 10

Window number is the middle of the greyscale range. Window width is the range from black to white.

Front 11

Describe the procedure for injection of contrast for myelography

Back 11

12-15 cc Omnipaque 180 for lumbar, 10-12 cc omnipaque 300 for cervical (patient put in Trendelenberg). Use 22 gauge spinal needle under fluoro.

Front 12

How should the patient lie with post myelography CT

Back 12

prone so as to allow contrast into the ventral thecal space and nerve root sleeves.

Front 13

Where does the filum terminale insert?

Back 13

The coccyx

Front 14

Where are the two areas of spinal cord expansion? Why do they expand?

Back 14

C4-T1 and T9-12. Expansions are to supply the brachial and lumbar plexae.

Front 15

How many spinal nerves are there? Where does C1 exit the cord? What does it do?

Back 15

31. Above the ring of the C1 vertebra. It is called the suboccipital nerve as it innervates the rectus capitis posterior major, the obliquus capitis superior and obliquus capitis inferior. It also innervates the rectus capitis posterior minor. Slipman says it is only sensory. This is wrong.

Front 16

Where in the foramen do the cervical nerve roots exit?

Back 16

In the lower foramen at level with the disk.

Front 17

What is a conjoined root? What's it's prevalence?

Back 17

Two nerve roots exiting in the same dural sleeve out the same foramen. About 5%.

Front 18

where do the nerve roots exit in the lumbar spine?

Back 18

in the superior part of the foramen above the level of the disk.

Front 19

What is the normal distance between the posterior aspect of the anterior arch of the atlas and the anterior aspect of the dens in an adult? In a child?

Back 19

3mm, 5mm

Front 20

What is the uncovertebral joint (aka joint of Luschka)?

Back 20

Where the uncinate processes of C3-7 that extend superiorly from the lateral aspects of the vertebral bodies to articulate with the vertebra above.

Front 21

What is the minimum AP diameter of the central canal at C1-2? In the lower cervical region?

Back 21

15mm, 12mm

Front 22

What's the minimum AP diameter of the lumbar central canal?

Back 22

11.5mm

Front 23

What are the three components of the discovertebral complex?

Back 23

Cartilaginous endplate, anulus fibrosus, nucleus pulposus.

Front 24

What is the intranuclear cleft in the nucleus pulposus?

Back 24

The normal formation of a horizontal low signal band in the center of the nucleus on T2 weighted images representing higher collagen concentration.

Front 25

What are Sharpey's fibers?

Back 25

peripheral lamellae of the outer ring of the anulus fibrosus that inserts on the bony ring apophysis.

Front 26

Describe the relationship of the PLL to the disc, the ventral epidural venous plexus, and the vertebral body

Back 26

The PLL is attached to the outer annular fibers. It is seperated from the vertebral body, but held by a midline septum. Between the vertebral body and PLL are some ventral epidural veins.

Front 27

What is the cartilaginous endplate consist of?

Back 27

Hyaline cartilage and some fibrocartilage.

Front 28

Differentiate between focal and broad-based disc herniations, and bulges.

Back 28

Focal herniation: 25% or less circumference, broad based: 25-50%, bulge: greater than 50%.

Front 29

What is a Schmorl's node?

Back 29

craniocaudal disc herniations through the vertebral body.

Front 30

Describe the central zone of the canal

Back 30

between the medial edges of the articular facets

Front 31

Describe the subarticular zone in the central canal

Back 31

between the medial aspect of the superior articular fact to the medial edge of the pedicle.

Front 32

Describe the foraminal space

Back 32

from the medial edge of the pedicle to the lateral edge of the pedicle.

Front 33

Describe spondylosis deformans

Back 33

a consequence of normal aging. Anterior and lateral osteophytes (not posterior), disc desiccation without interspace narrowing, small transverse annular tears with gas in the annular entheses.

Front 34

Describe intervertebral osteochondrosis

Back 34

Desiccation and narrowing of the disc, extensive gas in the disc, bulges, posterior osteophytes, endplate sclerosis

Front 35

Where do concentric and transverse disc tears occur?

Back 35

Concentric between lamellae, transverse between the annulus and the ring apophysis.

Front 36

What ratio is skewed leading to disc desiccation?

Back 36

the glycosaminoglycan to collagen ratio.