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32 Cards in this Set
- Front
- Back
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T/F - Spinal imaging is included in the standard assessment of patients.
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True
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What is the MOST CRUCIAL in the diagnosis and disposition?
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History and PE
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What does a Scoliosis survey include?
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Standing AP and lateral
of the entire spine |
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What does it mean that Scoliosis is 3-dimensional?
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Curvature in the sagittal, coronal, and axial secions.
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Cervical Lordosis:
- Seen at what level? - What is suppose to be nl curvature of the C-spine? |
Axis to T2
20 to 40 degrees |
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Thoracic Kyphosis:
- Seen at what levels? - Normal curvature for T-spine? |
T2 to T12
20 to 45 degrees |
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Lumbar Lordosis
- Seen at what levels? - Normal curvature for L-spine? |
T12 to S1
40 to 60 degrees |
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Cervical spine:
- whats unique about C3 to C6 - whats unique about C7 |
Vertebral aa via transverse foramen
Small, bifid spinous process Vertebral aa absent Large, nonbifid spinous process |
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Thoracic spine:
- whats unique about it |
Spinous process projects downward
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What is the most rigid and stable portion of the spine and why?
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Thoracic
b/c of costal articulations |
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Pars Interarticularis:
- which spinal section - where on vertebrae - why clinically important |
Lumbar spine
Between pedicles and lamina Weakest part of vertebral body, thus watch out for spondylolysis |
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What is the first step in spinal imaging and what is it good for?
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Plain view X-rays
Spondylolysis Spondylolisthesis |
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Cervical spine series:
- in the ER? - additional clinic views? - must see what? - what makes it normal x2 |
AP, Lateral, and Open-mouthed odontoid view
Right and left anterior oblique C7-T1 junction 4 smooth running cervical lines Soft tissue anterior to C6 is equal in size to the vertebral body. |
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What is the most important view in the Trauma/Clinic series?
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Lateral view
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What happens if all the vertebrae in the C-spine and the C7-T1 junction can NOT be seen with the x-rays?
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Get a swimmer's view
(or a CT) |
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For Bone pathology, which is better.... CT or MRI?
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CT
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For trauma purposes, which is better....CT or MRI?
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CT
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For combined soft tissue AND bony neural compression, which is better....CT or MRI?
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CT
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For evaluation of post-op spine in accuracy of hardware placement, which is better.....CT or MRI?
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CT
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What are the two major disadvantages of CT usages.
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Not good as MRI in visualing NEURAL ELEMENTS.
36% of asymptomatic patients have abnormal findings. |
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What is myelography used for?
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Testing for neural compression
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What has replaced myelography today?
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MRI
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What is CT Myelogram?
When is it used? x2 |
CT scan after myelography.
When MRI is contraindicated or if spinal hardware is present |
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What are the Bone scan contrast solutions, and when do you use them?
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Technetium-labeled Phosphonates
(absorbed where bone metabolism/turnover is higher than normal) Gallium (For localizing site of inflammation and neoplasia) Indium (For localizing site of inflammation without neoplasia) |
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What is MRI excellent for?
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Neural compression FROM
soft tissue trauma infection trauma ligamentous trauma |
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What is the major disadvantage of MRI?
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Higher rate of abnormal findings in asymptomatic patients.
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When should you use MRI clinically?
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Only if diagnosis cannot be made with Hx, PE, and X-rays
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What is the strategy with reading MRI's? x2
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Look at T2 sagittally, than T2 axially for majority of pathology.
Look at T1 for tumors |
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Protocol in Clinic for patient with neck or back pain for:
- Less than 6 weeks - Greater than 6 weeks |
Hx and PE (NO X-rays)
Hx, PE, and X-rays |
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In clinic and ER, what red flags justify use of MRI? x3
How are they to be used? |
Neural compromise
Infection Tumor Based on adv/disadvantages NOT AT SAME TIME |
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Health care costs are high and increasing, thus what two things should we do when using imaging?
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Do not order lab tests that are UN-USEFUL for diagnosis or care
Look at EVERY imaging study (DON'T JUST READ REPORT) before jumping the gun to the next test. |
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In asymptomatic patients, what percentage of them will have an abnormal test for:
- MRI - CT |
64%
36% |
