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32 Cards in this Set

  • Front
  • Back
T/F - Spinal imaging is included in the standard assessment of patients.
What is the MOST CRUCIAL in the diagnosis and disposition?
History and PE
What does a Scoliosis survey include?
Standing AP and lateral
of the entire spine
What does it mean that Scoliosis is 3-dimensional?
Curvature in the sagittal, coronal, and axial secions.
Cervical Lordosis:

- Seen at what level?
- What is suppose to be nl curvature of the C-spine?
Axis to T2

20 to 40 degrees
Thoracic Kyphosis:

- Seen at what levels?
- Normal curvature for T-spine?
T2 to T12

20 to 45 degrees
Lumbar Lordosis

- Seen at what levels?
- Normal curvature for L-spine?
T12 to S1

40 to 60 degrees
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
Thoracic spine:

- whats unique about it
Spinous process projects downward
What is the most rigid and stable portion of the spine and why?

b/c of costal articulations
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
What is the first step in spinal imaging and what is it good for?
Plain view X-rays

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.
What is the most important view in the Trauma/Clinic series?
Lateral view
What happens if all the vertebrae in the C-spine and the C7-T1 junction can NOT be seen with the x-rays?
Get a swimmer's view

(or a CT)
For Bone pathology, which is better.... CT or MRI?
For trauma purposes, which is better....CT or MRI?
For combined soft tissue AND bony neural compression, which is better....CT or MRI?
For evaluation of post-op spine in accuracy of hardware placement, which is better.....CT or MRI?
What are the two major disadvantages of CT usages.
Not good as MRI in visualing NEURAL ELEMENTS.

36% of asymptomatic patients have abnormal findings.
What is myelography used for?
Testing for neural compression
What has replaced myelography today?
What is CT Myelogram?

When is it used? x2
CT scan after myelography.

When MRI is contraindicated or if spinal hardware is present
What are the Bone scan contrast solutions, and when do you use them?
Technetium-labeled Phosphonates
(absorbed where bone metabolism/turnover is higher than normal)

(For localizing site of inflammation and neoplasia)

(For localizing site of inflammation without neoplasia)
What is MRI excellent for?
Neural compression FROM

soft tissue trauma
infection trauma
ligamentous trauma
What is the major disadvantage of MRI?
Higher rate of abnormal findings in asymptomatic patients.
When should you use MRI clinically?
Only if diagnosis cannot be made with Hx, PE, and X-rays
What is the strategy with reading MRI's? x2
Look at T2 sagittally, than T2 axially for majority of pathology.

Look at T1 for tumors
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
In clinic and ER, what red flags justify use of MRI? x3

How are they to be used?
Neural compromise

Based on adv/disadvantages
Health care costs are high and increasing, thus what two things should we do when using imaging?
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.
In asymptomatic patients, what percentage of them will have an abnormal test for:

- CT